In a move to implement a healthcare model unique to Manitoba, the Town of Niverville will assume ownership of Open Health Niverville effective March 2. Open Health is the community’s primary health clinic and has been owned and operated by Drs. Chris and Mairi Burnett for 15 years.
However, the clinic has been in crisis since earlier this year when it was announced that the unexpected illness of Dr. Mairi, who’s been forced to discontinue her practice while she undergoes treatment, had rendered the business financially unsustainable.
One month ago, Niverville’s town council hired Kathy McPhail, former CEO of Southern Health-Santé Sud, to write an independent report detailing the community’s options.
“Kathy McPhail’s report was transparent and clear, with no reservations, indicating that while healthcare services in Niverville currently face challenges, Open Health is viable and can be stabilized as well as sustained for the future,” reads a press release from the Town of Niverville. “Council deeply appreciates the good and hopeful work Ms. McPhail has provided for our community and is proceeding on a path reflective of the recommendations outlined in her report.”
New Management
In order to manage Open Health, the town is forming a new entity, Niverville Healthcare Services Inc. (NHCSI). Council is in the process now of appointing board members. Once complete, this board will include an Open Health clinician, a member nominated by the Chamber of Commerce, a couple of town councillors, and one at-large member of the community.
“NHCSI is in the process of securing a business manager for Open Health who will report directly to the board of NHCSI and the CAO for the town,” the press release says. “This new manager will be responsible for ensuring efficient and effective client-centred care in a positive customer service environment and in a fiscally accountable manner during this transition period, ensuring a long-term future for Open Health. The manager, along with the board and CAO, will be actively recruiting additional professionals, in addition to working with those professionals already a part of Open Health, to expand the offerings and hours in the coming months.”
It is expected that the business manager will be hired before the end of this current week.
While the town assumes responsibility for the clinic, all of the current doctors and clinicians, including the Burnetts, will continue to operate there, meaning patients will experience minimal disruption.
Operating Costs
Mayor Dyck says that the clinic has been transferred to the town’s control in exchange for $1. However, there will be some significant costs associated with the lease and overhead.
Dyck explains that doctors in Manitoba work under a fee-for-service structure, where they bill the province for their services. Previously, Open Health had a 70/30 pay structure for its doctors, meaning that the doctors kept 70 percent of their pay and contributed the other 30 percent to the clinic’s overhead.
“However, from a recruitment point of view, what we’ve been told is that 80/20 is where we need to be if we’re going to attract doctors,” Dyck says. “When doctors are coming out of school, they can go to community X and pay 20 percent overhead, or they can come to Niverville and pay 30. So they’re not coming here. Why would they pay the extra 10 percent? So part of the model is we’re going to an 80/20 split.”
He acknowledges that the next six to nine months will be difficult, and the town has forecasted overhead costs in the range of $75,000–90,000. In order to avoid new taxation, this money will come from the sale of the former municipal building at 86 Main Street, which sold for almost $200,000 last year. That money had originally been allocated to go towards improvement at the new municipal building on Bronstone, but now it will go instead towards keeping Open Health running.
However, beyond this initial rough patch, Dyck says there is every reason to expect a bright future for the clinic.
“Within 12 months’ time, based on the forecasts we’ve [gotten from] Kathy McPhail and others, we expect to be flush or in a slightly profitable position,” he says. “So basically we’re looking at a one-year cost to transition.”
One reason to expect Open Health to become more profitable in the short-term is that a physician assistant who’s currently on maternity leave will be back at work in September.
“There are two new physician recruits anticipated for late summer,” McPhail writes in the report’s executive summary. “One physician currently on maternity leave will return to work during that timeline as well. It is anticipated that physician assistant opportunities are available.”
McPhail reemphasizes that in addition to the physicians, the clinic currently employs a range of other clinicians which are available to patients, including two nurse practitioners, a public health nurse, a dietician, mental health workers, and a chronic disease nurse specialist.
If all goes according to plan, by this time next year the clinic will be operating at its previous capacity. Mayor Dyck adds that they’ll be actively recruiting. Although there’s a shortage of full-time doctors right now, council would like to see that number climb to six or seven.
“We want to see this centre be profitable and build on the services that we know are vital to our community,” Dyck says. “We don’t just want to scrape by on the basics. But we have about a six-month rough patch, I’m not going to lie.”
First of its Kind
With NHCSI, the operating model for the clinic will be a social enterprise. Under this model, once the operation becomes profitable all those dollars will be reinvested in the clinic. Mayor Dyck says that Open Health profits will never be used to cover other town expenses, such as clearing roads, building parks, etc. Rather, profits will go towards recruiting doctors and purchasing new equipment, such as an X-ray machine.
“So then we continue to expand the services,” Dyck says. “The role of council is to say, ‘Okay, now we have this. We want to continue to build it. And that was always Dr. Burnett’s dream.”
In the short term, the Town of Niverville will provide an initial grant of about $30,000 to NHCSI to provide fiscal support during the clinic’s transition from a deficit-run centre to one that generates a profit.
This will be a unique healthcare model in the province of Manitoba, and very probably beyond our provincial borders as well.
That said, Eric King, Niverville’s CAO, reminds us that it’s not unique for a municipal council to support healthcare clinics. It just usually doesn’t come in so direct a form.
“Communities spend lots of money on doctors or facilities, just in a variety of different ways,” says King. “But we have not seen anything exactly like the way we are proposing.”
A similar model exists in Winkler, where the local municipalities own a clinic’s building. However, those municipalities have no hand in the clinic’s operation.
“We’ve already received congratulatory emails from Southern Health-Santé Sud,” Dyck says. “Because without going this way, it was very likely that the health clinic in our community would be minimized, if not lost. Kathy McPhail’s report says that she talked to a lot of community members, and she told us directly. [She spoke to] members of the Chamber, too, because it’s the whole issue of business and government. [The feedback she got] was overwhelming in support that, yes, the town should be doing something.”
Another key part of the decision, Dyck says, was considering the substantial economic spinoff that occurs as a result of Open Health’s 6,500 patients, many of whom come from other communities.
“People are coming into the community, they’re buying some meals here, they’re buying fuel here… who knows what else they’re doing. We know that from an economic development angle, we need to keep these people coming to our community.”
Importance of Continuity
While this means that the Burnetts are having to give up ownership, Mayor Dyck wants to emphasize that they haven’t had to give up on their dream for exceptional primary healthcare in Niverville. He says council consulted extensively with the couple in coming to their decision.
“They’re still able to realize their dream,” Dyck says. “We want to honour that. And we want to make sure there’s continuity.”
This continuity comes in a couple of different forms. For patients, it means that they don’t have to change their doctors. Although there will be rough spots in the next couple of months, Dyck says patients don’t need to pull their files and go elsewhere.
There will also be continuity in terms of the board. Although members of council will change from time to time, as new councils are elected and members come to the end of their terms, the board will have stable representation from the clinicians, from the Chamber, and from the community.
“Council wishes to thank and acknowledge the patience and support our community has shown during this disruptive and challenging time for Open Health,” concludes the press release from the Town of Niverville. “Particularly, our community owes a debt of gratitude to the Burnetts for the investment, commitment, and vision in birthing Open Health. All that they have done and will continue to do for the betterment of our town and region is inspiring. As a community, we continue to stand with and pray for their family as Dr. Mairi navigates her healthcare journey to full recovery.”
