Monthly Archives: April 2016

Olympic Medical Center to Host Conversation on End of Life Choice and Care

This coming Wednesday April 27th, Olympic Medical Center will host a workshop of end of life care and decision making in the Linkletter Room, 939 Caroline St., Port Angeles from 1-4pm.Hospice Care

Physicians and hospice workers will be present during the event to connect with patients and their families in order to best assist the families in starting a conversation about end of life care. This can be a very difficult to have between an adult son/daughter and their elderly parents, or a conversation between elderly spouses. However difficult a conversation about one’s end of life wishes may be, forgoing the opportunity to discuss these matters with loved ones can lead to many hard choices and the sensation of missing out on the final chances to connect with a terminal family member in a meaningful way.

Patients who have yet to draft important legal documents (such as a will, living will, durable power of attorney, and do not resuscitate order) can leave their family members in the terrible position of having to guess what the wishes of a recently departed family member might have been. Families who haven’t prepared these documents at the time of death are hit with a “double whammy” – dealing with the grief of a recently passed loved one and scrambling around with lawyers and estate professionals to make all the necessary arrangements for the deceased. It’s hard enough to mourn the loss of a parent or spouse, but having to do so while simultaneously sifting through legal issues can make this difficult time significantly worse for the family of the departed.
Discussing end of life care goals is vitally important at the family level, but it is also important for our healthcare system as a whole. Medical expenditures in the final year of life are on average 5 times greater than medical expenditures in nonterminal years ($7.3K vs $37.3K)Hoover D, et. al, so our society is spending a great deal of resources on medical care for patients in the final year of their lives. Sometimes these expenditures are desired by patients and family members alike who wish to extend the amount of time they have left with an ailing loved one. In other instances, a patient may desire less end of life care, or less invasive care like hospice.

No one wants to find themselves in a position of having to guess what level and nature of care a family member might want. Estate planning and legal issues are important, but they are just a small piece of end of life planning. There are an infinite number of topics that a family facing a terminal illness may want to discuss beyond wills and insurance. The amount of medical care, and the nature of the care that a terminal patient may desire can be different than that of other family members. The goal of this workshop at Olympic Medical Center next Wednesday is to give families the tools to begin to have these difficult conversations.

MultiCare Making Big Changes in the Lives of Children with Special Needs

This year, the Children’s Therapy Unit (“CTU”) in Puyallup, WA, which is part of the MultiCare Health System, is celebrating 50 years of helping infants, children and teens with special needs. The program serves children from birth to age 18 and saw 2,500 patients last year.

Lisa Yates, who began as a therapy student at what was then Good Samaritan Hospital (later part of MultiCare) and started the program in 1966, says the CTU has always operated under a basic philosophy for each child it treats: “What are the strengths, what are the weaknesses? That takes you where you need to go. You either build up the areas of weakness or you find ways around them.”

Yates came to the hospital as a student intern in the adult rehabilitation unit. At the time, there were no facilities for children at Good Samaritan. Societal attitudes and treatment of people with special needs were still in a period that many regard as the dark ages. School districts across the nation didn’t allow children with disabilities to attend school. They were sent to institutions which provided room and board, but not education, to those housed there.

“It was assumed that a lot of the kids — if they had a physical disability — were also cognitively impaired, which, of course, is not true,” Yates said.

Two such children were referred to the hospital just after Yates began. The only facilities available to them was the middle of the adult gym, not an ideal place for kids, especially those who needed special attention. Yates found a private place where the two kids could work, and after some successes, referrals increased. The fledgling program began to grow.

Today the CTU is housed in a 16-year-old, nautical-themed building on the Good Samaritan campus. It is home to a playground, basketball court, computer lab, classrooms for professionals and parents, and a pool shaped like a shell which is used for therapy.

