Marin health clinics suffer funding hit
Shelter order keeps patients away from centers for needy, uninsured
Marin’s four federally qualified medical centers ceased seeing most patients in their examination rooms when the Bay Area’s stay-home order was issued and are trying to subsist on reimbursements from telemedicine.
The centers — Marin Community Clinics, Ritter Center, the Marin City Health and Wellness Center and Coastal Health Alliance
— provide care to Marin’s low-income and uninsured patients. Federally qualified medical centers are eligible for enhanced reimbursement from Medicare and Medicaid, as well as other benefits.
“In the short run, our whole operation is being disrupted by this because 90% of our reimbursement comes from seeing patients and billing governmental and private insurance,” said Dr. Mitesh Popat, executive director of Marin Community
Clinics.
“Mostly everything has been converted to telephone visits to the extent we can provide them,” Popat said.
It is difficult, however, to provide dental care over the phone. Marin Community Clinics has suspended all elective dental care and is only providing patients with emergency needs. The same is true at Coastal Health Alliance, which provides medical care for about 5,000 West Marin residents.
“Losing dental is a big deal because it is a big part of our encounters. American health care is an encounter-based system,” said Steven Siegel, Coastal Health’s CEO. “You get paid for the people you see. We are taking a financial hit.”
Mark Shotwell, executive director of Ritter Center, which provides medical care and other services to much of Marin’s homeless population, said,
“We’ve seen a 50% drop in the number of patient visits since the crisis started. That’s a bad thing for the quality of health care and that is also a bad thing for the organization’s revenue.”
Shotwell said revenue from provider visits is used to pay the salaries of case managers, patient navigators, peer support staff and health educators.
“It takes that whole village of health care workers to effectively work with people,” he said.
Brenda Crawford, CEO of the Marin City Health and Wellness Center, said, “Our biggest challenge is trying to operate with the decrease in revenue while trying to make sure our patients’ needs are met under these extraordinary circumstances. We have had to lay some folks off and eliminate some positions.”
The federal Health Resources and Services Administration (HRSA) has
provided about $13.8 million in coronavirus emergency funding to California’s 178 federally qualified health centers, or FQHCs. Marin Community Clinics received about $91,000 and Marin’s other three clinics, which serve fewer patients, received about $50,000 each.
“Which is a drop in the bucket,” Crawford said. “HRSA knows that.”
The $2.2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law by President Trump on March 27, provides $100 billion for hospitals and health care providers. Of that amount, $1.32 billion is earmarked for FQHCs. Community health centers were seeking $3 billion.
“There is definitely a shortfall,” Popat said.
Shotwell said Ritter Center receives a yearly $1 million grant from HRSA and some county funding for homeless services but relies
on revenue from medical provider billing to Medi-Cal and Medicare for most of its $6.5 million annual budget.
Both Ritter Center and the Marin City center are applying for small business loans under the CARES Act paycheck protection program. Shotwell said the program could keep some of the smaller FQHCs from falling off a fiscal cliff.
“As long as we keep everyone on payroll that we have on now, those loans will be forgivable; we won’t have to pay them back,” Shotwell said. “That’s huge.”
Crawford said the Marin City center plans to apply for a Small Business Administration loan.
Popat said Marin Community Clinics might not be eligible for the program because it has more than 500 employees.
Another challenge is a shortage of safety gear.
“We are looking high
and low for that,” Crawford said. “We’re even going on to Amazon looking for some things.”
Popat said, “We’re OK for the moment but we’re concerned about where the next supply is going to come from. There is some supply coming in from China but it’s questionable whether it is of good quality.”
He said some of the safety gear from China has turned out to be counterfeit.
Siegel said Coastal Health Alliance has an adequate supply of protective gear for the moment. As of last week, he said, no one in West Marin had tested positive for the coronavirus.
Siegel said the clinic has an emergency supply of N-95 masks that have been in its storage shed for years. He did not know how many masks.
“They were here when I got here seven years ago,” he said.