STRATEGIC PLAN 2019-2022 - Olympic Medical Center
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TABLE OF CONTENTS 3 Letter to the Community 4 Mission, Vision & Values 5 Strategic Overview 6 About OMC 8 Quality, Safety & Experience OMC & Community Relationships 9 Community Relations 10 Employee Relations 11 Medical Staff Relations Organizational Performance 12 Facilities, Technology and Services 13 Financial Stewardship 14 Accreditations & Affiliations Cover Photo: OMC’s Trauma Team, comprised of skilled and dedicated physicians, nurses and other care givers, provides Trauma Level 3 services 24 hours a day, 365 days a year. Pictured above from left: Robin Burse, RN, director, and Tina Johnson, RN, Medical/Surgical/Pediatrics.
LETTER TO THE COMMUNITY Dear Community Members, We continue to see tremendous support from our community for Olympic Medical Center and the rural health care delivery system. We want to whole heartedly thank the community for this support, and for participating in the development of the 2019-2022 Olympic Medical Center Strategic Plan. As OMC’s publicly elected Board of Commissioners, our responsibility is to safeguard the health and viability of Olympic Medical Center and ensure safe, quality health care; however, input from the community and patients is our compass. We are working hard for you. Government reimbursement and regulations are the basis of many of the difficulties we face. For example, in 2018 the Centers for Medicare and Medicaid Services (CMS) established a rule that cut our off-campus (more than 250 yards from a hospital, previous rule was 35 miles from a hospital) outpatient clinic practice expense reimbursement by 30% in 2019 and will increase to 60% in 2020. The community rallied behind us and helped provide clear evidence to CMS that this would harm the rural health care delivery system. It has slowed down the development of new services, but we have maintained all existing services and we plan to continue to do so. We continue to fight this in the legislative arena and in federal court, but as of the printing of this strategic plan this issue is still unresolved. We continue to see proposed and actual cuts to federal and state reimbursement, while also seeing new regulatory burdens that increase cost. This is an unsustainable condition. Knowing we will continue to face uncertainty within the health care delivery system in the United States and Washington State, this plan outlines a vision for remaining viable and continuing to serve our community by providing high-quality, safe health care. Regardless of what is happening to us, we must move forward and continue to invest in Clallam County health care! Our goal as Board members is to provide a vision and needed leadership to keep improving our local health care delivery system. OMC is transforming, and we will be the better for it. As described in this plan, the transformations include: • Maximizing primary care and increasing access; • Improving our emergency services operations and reducing wait times, while augmenting emergency services with more primary care and an urgent-care type service; • Re-organizing and increasing the number of hospital inpatient beds, adding telemedicine options and palliative care services to make the best use of our expert clinical staff; • Continuing with updates to our workforce development plan, including recruitment and retention of staff, the expansion of training opportunities, focus on culture and engagement and more. In addition to transformation activities, we will – as always – continue to work with community partners to ensure that the people who call the North Olympic Peninsula home live in a healthy community. We will also continue our assertive advocacy at the federal and state levels for adequate reimbursement, and to help define regulations and policies that are reasonable. As your elected representatives of the Olympic Medical Center Board of Commissioners, we are accessible to you. Please reach out to any of us with questions, comments or concerns about the strategies and goals listed in this plan. Find our contact information at www.OlympicMedical.org > About Us > Board Information. You may also write to Eric Lewis, OMC’s Chief Executive Officer, at elewis@olympicmedical.org. Sincerely, Olympic Medical Center’s Board of Commissioners, 2019 (Strategic Planning Committee noted with asterisk.) John Nutter, President Jean Hordyk, Secretary* John Beitzel* Thom Hightower, RN Jim Leskinovitch John Miles, MD Tom Oblak*
MISSION, VISION & VALUES OUR MISSION OUR CORE OUR VISION Working together to provide VALUES • Olympic Medical Center excellence in health care. Quality – Provide care that is safe, will achieve excellence, and effective, patient-centered, timely, provide quality, value and efficient and equitable. safety in everything we do. Safety – Promote a culture of • Medical staff, clinicians safety for our patients, visitors and and employees will exhibit Every strategy in employees. Olympic Medical Center’s this plan ties into core values and perform Teamwork – With individual skills, daily activities with the our core values, and knowledge and positive attitudes, highest professional and effectively work collaboratively in ethical standards. each successfully providing excellence in health care completed goal for our patients. • The community will