About 10 percent of the patients at the CTU are the children of servicemen and women, many of whom are posted at Joint Base Lewis-McChord. Roughly 60 percent of the patients at the CTU receive Medicaid. Patients served have a variety of issues, including cerebal palsy, autism, and Down Syndrome. The majority of children at the CTU are in occupational therapy to learn the skills of daily life. Speech therapy, followed by physical therapy, are the next most popular programs. While they all have unique issues to address, they generally share one goal: to live an independent life.

“I don’t want to be dependent on everyone else for the rest of my life,” said Kristie Gronberg, an 18-year-old who recently aged out of the CTU. “I have things I’d like to do, and I’d like to do them by myself.”

MultiCare continues to grow and has openings for healthcare professionals who are passionate about their work. See their current openings here.

Olympic Medical Center joins community coalition to fight chronic disease and increase overall health

A group of community organizations in the Sequim/Dungeness Valley area, including Olympic Medical Center, have joined forces to foster healthier lifestyles for residents of the region.

The plan, known as “Ready, Set, Go 5210!” has four major components, one for each of the digits in the name of the initiative.Food Pyrimad

  • 5 – The number of serving of fruits and vegetables residents are encourages to consume each day
  • 2 – Maximum hours of recreational screen time per day
  • 1 – Minimum hours of physical activity per day
  • 0 – Number of sugar sweetened beverage to be consumed each day!

Monica Dixon, a registered dietitian will co-chair the coalition with Clallam County Commissioner Mark Ozias.

Launching a community coalition is one thing, but affecting long term lifestyle and diet change is a whole different ball game. Our diets are a function of many different factors, including cost, convenience, time, and perhaps most importantly – taste! It can be difficult for many people to give up their lunch time coke, especially once it becomes a part of someone’s daily routine. Breaking ones own habits is hard enough, but healthcare practitioners who are tasked with getting their patient to make long term changes to their diet and physical fitness levels face an entirely different challenge.

For someone who has never consciously attempted to fill their diet with 5 servings of fruits and veggies, the task may be daunting. Working with a patient to teach them strategies, meals, and tactics to eat more fruits and vegetables is the first step. Directing patients to resource with recipes and photos can help give them the confidence/inspiration that they need to make a lasting change. After all many fruits and vegetables can be consumed raw with little to no prep time. The key is making it clear in a patient’s mind that while it may be a bit of a chore at first, a balanced diet and an active lifestyle will do wonders for their long term mental and physical health.

National Physician Shortage Projected

On April 5th 2016, IHS Inc. released a  2016 update to their report on behalf of the Association of American Medical Colleges about the projected supply and demand for physicians in American from 2014 – 2025.1


The updated report comes in at around 40 pages, and contains projections for many different scenarios that have an effect on demand for physicians services such as demographic changes like the aging of the baby boomer generation, or the ability of non-physician healthcare providers like ARNPs to provide services presently offered by physicians. The report also discusses the supply of physician services, which is impacted by the number of physicians retiring in the next decade and the number of physicians graduating from medical school who are expected to enter the workforce. The report is very detailed, and it is worth a read to anyone who faces the difficult task of recruiting physicians over the coming decades.

 Empty Waiting Room

The key findings of the report are:


1. Even under the “brightest” of assumptions, there will be a physician shortfall in 2025, it’s just a matter of how large that shortfall is. The report projects there will be between 61K-94K fewer physicians than needed by 2025. For comparison, the US had about 1 million physicians in 2012.2


2. There will be a shortfall in both primary care physicians and non-primary care physicians by 2025.


3. The largest impact on supply will be the retirement of currently practicing physicians. Just as the aging of the baby boomers will have a drastic effect of the age diagram of the American population over the coming decade, many physicians are members of the baby boom generation, so we will see a similar demographic trends. Today 11% of the physician workforce is age 65-75. That fraction will increase to one-third by 2025. The exact percentage that will retire as they age is unknown, but the aggregate effect will push down the total supply of physicians.


4. The aging of the American population will be the primary cause of increased demand for physician services. The population under 18 is expected to grow by 5% and the population over 65 will grow by 41% – a factor of 8X.


