Family Care Network inpatient care at PeaceHealth St. Joseph Medical Center in Bellingham will abruptly end on April 30 after about 15 years of service, leaving hospital staff uncertain about their future.
The stoppage also raises concerns among the PeaceHealth hospitalists who will remain, as they navigate the logistics of a rapid transition. Hospitalists are clinicians who specialize in general hospital care.
“It’s an enormous loss, not just for Family Care Network, but more importantly, it’s a loss for the community — it’s a loss for our patients,” said Dr. Chao-Ying Wu, who was a founding member of the Family Care Network and helped launch the FCN inpatient services program in 2010. Wu retired at the end of 2022.
Michele Anderson, the FCN marketing director, declined to provide a number of affected positions. She also declined to detail the reasoning behind shuttering the program. PeaceHealth also declined to comment on the impact to the overall hospital workforce.
FCN is a locally-owned, independent health care network that serves about 105,000 patients at 15 clinics and urgent care centers in Whatcom and Skagit counties. Its hospitalist program provided inpatient care during the day and evening to FCN patients admitted to the hospital — an effort to provide continuity of care and relationships.
“Although our hospitalist program is ending, inpatient care at the hospital will continue, for all patients,” said Dr. Rodney Anderson, the CEO of FCN. “We recognize that this change is acutely felt by those who are directly impacted, and that it can create a sense of uncertainty for others.”
FCN is working with affected clinicians to support internal transfer opportunities, “which may help mitigate the potential impact of this change,” Michele Anderson wrote.
The loss is concerning for remaining PeaceHealth hospitalists such as Meg Lelonek, who said on Thursday, she worried they may need to see 20-30% more patients a day starting in May.
On Friday, Feb. 28, she was told the hospital would hire 10 more full-time hospitalists pending contract negotiations, which would significantly relieve that pressure.
Nonetheless, Wu issued a warning:
“When you have a big change in the supply of an essential health care service, like physicians working in a hospital, those … are always times of hazard for patients,” Wu said. “When systems change … those changes need to happen mindfully with good preparation.”
Both FCN and PeaceHealth told Cascadia Daily News that they are working to provide a smooth transition. PeaceHealth declined to comment on plans to bring 10 more hospitalists on board.
A crucial service
When working shifts at the hospital, Wu recalls making a quarter or a third of what he made while in his office. Yet, for years, he said he worked 30-plus-hour weekends, in addition to his full-time job, to help get the program off the ground.
He did that because he sees the service as crucial: it provides FCN patients a smooth entry into the hospital and exit into outpatient primary care.
“Patients get better faster, more thoroughly, when they feel that they are safe and cared for in a long-term, ongoing relationship,” Wu said. He recalled when he would see a patient at the hospital, even one he had never met before, and say: “I am one of your primary care physician’s partners, and I am working in the same group to take care of you together.”
“I can tell you the look of relief that people had when they heard that was just profound,” Wu said.
But Wu said it wasn’t a profitable program.
Wu recalls FCN’s hospitalist program losing hundreds of thousands of dollars a year. The program remained operational because it was often subsidized by revenue generated by outpatient care practices, he explained.
While hospitalist programs tend to lose money in general, they increase efficiency for the hospital and generate revenue for the facility, while also boosting quality of care.
“All the financial advantage was actually being accrued by the hospital,” Wu said.
Michele Anderson declined to detail the reasoning behind shuttering FCN’s hospitalist program. However, CDN is aware that an inpatient care contract between FCN and PeaceHealth had recently been under negotiation.
“We are not able to answer questions related to our private business operations, contract negotiations or company financials,” she wrote.
Rodney Anderson explained that FCN operates in a “complex, changing health care environment” and that its goal is to make decisions based on how it can best serve patients, “whether that is by FCN or through a local partner.”
He noted that this could lead to adding or changing services. And, in this case, ending one.
Remaining hospitalists
Consolidation of health care is a tremendous boon and a “gold mine” for consultants and bureaucrats and attorneys, but there’s no evidence that it’s beneficial for clinicians or patients, Wu said.
He pointed out that FCN not having an inpatient service means that more than 100,000 patients, many of whom are on Medicaid, will have lost the option of having their primary care physician group take care of them at the hospital.
The FCN hospitalists are one of two such groups at St. Joseph.
The other is a group of about 30 clinicians working at hospitals in Bellingham and Sedro-Woolley. They are currently piloting a contentious unionizing process, with SoundPhysicians and PeaceHealth named as joint employers.
Those hospitalists previously told CDN that they were unionizing to be in a better position to advocate for patients’ needs in the hospital and better navigate an environment that is fueling clinician burnout.
“There is a lot of chaos and uncertainty,” Lelonek, one of the unionizing hospitalists, said Thursday. “It is — for me — creating an undercurrent of stress and anxiety in an already very stressful job.”
The following morning, she was told that PeaceHealth was ironing out contract details with SoundPhysicians for the 10 additional hospitalists. It was welcome news, though she “can’t imagine the logistics — how we will all fit in our current, already cramped workspace,” as well as what schedules will look like.
“We’re going to do everything we can to care for the person in front of us and make this transition seamless,” Lelonek said on Thursday.
Navigating the transition
In his statement to CDN, Rodney Anderson said FCN would be working with various partners through the transition. PeaceHealth said the same.
“We are collaborating with Family Care Network for a seamless transition, and with our other group of hospitalist clinicians to ensure our patients will continue to receive exceptional care,” said Lorna Gober, chief medical officer for PeaceHealth’s Northwest network and a former FCN physician who helped start the inpatient services program.
In its statement to CDN, SoundPhysicians gave no indication whether or not it was in negotiations with St. Joseph to fill the gap created by FCN exiting the hospital. The for-profit national labor management company did not respond to a request to confirm the hirings Lelonek was told about.
“Should there be a need for additional hospitalist support in the future, we are always open to discussions to assess how we can best serve the needs of patients,” said Dr. Chia-Shing Yang, the regional chief medical officer at Sound Physicians, said on Thursday.
PeaceHealth’s failure to renew the FCN contract is part of a series of blunders made by the not-for-profit headquartered in Vancouver, Clark County, said Wu. He pointed toward ending comprehensive outpatient palliative care — months later it vowed to restore the program — and the firing of Bellingham physician Dr. Ming Lin after he raised concerns about working conditions during the COVID-19 pandemic. Lin recently reached a multi-million-dollar settlement with PeaceHealth.
“The complete lack of local decision-making and lack of local accountability essentially has made PeaceHealth an unreliable, untrustworthy and actually unsafe partner for health care in the community,” Wu said. “I know those are strong words, but I believe that.”
Isaac Stone Simonelli is CDN’s enterprise/investigations reporter; reach him at isaacsimonelli@cascadiadaily.com; 360-922-3090 ext. 127.