benefit from Olympic Medical brings us closer to Compassion – Engage patients as Center’s local focus as it individuals in a mindful, empathetic addresses the health care achieving our vision. and meaningful way. Take the time needs of our citizens through to communicate and listen to our focusing on the Triple Aim of patients. improving individual patient experiences, improving Respect – Value our patients and our community’s health, regard them and their loved ones while maintaining financial with acceptance, courtesy and stewardship. dignity; provide the same value to those with whom we work. • Olympic Medical Center will remain a viable Integrity – Adhere to moral community-owned and principles that include honesty, operated medical provider, sincerity, fairness and decency, and and earn its place as our reflect these principles in the care community’s first choice for and service we provide. quality, compassionate and Stewardship – Carefully and convenient health care. responsibly protect and manage the resources entrusted to the hospital district. 4
STRATEGIC OVERVIEW Olympic Medical Center is a requires it and we will persevere OMC & COMMUNITY beacon in our community, a vital to ensure that our patients and source of safe, quality health care. community members have access RELATIONSHIPS We continue to take thoughtful, to safe, quality care. We look Our community, our employees planned steps to maintain future at this transformation through and our medical staff are our most viability and grow our services to a strategic lens: Do our plans valuable assets. People are at the meet community need despite improve efficiency? Decrease cost? heart of our work. Only by working the unpredictability of the health Provide a better experience for our together toward the same set of care environment in which we patients? Support better clinical goals can we be at our best. We operate. Our Strategic Plan sets our outcomes? must foster these relationships direction and defines our path. through investments in resources, The goals in this plan support time and support. Our connections The environment in which Olympic our core values: Quality, Safety, strengthen our mission to provide Medical Center operates is Teamwork, Compassion, Respect, excellent health care locally. complex. Nationwide workforce Integrity and Stewardship. Every shortages make it challenging transformation we embark upon to recruit an adequate number will stay true to these values. We ORGANIZATIONAL of physicians, nurses, clinicians take great pride in this, and look and other skilled workers to rural forward to collaboration between PERFORMANCE areas. Additionally, decisions made the board, leadership, medical staff, Our community depends on us by federal and state government caregivers, employees and the to maintain economic vitality agencies and legislators on an community to achieve our goals. even when reimbursement is annual basis make it extraordinarily This plan will help us maintain our challenging. Our organizational difficult to plan for the future. focus on three key areas: performance is the key to ongoing We are unable to predict what stability and future viability. Only • Quality, Safety & Experience we will be reimbursed next year, through thoughtful planning, • OMC & Community nonetheless in the next five years. astute financial stewardship Relationships Insufficient, below-cost • Organizational Performance and intentional investments in reimbursement for Medicare and infrastructure and equipment Medicaid services is a constant are we also able to offer needed reality for our rural medical center, QUALITY, SAFETY medical services and programs, while retaining the approximately and we continue to see the risk & EXPERIENCE 1,513 people we employ and of cuts and regulations that can further impact our future. Quality, safety and experience continuing to thrive. is at the heart of what we do We’ve done a great job of providing as a provider of health care. health care to our community. We The compassion we have for have certifications, awards and our patients is inherent, as is accolades that attest to this. Yet our clinical expertise; however, we cannot remain the same. We standardizing processes must progress further to become and strategic initiatives help more efficient, decrease costs strengthen our systems to allow and constantly strive to improve us to consistently deliver the most outcomes for our patients. This positive experience at transformation isn’t insignificant; every interaction. but the external environment 5
ABOUT OMC Who we are now speaks to where we are going. What do we mean by this? Olympic Medical Center is a fairly unique health care organization, and this makes it challenging in a rigid health care environment. Our structure has been developed over time to meet the needs of our community. We offer a multitude of services – in a variety of locations convenient to our patients – which allows community members to obtain the services they need, right here at home. These services include: • A relatively large (67-bed) rural, acute care hospital, including a Level 3 Trauma Center and emergency department, and a busy labor and delivery unit. • Primary care, immediate care and pediatrics • Specialty care, including cancer care, cardiology, gastroenterology, general surgery, neurology, obstetrics and