5. The expansion of coverage under the Affordable Care Act (ACA) will push up demand for physicians. Depending on how many states expand medicaid, the ACA could contribute to the shortfall by 10,000 to 17,000 physicians.

What does this all mean for physician jobs in Washington state?


It’s good news for physicians. The shortfall should push up wages for physicians as employers compete to hire the best talent. This is also good news for non-physician providers who may be able to perform services once restricted to physicians as states change their regulations in order to help address this shortfall. The labor market for physicians is national and many physicians practicing in Washington state attended medical school in other states. Fortunately the opening of Washington State University’s medical school in Spokane and its inaugural class in 2017 will lead to a direct increase in the supply of physicians coming out eastern Washington. Whether or not those new WSU medical graduates will remain in Washington for their residency is difficult to know.


All signs indicate that physician recruiters will have an increasingly challenging task ahead in the coming decade. While the exact magnitude of the shortfall is unknown, its impending presence is rather certain according to this report. Employers will need to continue to innovate and improve their recruiting practices to stay competitive with the hospital down the road.

Team-Centered Wound Care Provides Improved Outcomes, Patient Comfort and Job Satisfaction

This post was written by guest blogger, Ryan Dirks, PA. Ryan is a Physician Assistant and founder of Ryan DirksUnited Wound Healing located in Puyallup, Washington.  Ryan’s team of Nurse Practitioners, specializing in wound care, partner with skilled nursing and rehab centers throughout Washington to provide “Team-Centered Wound Care.”  Through weekly wound rounds, these Nurse Practitioners lead multi-disciplinary teams of skilled nursing home caregivers resulting in extraordinary clinical outcomes, education, prevention and great job satisfaction.  United Wound Healing is seeking ARNPs skilled in leadership and a desire to transform their patients’ care through a team approach.


Have you become discouraged about your role as a health care provider?  Have changes in documentation, Meaningful Use, and quality measures left you feeling dissatisfied and disconnected from what you find meaningful in your career?  Well, you are not alone.  In fact, the solution you may need may also be the best thing for your patients and our healthcare system.


“The strength of the team is each individual member and the strength of each member is the team.” –Phil Jackson former coaching legend of the Chicago Bulls 


Perhaps the solution we all need is not found in regulations and quality measures.  A transformation of health care that includes strengthening and building teams may prove not only to improve your career satisfaction, but improve patient outcomes, quality measures, and cost savings.

I founded United Wound Healing after years of working in medicine only to find that the team environment I wanted to practice in was not truly a team, it was just as broken as our national health care system.  We created “Team-Centered Wound Care”™ in response to a dire need in local skilled nursing and rehabilitation centers.  Patients with chronic wounds were being transported weekly to remote wound care centers creating uncomfortable and expensive traveling, often to receive basic wound care services that could have easily been performed where the patients were residing.  The communication between the patients’ caregivers and wound care providers was less than adequate.  Team work was non-existent.


Research has validated the value of team-centered wound care.  In 2012, a review of retrospective cohort data was conducted to compare Medicare expenditures between two groups of skilled nursing facility residents with a diagnosis of pressure, venous, ischemic, or diabetic ulcers whose wounds healed during the 10-month study period.  A rough population prevalence rate for chronic non-healing wounds in the United States is 2% of the general population and caring for these wounds exceeds $50 billion per year.

The study group included 372 residents who were managed using a structured, comprehensive wound management protocol provided by an externally-led wound management team. The matched comparison group consisted of 311 skilled nursing facility residents who did not receive care from the wound management team.  The study group residents experienced lower rates of wound-related hospitalization per day and shorter wound episodes than comparison group patients. Total Medicare costs were $21,449.64 for the study group and $40,678.83 for the comparison group.

This study supports the cost savings and quality outcomes patients and our health care system need.  However, instead of resulting from rules, regulations, and EMR’s, the outcomes are a result of teamwork, synergy, and collaboration.  I would venture to say these virtues are also the very characteristics we all crave as health care providers and what is lacking in our own job satisfaction.


