Super Clinics in Kingston: A Hat Trick of Wins
Abstract: An op-ed published in the Whig Standard on June 3, 2024
Read the original article in the Whig-Standard
A Super Clinic seeks to get three wins. A win for the City, a win for the clinics, and a win for the health of the people of Kingston. The basic goal of the Super Clinic is to increase access to high quality healthcare for the greatest number of people at no cost to the taxpayer in a scalable and duplicatable model. A Super Clinic is an example of municipal government working with healthcare providers to improve the health outcomes of the population for generations to come.
The funding piece has been figured out and does not involve any increase in taxes or any regular yearly budget outlays. Beyond the one-time initial funding that has already been earmarked for the purchase of 309 Queen Mary Rd, the cost of renovations above budget will be funded through a pay-as-you-go formula in which the cost of renovations are amortized and collected through the clinic's lease payments. The Super Clinic, because it is in partnership with the City, allows the City to enter into a debt financing plan through Infrastructure Ontario (the go-to source for municipal debt). They provide loans at below market rates and longer amortization periods – these savings can be passed on to the medical organizations that will fill the building at 309 Queen Mary Rd., thus making them more fiscally feasible and operationally secure.
This type of partnership, where the City of Kingston facilitates projects in the public interest, extends beyond just financing. Facilities Management and Construction Services is another noteworthy example of a City department in partnerships that enhance project feasibility. The City manages over 160 buildings (we recently took over the building envelope management of the Police Station, Slush Puppie Place, and the 5 libraries) and has many assets that are used to maintain all these buildings. When the City takes on another building to manage, like 309 Queen Mary Rd, our marginal costs go up slightly. But that increase in marginal cost is lower than the total cost for the organizations who lease the space if they did it all on their own. A price above the City's marginal cost and below the total cost to the clinics is a win-win for both. Then it becomes a triple-win since we are now talking about facilitating increased healthcare access for the community.
So far this is relatively common, these finance and maintenance models are not new. They have been tested and have been shown to work. The unique innovation that I am proposing is to extend this mutually beneficial principle through more services the City does and has expertise in. I am thinking about services that normally have to be done by a clinic but that take away from a medical professional's time or income. Such things as human resource management, accounting, IT and cyber security services, basic legal, advertising and messaging, customer relations, and call center services. These are all expected or required in a modern clinic, but they are not the core competencies of healthcare workers. They take away from the healthcare professional's time or income. It is a generally accepted principle that you want the right expertise in whatever service you need. Therefore, if the City can offer any of these expert services on a full cost recovery basis – that is at a price point that does not affect the City's budget – then this would be better for the clinic than to farm out these services to a for profit company. This is a savings that can be passed on to clinics in reduced operating costs and to patients in the form of healthcare practitioners that are less stressed and have a better work-life balance.
Let's consider one possible example: human resource management. The City of Kingston has a very sophisticated HR department – it is likely that a new medical clinic will not need all the services the City could provide but the clinic might be able to benefit from a super simple HR task like payroll. If your expertise is not in payroll, as is the case with most healthcare professionals (and most people in general), it can be a pretty daunting task every time you have to do it – or it could be relatively expensive if farmed out to a for profit company. For HR professionals, on the other hand, payroll is a walk in the park. The City, as a non-profit with a full cost recovery mandate but not a profit mandate, could offer a savings to the clinic in time, money, energy thus freeing up a medical professional's time and energy, reducing a source of burnout, business instability and uncertainty. What in total the City of Kingston can do in all the fields of its expertise is speculative at this point but worth exploring in order to make family medicine more attractive to those entering the field and retaining those in the field.
Some of these services may become more attractive with increased economies of scale. This is why having several clinics under the City's service umbrella is better. Things like ministry reporting, billing, and WSIB processing services might not be immediately needed but later after some growth and expansion, when a critical mass of clinics is reached it could make cost-effective sense to contract the City's services for synergistic help; that is if and only if the City's marginal increase in costs is less than the clinics' total cost to do it themselves. When this is the case, everyone benefits. This Super Clinic model over time will very likely generate more opportunities to benefit from economies of scale.
The economies of scale in close proximity facilitate an ecosystem of healthcare with several different clinics running different delivery models that can build on each other, support each other, and learn from each other. They can pool their business service needs and when they reach a critical point they can explore a partnership with the City.
The basic principle that makes the Super Clinic model unique is the facilitation that the City can provide through its service expertise from many City departments. Let me be clear: this is not going to be easy. Anything innovative is hard – very hard – there are a lot of unknowns with any endeavor and with a novel idea. But if we don't take chances by evolving successful strategies into new domains then we will fail to be innovative, we will fail to find new solutions because we were too afraid to take a calculated risk. In this Super Clinic model, we have a well-tested formula applied by expanding in a managed and calculated risk that will accrue cumulative health benefits for generations at no cost to the taxpayers. The Super Clinic model is scalable and duplicatable meaning it has the real potential to really solve some of the root problems in primary healthcare that have led to its crisis – rather than just manage our doctor shortage with old band-aid solutions.
The Super Clinic Model really is a hat trick of wins that will pay health dividends for generations of people and across the whole health continuum. If this idea is compelling, please let your City councillor know. City Council will make a decision on June 4th – join us at 7 pm to show your support.