gynecology, orthopaedics, pulmonary medicine, sleep medicine and urology. • Outpatient services, including laboratory, diagnostic imaging, cardiopulmonary services and diagnostics, physical therapy and rehabilitation, nutrition and diabetes education, and home health. Olympic Medical Center is a Sole Community Hospital, Rural Referral Center and a safety net hospital. These designations acknowledge our organization as a large, rural hospital and health care center of the North Olympic Peninsula Community. Olympic Medical Center is the largest economic player in our regional with approximately 1,513 employees. The medical staff consists of approximately 190 active physicians and allied health providers. Olympic Medical Center’s payer mix is primarily government (as of 2018): 83% Government-paid insurance (Medicare, Medicaid and other programs) 16% Commercially paid insurance 1% Uninsured Olympic Medical Center also participates in a federal Health Resources and Services Administration program called the 340B Drug Pricing Program. This program enables entities such as ours to stretch scarce federal resources and purchase specified pharmaceuticals at a lower cost in outpatient centers – such as chemotherapy drugs at Olympic Medical Cancer Center. The savings retained by our organization through this program are then reinvested into offsetting charity care costs, as well as invested into desperately needed programs, such as the Birth Center and the Level 3 Trauma Center. Olympic Medical Center is not reimbursed like an urban medical facility, which have significantly more high-paying commercial patients and more economies of scale, nor is OMC reimbursed like a small, critical access hospital (25 beds or less), which is paid based on costs by Medicare and Medicaid in Washington. OMC must live within our reimbursement while doing our best to meet our community’s needs, which is a balancing act. The 2018 Centers for Medicare and Medicaid Services rule that significantly decreased Medicare reimbursement for off-site physician clinic services hit us particularly hard because we have a campus in Sequim – this affects us more than most hospitals in the U.S. Having clinics and outpatient services in Sequim is the right thing to do for our Sequim patients, and we will continue to look for ways to stay this course. This Strategic Plan addresses how we must transform to continue our success, and stay true to our community- oriented approach to health care. 6
DESCRIPTION OF Hospital, which allows for a higher Olympic Medical Center is the only Medicaid reimbursement for hospital on the North Olympic TERMS & ACRONYMS outpatient services. Peninsula with this level of trauma Sole Community Hospitals are service. A Rural Referral Center is a designated by the Centers for classification given to rural A safety net hospital is a term Medicare and Medicaid Services, hospitals that meet specific criteria. used for hospitals that deliver a and are therefore eligible for a Essentially, Olympic Medical Center significant level of health care small add-on payment from the is a referral center for patients services and support to the federal government. Olympic outside of its primary service area uninsured, under-insured, Medicaid Medical Center qualifies as a (Forks, the West End and East and other vulnerable populations. rural Sole Community Hospital Jefferson County, specifically). As a public hospital, Olympic specifically because it is rural, Medical Center provides care to and because of distance, posted As a state-designated Level 3 anyone, regardless of their ability speed limits, unpredictable weather Trauma Center, Olympic Medical to pay, and also offers a financial conditions, and the travel time Center provides 24-hour trauma assistance program and charity between the main hospital and the emergency, operative and critical care to those who qualify. In 2018, nearest like hospital is at least 45 care services for the community. Olympic Medical Center provided minutes. The State of Washington This includes prompt assessment, more than $5 million dollars of also recognizes Olympic Medical resuscitation, emergency surgery uncompensated care. Center as a rural Sole Community and stabilization of trauma victims. 7
QUALITY, SAFETY & EXPERIENCE OMC leads as a health care provider MEASURABLE Goal 4 Leverage evidence-based by adopting, meeting and exceeding best practices for areas of high national standards for superior, GOALS risk in health care: manage chronic evidence-based quality care, safety conditions such as diabetes Goal 1 Assure best practices and experience. We strive to be a and heart failure, ensure timely are followed for use of opioids, leader in national quality, safety and interventions for conditions such reduce reliance on opioids when experience initiatives and promote as sepsis and stroke, continue OB appropriate, provide effective pain a culture of safety and service that Safe Deliveries Roadmap, and focus management and expand options consistently meets the expectations on medication safety to include to safely address pain, and work and fulfills the needs of our patients, antimicrobial stewardship, and together to help prevent overdoses their families and our community in obtaining and maintaining the most and provide treatment pathways all services we offer. accurate patient medication list. for those