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1. If we are moving clinical
services off Scenic, where are the services going?
HSA and CEO senior staff our currently evaluating available square footage,
remodeling costs and appropriate locations. We will return to the Board
of Supervisors at a future dates with detailed relocation and phasing
plan. It is anticipated at this point that all clinical services will
be relocated off of the Scenic campus by the end of this fiscal year.
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2. What will
happen to H.S.A. Administration, Public Health and BHRS when clinics move
off the Scenic campus?
These services will also be relocated over time when replacement facilities
are available.
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3. What happens to the
profits when Scenic campus is sold?
The revenue generated from the sale will fund the replacement and relocation
of BHRS, Public Health, and other administrative and county services currently
on this property.
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4. What about
abatement costs on the Scenic campus?
In 1998, an estimate to abate asbestos and lead from the property was
$5 million, an amount that has likely gone up. But, the value of our property
has also increased substantially. It is not thought that the abatement
costs would be a deal breaker; they would be addressed through the RFP
and purchase negotiations.
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5. How will core
Public Health services be impacted and maintained? How will the mandates
and mission of Public Health be protected in this process?
Our Public Health mandate and mission is not changed as a result of these
recommendations, nor is the county commitment to those mandates. Although
the Public Health division is interconnected with clinic system. Public
Health division is interconnected with the Clinic system, Public Health
services will continue to meet its obligation to assess and assure specific
health services.
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6. Will there
be staff reductions?
There will undoubtedly will be a need for fewer staff should the Board
of Supervisor eventually adopt all of the recommendations contained in
the report. Some staffing reductions may be accommodated through normal
attrition and through the use of fewer part-time and temporary help. It
is our goal to place the remaining affected employees in other County
jobs wherever possible.
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7.
Will support services such as housekeeping, billing and purchasing be
contracted out?
In the private sector, clinics generally do not hire in house or employed
and benefited staff for many support services such as housekeeping, billing
and purchasing services. One could argue that contracted staff would not
be as committed or do as good a job as our current staff. There are also
legal issues involved with contracting out services.
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8. How are
you going to reduce patient volume?
There are numerous ways to impact volume, by payer, by site, by provider.
We will be evaluating all those mechanisms in the coming months. We will
carefully examine the need to close to new patients as well as eliminate
or reduce contractual obligations. We will meet our obligations to patients
in the current course of treatment. We will always remain open to serve
our mandated population of the Medically Indigent.
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9. What about
our Medi-Cal patients – what will happen to them? Where will the
go for services?
Some Medi-Cal patients may be impacted by these changes. They can receive
care from other Medi-Cal providers in the community as well as Federally
Qualified and Rural Health Centers.
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10. Why are the
cash payment (previously referred to as a “Cash discount) and the
cash deposit going up?
These charges are for private pay patients, not Medi-Cal, MediCare, or
Medically Indigent. As there is no legal obligation to serve this population,
these persons will need to cover the cost of their care. Even when these
charges were established in 2001, they did not cover our costs. The new
charges should cover our costs for most services.
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11. What about patients
who cannot pay the deposit? Where will they go for services?
The alternatives for this population are to seek care at Federally Qualified
Health Centers, such as Golden Valley Health Center, at Rural Health Centers,
such as Oakdale and Riverbank Community Clinics, and the County-owned
Hughson Medical Office where services are available on a sliding scale.
They may make arrangements for care with private physicians in the community.
Sadly, some may defer care. They may also seek an inappropriate and expensive
level of care in local emergency rooms.
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12. What about IHCP –
Medically Indigent Adults, our mandated patients under Welfare and Institution
Code Section 17000?
Our obligation doesn’t go away as a result of these changes. By
law, we need to provide or arrange care for this patient population.
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13. There is a ¼
cent tax for the library – can we pursue this for health care?
It would have to be passed by a 2/3rd’s majority during an election,
and it is unclear if such a measure would be successful.
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14. Can the Agency
integrate a business for profit model and be run more like the private
sector?
We have sought to run our clinics like a business, but a private business
would be unlikely to serve this population. Otherwise there would be numerous
private clinics serving Medi-Cal and the uninsured competing for this
population. A private clinic it wouldn’t turn a profit unless it
altered the payer mix (increased commercial insurance and reduced or eliminated
Medi-Cal) and substantially reduced salaries and benefits for employees.
The private medical community may perceive that we are competing against
them when we accept commercial insurance instead of Medi-Cal.
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15. Will the county
reduce their administrative cap charges?
The County will always need to provide certain administrative services.
However, the methodology and level of the charges is being examined. Also,
we are seeking to eliminate any duplicate services.
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16. Are there other FQHC’s
in Stanislaus County?
Golden Valley Health Centers (GVHC) is based in Merced County and has
added other clinics by expansion, including sites in Stanislaus County.
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17. What input
would Golden Valley Health Centers (GVHC) have on our request for FQHC
status? Can GVHC make it hard for us to get a FQHC designation?
Federal law delegates to the State the power to review and comment on
applications. In California, the State has designated the California Primary
Care Association (CPCA), which represents all non-county FQHC clinics.
When we submit our application for FQHC Look-Alike status, CPCA will consult
with the local FQHC-GVHC. It is likely that GVHC will be asked for their
assessment.
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18. Why doesn’t
the County contract with Golden Valley to provide our clinic services?
There have been discussions with GVHC over the past several months. However,
There are several significant challenges that would need to be addressed,
including:
- A long term commitment to providing health care to this population
at these sites
- Labor Issues
- Conformance with the Ommibus Agreement with Doctors Medical Center
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19. If we can get Certified
Public Expenditures (CPE), do we need to proceed with pursuing FQHC status?
We will continue to evaluate this issue. Since the financial benefit
is largely the same, it may be preferable to seek and obtain CPE and forego
the FQHC Look-Alike designation. With CPE, we would not have to make any
changes to our governance structure, required under FQHC. However, the
CPE mechanism is subject to change in federal law and subject to federal
budget appropriations.
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20. Does it make sense
to open a new hospital?
The old hospital on Scenic would not work as a hospital; it would never
meet the current standards for licensing. There are no funds to pay for
new facility, and hospitals are an extremely high cost facility to build.
For example, Kaiser is building their facility for $300 per sq. ft. Most
California hospitals, public and private, are losing money.
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21. An $8.7 million
deficit represents just over 1% of the County’s total annual budget-
why can’t the County find the funding to address this need?
Only $80.27 million of the County’s $797 million in revenue is
available for funding programs at the Board of Supervisors’ discretion.
Of this $80.27 million, close to $50 million of it is used to support
Public Safety programs, leaving only $30 million to support the remaining
programs, many of which have some level of mandate (i.e. Animal Services,
Assessor, Auditor-Controller, CEO, Elections, Office of Emergency Services,
Parks and Recreation, Purchasing, Risk Management, Tax Collector…)
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22. If patient
visits are reduced to 1997 levels, who will be affected and where will
they go for care?
First, we will always remain open to serve our mandated population of
Medically Indigent. With the increase in the cash payment and cash deposit,
we anticipate that there will be fewer private pay patients, utilizing
our services. Many Medi-Cal and MediCare patients may seek care at Federally
Qualified Health Centers, such as Golden Valley Health Center, or at Rural
health Centers such as the Oakdale and Riverbank Community clinics and
the County-owned Hughson Medical Office.
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