Ok­la­homa health cen­ters plan to make cuts after los­ing fund to care for the unin­sured

The Oklahoman (Sunday) - - NEWS - BY MEG WINGERTER Staff Writer mwingerter@ok­la­homan.com

Su­san Sav­age knows some ways to re­duce the odds Ok­la­homans will end up in the hos­pi­tal for pre­ventable con­di­tions.

Care co­or­di­na­tors who could help patients with their so­cioe­co­nomic needs could go a long way, said Sav­age, CEO of Mor­ton Com­pre­hen­sive Health Ser­vices in Tulsa. So would of­fer­ing med­i­ca­tion-as­sisted treat­ment to peo­ple suf­fer­ing from opi­oid ad­dic­tion, she said.

But ef­forts to of­fer those ser­vices have stalled as health cen­ters have to cope with un­cer­tainty about their fund­ing and cuts that seem to come from all di­rec­tions, Sav­age said.

“If you fail to in­vest in the in­fra­struc­ture, what­ever your goal is, you’re not go­ing to be suc­cess­ful,” she said.

The Ok­la­homa State Depart­ment of Health on Wed­nes­day of­fi­cially will elim­i­nate the un­com­pen­sated care fund for fed­er­ally qual­i­fied health cen­ters like Mor­ton. Health cen­ters can ap­ply to the un­com­pen­sated care fund only after they’ve tapped all their other op­tions, in­clud­ing grants and do­na­tions, said Cas­sidy Heit, pub­lic pol­icy and com­mu­ni­ca­tions as­so­ciate at the Ok­la­homa Pri­mary Care As­so­ci­a­tion. At times, cen­ters have got­ten enough to cover all of their un­com­pen­sated care, but this fis­cal year the fund only had enough for about half of their costs, she said. The fund peaked at about $3.9 mil­lion in 2009 and has fallen since.

The move isn’t en­tirely un­ex­pected, after the state re­duced the fund in prior dif­fi­cult bud­get years. Brooke Lat­ti­more, chief oper­a­tions of­fi­cer of the Health and Well­ness Cen­ter, which has seven clinics, said the clinics don't have large num­bers of unin­sured patients, and fig­ured they wouldn't re­ceive the pay­ments when the health depart­ment ran into fi­nan­cial prob­lems.

“There were cer­tain months that we would ap­ply for it and not re­ceive it,” she said. “They would put that money in the bud­get, and that was one of the first things that they would take away.”

The health depart­ment faces a $30 mil­lion short­fall after al­legedly us­ing “ac­count­ing tricks” to con­ceal over­spend­ing for years, ac­cord­ing to in­terim Health Com­mis­sioner Pre­ston Do­er­flinger. Other mea­sures to ad­dress the short­fall in­clude cut­ting con­tracts for child abuse pre­ven­tion, re­quir­ing many em­ploy­ees to take fur­lough days and plan­ning lay­offs. It hasn’t re­leased how the ap­prox­i­mately $1.2 mil­lion in the un­com­pen­sated care fund will be redi­rected.

Lou Carmichael, CEO of Va­ri­ety Care, which has 17 clinics in cen­tral Ok­la­homa, said it may have to re­duce den­tal ser­vices and cut clinic hours. Health cen­ters can’t turn away unin­sured patients if they have ap­point­ments avail­able, so cuts ul­ti­mately will af­fect ev­ery­one who gets care from the cen­ters, she said.

“The sys­tem is not just doors (for patients) that have no re­la­tion to each other,” she said.

Carmichael said she isn’t sure how deeply Va­ri­ety Care will have to cut, but even a rel­a­tively small re­duc­tion could mean more peo­ple in the emer­gency room or go­ing with­out needed health care. The tim­ing is par­tic­u­larly bad be­cause flu sea­son is ramp­ing up, she said.

“Pri­mary care is the thing that can re­duce health care costs, and it’s the one thing the state seems hell­bent on cut­ting,” she said.

Health cen­ters are fac­ing chal­lenges on mul­ti­ple fronts be­cause Congress hasn’t re­newed fed­eral health cen­ter grants, which ex­pired in Septem­ber, Heit said. Some cen­ters have re­ported providers they had re­cruited de­cided to take other jobs, that they couldn’t get lines of credit or that they put off fa­cil­ity im­prove­ments be­cause ad­min­is­tra­tors lack clar­ity about the fi­nan­cial fu­ture of the cen­ters, she said.

“This is just con­tribut­ing to this whirl­wind of un­cer­tainty,” she said.

The Tulsa health cen­ter also is tak­ing hits on mul­ti­ple fronts as state agen­cies are forced to cut men­tal health care and ser­vices for older peo­ple who want to stay in their homes, Sav­age said. The com­bined cuts will in­crease pres­sure on health cen­ters and emer­gency rooms, and push peo­ple to de­lay care they need, she said.

“It’s just un­be­liev­able to me what the state agen­cies have had to do in this cli­mate,” she said. “These are cuts to peo­ple’s ac­cess to ser­vices.”

“I think we’ve lost that un­der­stand­ing some­where on the way.”

Pri­mary care is the thing that can re­duce health care costs, and it’s the one thing the state seems hell­bent on cut­ting.” Lou Carmichael, CEO of Va­ri­ety Care

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