with substance use Our Board of Commissioners is disorders. Goal 5 Refine patient access and responsible for the oversight of all Goal 2 Further cultivate the engagement experience to facilitate OMC quality, safety and patient culture of safety and quality prompt, satisfying, and convenient experience efforts. The Board of patient-centered care by facilitating care at OMP Specialty and Primary Commissioners completes Board efficient, reliable, and convenient Care Clinics by leveraging Epic Safety Rounding on a quarterly communication strategies and MyChart capabilities and other basis to inspire a culture that tools for clinical teams to provide enterprise communication and promotes excellence in quality and seamless care. process enhancements. safety, while raising the bar for patient experience. Goal 6 Develop plans to protect Goal 3 Enhance the patient reimbursement from Medicare on experience by strengthening Value Based Payments for hospital, employee-patient communication provider and home health services. and courtesy, decreasing wait times, implementing Age-Friendly Care and improving comfort to Goal 7 Reduce emergency provide the best possible, patient- department wait times, admission centered care experience across the times and “left without being seen” hospital, home health and clinics. to averages that are below state Improve comfort by instituting and national averages. measures to create a demonstrably quieter, more restful environment. OMC leads as a health care provider by adopting, meeting and exceeding national standards for superior, evidence-based quality care, safety and experience. 8
OMC & COMMUNITY RELATIONSHIPS By fostering and growing MEASURABLE Goal 2 Prepare annual goals and positive partnerships and strong operating plans for the Swedish relationships with our community, GOALS affiliation with specific focus on OMC can actively promote and cardiology and neurology service Goal 1 Develop outreach initiatives inform the community about lines, telehealth services, and to engage our community and available services and wellness, Epic electronic health records elected officials in support of while also listening for input and optimization and reporting. local health care to improve needs, and can more successfully patient access, maintain financial impact legislation and policy that Goal 3 Expand OMC’s wellness stability, and enhance patient affects the local health care delivery initiative by assessing expertise service. Continue development system. at OMC and locally; studying the of productive relationships with science of lifestyle medicine, OMC advocates for public health, key federal, state and local leaders researching best practices, promotes health and wellness to advocate effectively for the evaluating external speakers and through appropriate lifestyle protection of local health care. programs, and identifying staff choices, and provides education in Communicate with the public about and provider wellness champions. chronic disease management and the effects of actual and proposed Enhance OMC’s support of diabetes prevention. OMC also works with regulations, laws and budget and heart disease prevention and community partners to help support proposals, providing resources education, the YMCA partnership, community development through for participation in advocacy on 5-2-1-0 and other current programs promoting health care access, health care issues important to our with the goal of preventing or advocacy and disaster preparation. community. reversing chronic disease. The Employee and Provider Wellness Committees will gather and provide Pictured: Raymond Martinez, MS, exercise physiologist information on other health care and wellness program coordinator, Wellness Services. system employee and medical staff wellness programs as support for the future goals of commitment and action. Goal 4 Investigate options for new payment models that will reward better population health. 9
OMC & EMPLOYEE RELATIONSHIPS OMC actively promotes The OMC MEASURABLE Goal 4 Continue to build on OMC’s Way, an intentional culture of workforce development plan which excellence that inspires employees GOALS includes reducing use of travelers, to strive to embody our Mission, Goal 1 Launch a comprehensive locums and contract staff; Vision and Values. Through positive organizational development plan improving recruitment metrics in recognition and celebration, in 2020 that includes workforce key areas such as difficult-to-fill OMC perpetuates and reinforces development and career path positions as identified; augmenting principles of open communication, support, manager/leadership tools to attract and retain health teamwork and respect, while education and training, focused care personnel; and strengthening providing needed resources and operational efficiency, and ties with partners, such as tools for employee engagement and standardization of organizational Peninsula College, as well as other organizational development. OMC’s processes. programs and institutions to create strong commitment to our Mission training, scholarship and career is demonstrated daily by our pathways. employees’ dedication and service Goal 2 Based on the 2018 to our patients and the community. employee survey, and compared Goal 5 Evaluate OMC’s medical to a follow-up employee survey to As OMC’s workforce continues to