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