General News · 9th September 2010
CCHA Executive Board
People have asked for background to the CCHA decision not to offer a lease to Dr. Overhill.
The CCHA had hoped to avoid a public discussion of some of the issues referred to in this letter. However, in view of the widely expressed wish for an explanation, the CCHA feels compelled to respond.
This is how the current model for a physician practising in the Cortes Health Centre works. The physician on Cortes receives a guaranteed fee under the Ministry of Health alternative payments program to deliver services from the CCHA Health Centre. The physician is not an employee of VIHA and is not a private practitioner paid for billable services delivered.
Physician fee information is a matter of public record in BC. We disclose details here as they are relevant to the discussion of what is an appropriate fee for lease of the Health Centre facility.
Here are the details of how the model works:
1. The physician receives a guaranteed fee of approximately $293,000
2. The physician must enter into an agreement for a lease and services contract with the CCHA to practise in the Health Centre.
3. The cost of operating the Health Centre is $5,200.00 per month. These costs include the salaries of 5 part time employees, supplies, utilities and general costs of maintaining and operating the building.
4. The physician receives a turn-key operation and has a net income in excess of $230,000 per year including 43 days vacation pay.
Before the CCHA put this model in place, Dr. Overhill, practicing through a limited company called Overhill Ltd, paid a lower rent ($600 per month minus a $100 rebate), but was responsible for a portion of the operating costs, including staff costs (with VIHA paying a portion of the overhead costs relating to the nurse practitioner).
There has been talk of mediation and negotiation on the new CCHA contract. There is no room for negotiation as employees are not overpaid and the other costs are fixed. After operating this new model for 6 months, the CCHA has $1,200.00 in the contingency fund. This money will be allocated by year end.
The Cortes Health Centre is dependent on many hours of service from volunteers as funds are limited. Furthermore, the CCHA in conjunction with VIHA is installing an electronic record system which will be a further cost to the CCHA.
The current collaborative community health model was developed to ensure the continued operation of the health centre in the event of a physician departure for any reason. The model ensures there will always be an operating clinic for a locum or a replacement doctor to step into. This model was presented to the membership and the community in a mail-out flyer, at the AGM and on a phone-in radio show. There were no objections to its implementation.
The reasons for adopting the current model for operation of the health centre stem from a series of events that escalated after November 2009 and continued into 2010. The CCHA has every sympathy for Dr. Overhill’s illness. At the time of her illness, Overhill Ltd had issues with VIHA over money and other matters, some of which were outlined in Dr. Overhill’s letter to the community in November, 2009. (see a copy attached below). As a result of Dr. Overhill’s illness and these other issues, the operation of the health centre was placed in jeopardy and finally Overhill Ltd closed the facility and laid off the office staff.
There were other options open to Overhill Ltd that would not have provoked such a crisis and would have been fairer to all concerned, particularly staff.
The CCHA's position is that the Health Centre is vital to the community and should not be at risk. Accordingly the CCHA took steps, in conjunction with VIHA, to re-open the clinic and hire staff as soon as possible, implementing a new model designed to minimise the possibility of such a situation re-occurring.
The CCHA has decided that it will not offer a new lease and services contract to Overhill Ltd for the following reasons:
- Dr. Overhill has publicly stated that she does not agree with the current model
- Based on past experience and Overhill Ltd’s reaction to the current operating model, the CCHA foresees ongoing contractual disagreements with Overhill Ltd in the event of a renewal.
The business relationship between Overhill Ltd and the CCHA has been extremely difficult. For years Overhill Ltd refused to sign a lease with the CCHA. A 6 month lease for $600.00 per month, less $100.00 for expenses, was eventually signed, but not renewed by Overhill Ltd. when it expired. The lease became monthly and eventually lapsed. $600.00 was insufficient to cover basic costs of the CCHA but Overhill Ltd continually complained about the high rent.
There have been suggestions that the current lease fee of $5,200.00 per month is too high. For the reasons given above, the CCHA believes this is a reasonable cost in view of the services it includes. The fee represents 21% of the physician’s gross income. Comparable overheads at other island clinics are 25-30% or $6,100.00 per month.
The CCHA has no issues with Dr. Overhill’s competency as a physician and is grateful for her past medical services. We have expressed our appreciation in the past.
The CCHA understands concerns expressed about physician shortages and the possibility of Cortes being left without a physician. The process to hire a new permanent doctor is well under way and the CCHA does not have a concern over finding a first class permanent replacement for Dr. Overhill.
signed by the CCHA Executive Board
CORTES MARKETER November 20, 2009
LETTER FROM DOCTOR OVERHILL TO CORTES COMMUNITY RE CLOSURE OF HEALTH CENTRE
Due to a combination of unfortunate circumstances, the medical clinic will likely be closed from November 23, 2009 for a period of two to five days. Anita Dotts is on vacation and away from the island and Kirstie Overhill will be on medical leave.
Most people may not be aware that the funds to operate the Health Centre are provided largely by my salary, with a smaller contribution from VIHA (Vancouver Island Health Authority) for Anita's expense. This means that the staff to run the clinic, book blood work appointments, schedule mental health, etc. are all paid from my salary. This is not the case in other communities (such as Gold River) where the physicians pay a small monthly amount and the overhead of the clinic is covered by VIHA. When I am sick, if I do not work, I do not get paid. Therefore when I am off work I have no income to pay for the overhead expenses at the Health Centre. I can receive locum coverage for my practice if I give up my holiday time, which is what happened for the first two weeks of November. However, there is still no money to pay for staff support for the locum since VIHA does not fund practice expenses on Cortes Island.
We have also attempted to obtain funding for laboratory collection on Cortes, (as is available in other communities) again without success. Unfortunately I no longer feel able to cover the cost of this service under the circumstances. As of the new year I am notifying VIHA that the Cortes Clinic will no longer be able to perform a blood collection service. I will provide staff at the Health Centre on Mondays, Wednesday and Friday from 1-4 pm. To provide pink TAPS forms to assist with travel. I am aware of the detrimental effect of these decisions on the community and I deeply regret the limitations on service to patients that have become necessary because of my personal circumstances.