plan for consideration of options be completed in 2020, measurably grow, our investment in recruitment that are less rigid, such as those improve employee engagement. and retention of skilled and talented that allow for more flexible use employees increases. OMC’s local of per diem staff, with the goal of Goal 3 Commit leadership efforts partnerships are vital to training identifying a plan that is equivalent and invest resources to continuing crucial health care personnel. Our or better in cost and benefits to the intentional culture initiative, collaboration with community employee and dependents; that summarized by The OMC Way in partners has ignited opportunities promotes wellness programming; alignment with Mission and Values, for workforce development and and will encourage utilization of including leadership rounding on economic invigoration. By offering local delivery system of providers. departments, enhancing internal excellent benefits, market wages, leadership communications, career pathways and engaging and celebrating and supporting communications, OMC empowers employee recognition and employees to succeed and prosper development. while strengthening the vitality of our region. OMC actively promotes The OMC Way, an intentional culture of excellence that inspires employees to strive to embody our Mission, Vision and Values. 10
OMC & MEDICAL STAFF RELATIONSHIPS OMC collaborates with medical MEASURABLE Goal 3 Work collaboratively with staff to ensure the highest North Olympic Healthcare Network, quality of health care delivery GOALS Jamestown Family Health Clinic, for our community. Maintaining Goal 1 Continue, pursue and and other organizations to secure and enhancing medical staff implement appropriate affiliation primary care access for community relationships is of the utmost options, including via telemedicine, members without a current medical importance as OMC works to with a focus on specialty services, home in OMC’s service area. increase local access to health care. including cardiology, neurology, The need for primary and specialty oncology, endocrinology, medical care close to home for our Goal 4 Improve provider rheumatology and behavioral satisfaction and decrease burnout patients and families drives OMC’s health. focus on medical staff recruitment, by supporting initiatives to reduce retention and resiliency as top administrative burdens that Goal 2 Continue to ensure obstruct the ability to provide priorities. Effectively resourcing patient access to high-quality optimal patient care. recruitment and retention of medical specialist care through the Provider practitioners, committing ourselves Recruitment and Retention Plan. to partnerships and working to In 2019-20, recruitment efforts meet medical staff needs is key to a will include hospital medicine, strong health care delivery system. family medicine, cardiology, OMC supports medical staff urology, oncology, psychiatry, through investment in telemedicine, gastroenterology, ENT, pain providing access to programs and management and other approved resources that further enhance specialties as needed. patient care and creating a strong clinical infrastructure that enhances providers’ ability to care for their Pictured: Colin Wolslegel, DO, gastroenterologist, and patients. Elsie Eaton, NCMA, medical assistant, OMP Specialty Clinic. OMC will continue to prioritize the Rural Family Medicine Residency Program in partnership with North Olympic Healthcare Network, Swedish and OMC Medical Staff. In addition, OMC will work with the Medical Staff on other medical education opportunities. 11
FACILITIES, TECHNOLOGY & SERVICES OMC helps to meet the health MEASURABLE Goal 3 Continue advance care care needs of the community by planning services and implement providing patient-centered facilities GOALS palliative care programs with and advanced medical equipment. inpatient hospice beds and hospice Goal 1 Update Sequim campus New services are developed services by the end of 2020. master plan with incremental based on community needs and growth strategy, beginning with OMC’s capabilities. OMC invests Goal 4 Partner with Jamestown completion of the Olympic Medical approximately $4 million annually S’Klallam Tribe to evaluate the Cancer Center expansion in early in new medical equipment. A safe feasibility of a 16-bed behavioral 2020, and consider, based on environment is a top priority as health evaluation and treatment financial viability, construction facilities are updated and expanded. facility in Sequim. Increase projects for an outpatient surgery behavioral health treatment options OMC will continue to invest in center and medical office space. throughout the community through and improve our Epic electronic For the Port Angeles campus, collaborative work with local community health record for which complete Central Sterile Processing partners and expansion of OMC we contract from Providence expansion in early 2020 and services. Community Technologies. This is a complete an inpatient bed redesign, key tool for helping our teams care surgical services expansion Goal 5 Develop and implement for our patients. and remodeling, and campus strategic goals to be completed by development including a new the end of 2020 for the following The communities that we service helipad and additional parking by service lines: Olympic Medical have