Posted on Mon, Oct. 15, 2007

Stanislaus County is making another round of cuts and changes to reduce the red ink at its health clinics. Several of the changes require a public hearing, which will be conducted Tuesday as part of the Board of Supervisors regular meeting.

The most dramatic impact will be on about 175 residents who will no longer qualify as medically indigent adults. This is a narrowly defined group -- not a generic label for poor people -- and the only group for which state law holds the county directly responsible for their health care.

In any year, about 6,000 Stanislaus County residents meet the medical indigent adult criteria. The county proposes lowering the income threshold for eligibility. Currently, those whose income is 250 percent of the federal poverty level are eligible. With the change, the limit will drop to 200 percent the federal poverty level -- the same as most other counties.

Medically indigent adults make up about 10 percent of the patients who use the county's seven health clinics. Most other patients are covered by Medi-Cal or Medicare, but the clinics also see the uninsured and some with commercial or private insurance.

Over the last several years, the county has faced increasing losses with its health clinics. That's why the county consolidated some services last year. But losses continued to grow, reaching $1 million a month earlier this year.

Two things are providing relief:

• Last month, the county received official notice that it qualified as a Federally Qualified Health Center Look-Alike, a federal designation that means the county will receive higher reimbursements for the treatment of Medi-Cal and Medicare patients. The Medicare rate will rise from $48 per patient visit to $115; reimbursements for Medi-Cal will go from $55 to $140. That will increase revenue about $6.4 million for the rest of 2007-08.

• A consultant and county staff identified about 50 ways to save money. The county implemented 21, with potential savings of about $6 million. Many involve staffing and paperwork efficiencies. The suggested changes will cut about 37 jobs, of which only 19 are filled. Mary Ann Lee, managing director of the Health Services Agency, said about nine employees will be able to move to other county jobs.

No one wants to see people lose medical coverage or jobs, but the county has to make adjustments to keep its Health Services Agency afloat. That's important to all residents for two reasons: First, the county clinics are a key part of the health care safety net, along with Golden Valley Health Centers and several rural health clinics. Without them, the hospital emergency departments would be even more crowded than they are today.

Second, the county general fund subsidizes the health clinics. Even with higher reimbursements and those efficiencies, the general fund will be tapped for about $4 million this year. That's the same fund that finances the sheriff's department, district attorney's office, parks and other services.

With the changes the county has made in the last several years and the higher reimbursements, it might seem that Stanislaus County's health problems should be resolved. Far from it. One of the most acute problems hasn't even been addressed -- the shortage of specialists.

We support the service reductions at county clinics only as a form of triage. This broken system can't and won't be cured at the local level. It is a national problem; a national solution must be found.

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Proposals

• Reducing hours at Scenic Drive urgent care center from 84 to 36 a week. Instead of being open 12 hours daily, it would operate from 5 to 9 p.m. weekdays, noon to 8 p.m. weekends. Sounds drastic, but county clinics-medical offices are going to same-day appointments, so many patients will be able to get an appointment. Depending on season, the urgent care center has been seeing from 19 to 144 patients per day. Reducing hours will funnel more patients into less time, increasing efficiency. Center would go from two physicians on duty to a physician and an assistant, reducing costs.

• Eliminating clinical lab and radiology services. The county will send these patients to commercially operated labs. The county is already contracting for some of these services. Potential savings: $500,000 to $1 million.

• Lowering income cutoff point to qualify as medically indigent adults. Currently, those whose income is 250 percent of federal poverty level are eligible; limit will drop to 200 percent. About 175 people will become uninsured.

• The public hearing is part of the 6:30 p.m. meeting Tuesday in the basement of Tenth Street Place in Modesto. Board of Supervisors meetings are televised on Comcast Channel 7 and Charter Channel 19.