Caroline E. Fife, MD, CWS; Marissa J. Carter, PhD, MA; David Walker, CHT; Brett Thomson, BS

Wounds, Volume 24 – Issue 1 – January 2012



Washington’s own Human Resources Group is the #10 Best Place to Work in Health Care!

Washington’s Healthcare Resource Group (HRG) has recently been featured on Fortune Magazine’s “20 Best Workplaces in Health Care” in America. The company of 325 employees is headquartered in Spokane, WA – the home of Washington State University’s brand new Elson S. Floyd College of Medicine. This #10 best company to work for is employee-owned since 1994.

Historic Building in Spokane, WAHRG offers a suite of services to hospitals and medical centers to optimize the performance of their revenue cycle departments. By leveraging their expertise in Health Information Management and Information Technology, HRG assists its clients in implementing best practices for scheduling, coding, billing, and many other points throughout the revenue cycle.
Revenue Cycle Management is the process of getting patients in the door, determining their eligibility for a given service, collecting any copays, coding the services provided in the correct manner, reporting claims in their insurer, tracking the claims, and collecting claims & following up with denied claims. Healthcare facilities use Revenue Cycle Management to ensure they have enough cash on their books to fund their operations, plan for capital campaigns, and demonstrate the sustainability of their business models when applying for grants or preparing for an acquisition/merger.

For large scale hospitals and medical centers, Revenue Cycle Management is very complex. The Revenue Cycle/HIM software and systems need to track tens of thousands of patients, insurance plans, billing codes, and insurance claims. Without proper oversight and expertise, the complexity of the operations and reports can be daunting. If you enjoy working with data, rules-based systems, finance, and information technology a careers in revenue cycle management might be right for you.

Today the company continues to grow at a healthy pace and its recruiters are hard at work looking for new talent with experience in Health Information Management, Revenue Cycle, Coding and other departments in healthcare support. Presently HRG is recruiting for the following positions:

HIM (Health Information Management) Operations
Coding: Inpatient, Outpatient, and Physician
Coding Validation Auditors & Educators
HIM Leadership / Consultants
ICD-10 Assessment, Implementation & Training
Coding Validation Audits and Education
HIM Operational Assessments
Insurance Follow Up Specialists / Analysts
Insurance Follow Up Supervisor
Medical Biller
Central Business Office Specialists
PFS Customer Service Representative
Data Control / IT
Software Developer
Operational Support

Check out their current openings at

Job Growth in Pacific Northwest fuels Housing Market Boom

Seattle is the #1 hottest housing market for the third time in row, according to the spring 2016 report from TenX, an online real estate market. Median home sales prices are up 12.1% from last year, reaching an all-time high at $425,000 last quarter. Presently, Seattle’s population growth outpaces the national rate.


Right behind Seattle in the #2 slot is fellow Pacific NW city Portland, where median home sales are up by 12.4% annually, bringing the median to $331,000 in the fourth quarter.


 The rise in housing costs can be attributed to the population increase in the Pacific Northwest, as well as the concentration of higher-paying jobs in the region. The median income in Seattle in 2014 was $71,273, compared to $61,366 in Washington State and $53,657 nationally, according to the US Census. The booming tech industry in Seattle saw payrolls rise 5% annually.

Technology is not the only sector that is fueling this growth. Seattle ranks first in the nation in revenue per capita from private foundations, according to the Urban Institute, which include large health-care companies, research institutes, and other nonprofits, like the Seattle-based behemoth The Gates Foundation. A 2015 study sponsored by the Washington Global Health Alliance said that global health (which includes research, logistics and manufacturing) now accounts for more than 12,000 jobs in Washington state and nearly $6 billion in economic activity.

The fields of nursing, psychiatric and home health aides grew by 2.8% in 2015, according to the Seattle Times. Physical therapy and occupational therapy grew by 3.9%. According to, the median income for Registered Nurses in Seattle was $76,097. The median income for Physical Therapists was $85,943, which puts both fields above the sector-wide median for the city.