significant unmet behavioral the end of 2022. Physicians, Cancer Center, Heart health needs and we plan to expand Center, Diagnostic Imaging, our services in these areas. There Goal 2 Transform operations Nutrition Services and Home is a shortage of mental health to improve patient experience Health. services, particularly for inpatient and improve financial viability of services. In addition, as our services across the organization. community ages, OMC will enhance Areas of focus will include access to geriatric services to meet emergency/immediate care growing needs. OMC’s patients will also benefit from an increased services, inpatient services, surgical OMC helps to services, primary care services and focus on advance care planning, physical therapy services. For each meet the health palliative care and hospice services, focus service, improve two major particularly inpatient hospice processes or more by standardizing care needs of beds. Due to patient needs and and eliminating waste, measuring the community reimbursement reductions, OMC and improving patient experience, must transform our services in and improving revenues or/and by providing order to remain viable and continue to improve each year. Each service reducing costs per day/visit by at patient-centered least 5%. must improve around access, facilities and quality measures and cost control. advanced medical equipment. 12
FINANCIAL STEWARDSHIP A key strategic direction is to MEASURABLE Goal 3 Increase productivity by maintain a financially strong 2% in 2020 and 2021 by improving locally owned and controlled GOALS processes, growing volumes to public hospital so we can meet the meet community needs, managing Goal 1 Achieve budgeted net needs of the community now and expenses and reducing waste. income annually with a goal of into the future. Local ownership Achieve employee compensation earning 2% or more over a rolling allows key decisions and strategic as a percentage of net revenue of five-year period in order to fund directions for OMC to be made by 61% or less in order to maintain capital investments, start new publicly elected Clallam County financial viability. services and pay principal on long- residents in public meetings. OMC term debt. is a non-profit, governmental entity but we must maintain at least a 2% Goal 2 Maintain a strong balance margin over time in order to invest sheet including increasing days in in facilities and equipment, invest cash to 90 or more by December in new and expanded services, and 31, 2020, maintaining debt to make principal payments on our equity below 33% and continuing long-term debt. to maintain 39 days or less in Regulatory compliance is a major accounts receivable. priority for OMC. We established the Security, Privacy and Compliance Committee to focus on this. The Pictured: Chad Morgan, CNMT, nuclear medicine technologist, Olympic Medical Center. Committee completes an annual risk analysis and an annual work plan as well as reports at least quarterly to the Board of Commissioners on regulatory compliance matters. OMC uses a corporate calendar, management training and standardized organizational processes to help drive operational efficiencies. We continually focus on improving processes and eliminating waste in order to maintain financial stewardship. 13
ACCREDITATIONS & AFFILIATIONS INFECTION PREVENTION Olympic Medical Center has received ISO 9001:2015 certification through its accrediting body, DNV GL Healthcare. By demonstrating compliance By developing evidence-based safe ISO 9001 is the most widely-accepted with national standards for practices to keep patients safe from quality management system in use health care quality and safety, Olympic harm, Olympic Medical Center has around the world, and is quickly gaining Medical Center has earned DNV GL earned DNV GL Healthcare certification acceptance among US health care Healthcare accreditation. in Infection Prevention. providers as a foundation for their quality and patient safety programs. The Chartis Center for Rural Health recognized OMC as a ABILITY® Network announced Olympic Medical Home 2019 Top 100 Hospital among all rural and community Health as a Top Agency of the 2018 HomeCare Elite, a hospitals nationwide according to the iVantage Health recognition of the top-performing home health agencies Analytics index. The index measures facilities across eight in the United States. Winners are ranked by an analysis pillars considered as hospital strength: inpatient share ranking, of quality outcomes, best practice implementation, outpatient share ranking, cost, charge, quality, outcomes, patient experience, quality improvement and patient perspective and financial stability. consistency, and financial performance. Level III Trauma Center as designated by: Notice of non-discrimination: www.olympicmedical.org/non-discrimination 14
Pictured: Amy Miller, PA-C, pediatrics, OMP Peninsula Children’s Clinic.
Pictured: David Turner, RPSGT, Neurophysiology Technologist, Olympic Medical Sleep Center. QUALITY SAFETY TEAMWORK COMPASSION RESPECT Pictured: Robert Henson II, MD, cardiologist, OMP Specialty Clinic. INTEGRITY STEWARDSHIP OMC24939 7-19 Pictured: Sherry Xiong, MS, clinical exercise specialist, Olympic Medical Heart Center. 939 Caroline Street | Port Angeles, WA 98362 | OlympicMedical.org
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