Valdez Medical Clinic: Fixing an Airplane While Flying it
Photo by Hush Naidoo Jade Photography on Unsplash
April 28, 2023
Keenan Britt
In a letter last week to their patients, Dr. Kathleen Todd, M.D. and Dr. John Cullen, M.D., announced that Valdez Medical Clinic LLC will be transferring management to Providence Valdez Medical Center.
The physicians, who high- lighted their combined 77 years of service in Valdez, called the move a “difficult decision” and stated the transition will occur by the first week of June 2023. The letter states that the decision is “aimed solely at ensuring that our community continues to receive the highest level of medical care possible.”
Drs. Todd and Cullen previously discussed the possibility of transferring management earlier this month in their April 4 presentation to Valdez City Council, where they were joined by Melanee Tiura, administrator for Providence Valdez Medical Center. The physicians sought the support of council for this transfer due to the City of Valdez’s contract with Providence for operating the medical center.
During the presentation, Dr. Cullen explained that for many years the medical community in Valdez operated on a model of having four broadly-trained physicians available to staff both the Valdez Medical Clinic (a private practice) and the Providence Valdez Medical Center (a hospital within the Catholic nonprofit Providence Alaska Foundation).
“We worked really hard. For us, COVID was extraordinarily difficult. There were three of us (doctors) towards the end covering the E.R. and unfortunately, that had a negative effect on the clinic.”
Dr. Cullen stated the model had served Valdez well and “because of that, we were able to have a surgical team that included Cesarean sections and then if there was ever an emergency, there were multiple physicians that could respond immediately.”
However, in the years following the onset of the COVID-19 pandemic, this model has come under strain. Currently, only three physicians - Dr. Todd, Dr. Cullen and a travel doctor - provide care in Valdez. Drs. Todd and Cullen provide services at both their private clinic and the Providence Hospital.
“We worked really hard. For us, COVID was extraordinarily difficult,” said Dr. Cullen, “There were three of us (doctors) towards the end covering the E.R. and unfortunately, that had a negative effect on the clinic.” The clinic also suffered due to rising costs and difficulties in hiring new staff while facing a reduction in payments from Medicare, Medicaid and private insurance.
“We’re such a small clinic, insurance companies really try to take advantage of us,” Dr. Cullen said, “We’re out of network for a lot of them, and as a result of that we’re seeing a big reduction in payments.”
One of the greatest strains has been to recruit new physicians who were willing to relocate long-term to Valdez. Dr. Todd explained recruiting new physicians has become even more difficult following the pandemic. “We can’t make it through the summer on what we’ve got right now,” Dr. Todd stated to Valdez City Council, “We need to recruit some doctors right now, this summer so that people will get seen...There’s no money in our personal pockets to do that.”
“We’re such a small clinic, insurance companies really try to take advantage of us. We’re out of network for a lot of them, and as a result of that we’re seeing a big reduction in payments.”
Dr. Cullen explained that Valdez Medical Clinic was considering “going under the umbrella of Providence” as a solution. “Providence, because they’re a critical access hospital and because they’re a facility, they can charge Medicare and Medicaid at a much higher rate than we can.”
Under this model, Drs. Todd and Cullen would continue providing medical care to Valdez as employees of Providence. In their letter this week Drs. Todd and Cullen stated that “Providence Valdez Medical Center and the Providence system nationally has the resources and expertise to maintain and enhance the care that you have come to expect from our clinic.”
Council member Alan Sorum asked about the option of creating a community health center with federal funding. Dr. Todd stated that Valdez did not qualify for federal programs to create a community health center. Dr. Cullen continued that he had been in communication with Southcentral Foundation and Valdez Native Tribe about creating a community health center but “they were not really in a position to move forward with that.”
Dr. Cullen explained that establishing a community health center independently had been considered, but that “it’s kind of like trying to fix an airplane while you’re flying it. We’re busy seeing patients that need to be seen, so trying to come up with community health center funding and all the rest - we don’t have the bandwidth at this point.” Dr. Todd added that establishing a community health center would still face the challenge of recruiting new physicians before summer: “We have a time limit here.”
“Providence Valdez Medical Center and the Providence system nationally has the resources and expertise to maintain and enhance the care that you have come to expect from our clinic.”
Councilmember James Devens asked what the process of transferring the clinic to the Providence hospital would entail. “There are so many moving pieces... there’s a million moving parts,” Dr. Todd answered, detailing the difficulties that would be involved with transferring medical records and inventory to Providence. Dr. Todd also commented on the invaluable experience of the clinic’s current employees, and “We’d have to figure how those employees are going to fit in.”
Councilmember Olivia Foster (who is employed by Providence as a nurse) asked, “Would any services change under the Catholic hospital model at the clinic?” Tiura answered that “under the Catholic organization, we do not perform abortions and vasectomies, but we do birth control.”
Councilmember Love asked what Providence’s strategy would be for recruiting new physicians “because clearly the linch-pin is getting the doctors needed.” Tiura answered that “recruitment across the state is challenging for every category of profession - physicians very much so. We have an excellent recruiter...better reach is something we’d have to offer.”
“This is a very emotional thing for us...These are my people... This is a big deal for us, to give up control of this. But it needs to happen quickly and appropriately so that Valdez still has medical care. I don’t want to leave Valdez with two nurse practitioners and a hospital that just has doctors that come in for three days at a time. Valdez deserves better. My patients deserve better.”
Tiura explained that Providence is unable to recruit nationally for the clinic while it remains a separate entity because “that’s governed by Stark Law, that’s not our choice, that’s a regulation that’s on us to not provide services to a referring entity that isn’t at fair market value. Whether we agree with it or not, that’s the law.”
Dr. Todd stated that neither she nor Dr. Cullen had any financial motivation for this transition. “This is a very emotional thing for us...These are my people... This is a big deal for us, to give up control of this,” Dr. Todd explained, “But it needs to happen quickly and appropriately so that Valdez still has medical care. I don’t want to leave Valdez with two nurse practitioners and a hospital that just has doctors that come in for three days at a time. Valdez deserves better. My patients deserve better.”
While not holding an official vote, a majority of council members voiced their support for the physicians’ plan.
In their letter this week Drs. Todd and Cullen stated that “we trust that the Valdez Medical Clinic under Providence management will continue to uphold the same standards of care and compassion that we have built together in our clinic.”
