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Clinic Transition Update from Jody Carona

ByLopez Island Hospital District

Reported at the October 22, 2025 LIHD Regular Board Meeting

Clinic Transition Update from Jody Carona, Health Facilities Planning & Development (HFPD)

Status of Work – Oversight/Partner Group: Potential Healthcare System Partners

  • Outreach to six potential partners has been completed — 100% agreed to an initial conversation.
  • One party elected not to proceed, citing past experience with small, remote clinics.
  • One party expressed willingness to continue discussions but envisions a model staffed solely by Advanced Practice Providers (PA/ARNP) supported by robust telehealth. As of this date, a confidentiality agreement has not been extended to this party.
  • Four parties have expressed preliminary interest; two of these are in the process of signing a Mutual Confidentiality Agreement (MCA).
  • All parties that sign the MCA will receive a comprehensive information packet prepared by HFPD, which includes:
    • Background on the clinic and its history
    • Roles and responsibilities of CWMA and LIHD
    • Performance data from UW Medicine
    • Overview of downstream revenues
    • Desired care model (staffing and services)
    • Overview of existing partnerships and healthcare providers on the island (EMS, pharmacy, etc.)

Status of Work – Independent Group: Potential Locally Owned and Operated Clinic

  • CPAs retained by LIHD are supporting the Independent Group with cost-center analysis, line items, and best-practice benchmarking. They have reviewed financial data provided by UW Medicine.
  • One member developed an initial financial model indicating feasibility with a tax subsidy. The CPAs are currently reviewing and refining the model to incorporate:
    • Actual payer mix
    • Salaries and benefits
    • Visit volumes
    • Review of potential under- or over-stated costs
      Three refined scenarios will be produced — Bare Bones, Mid-Point, and Gold — with delivery expected by November 3–10.
  • CPAs are also evaluating reimbursement potential under various structures, including:
    • Independent Rural Health Clinic (RHC)
    • Provider-Based Rural Health Clinic (PBRHC)
    • Federally Qualified Health Center (FQHC) Look-Alike
  • Two group members have identified approximately 26 clinics in communities with demographics similar to Lopez Island and are conducting outreach to gather comparative information. The local independent clinic on Orcas Island has also been interviewed.
  • The Independent Group recognizes that a key next step is to understand the operational and structural requirements of an independent clinic, including:
    • Ownership and certification
    • Provider employment model
    • Recruitment of qualified staff (including clinic manager)
    • Selection of an Electronic Health Record (EHR) system
    • The group has agreed that it is not yet ready to finalize an agreement with Charles Hall at this time.

Note: A Town Hall is tentatively planned for late next month. The purpose will be for both groups to share progress to date and respond to community questions.