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How to destroy a health-care program when it’s needed the most

Submitted by on Tuesday, 7 April 2009 One Comment

If a tree falls in a dead-red county and takes out a health-care program that sees almost a quarter million visits a year, would anyone hear it?  Would anyone notice before hospital emergency rooms become clogged with even more people who have no where else to turn?

Would Washington notice if a federal bureaucrat several layers deep in a department that’s been leaderless for months kills what should be an example of collaboration to provide primary care that other governments might want to consider in this day of soaring health costs and tightening budgets?

Residents in the Stanislaus County, in California’s Central Valley, won’t have to find out for at least a year what happens if the county’s family-practice residency program goes kaput. The county Board of Supervisors reluctantly voted last week to fund the program through June 2010 to the tune of $11 million.

Reluctantly, not because officials don’t believe in the program, but because the county already was facing a $35 million budget shortfall. “This really couldn’t have happened at a worse time,” county spokesman David T. Jones said.

Even the feds have no quibbles with the quality of the residency program, whose doctors have a 100-percent first-time pass rate on board exams, Jones said. About half of the graduates remain in the Central Valley area where they’re trained and 75 percent stay in California.

Let’s see: We have a program that trains family doctors in an under-served area where the unemployment rate already is 16 percent overall – Jones estimated that the rate in some neighborhoods is 40 percent. The doctors serve thousands of patients a year, keeping them away from expensive emergency care.

And the feds want to kill it.

Only $1.5 million of the funding will go to pay for the residency program, which trains 27 doctors a year and keeps the 30 physicians who serve as its faculty in the county. The rest will be forwarded to the federal Centers for Medicare and Medicaid Services.

That’s the federal agency that had funded the latest incarnation of the residency since 1997. The county closed its hospital at that time and contracted with a local hospital to handle in-patient care. The county would continue to operate its clinics, and the county and the hospital would go halvsies on the residency.

The feds had no problem with that arrangement until 2006, when officials began to question the transition to the private-public partnership.

Oops. You can’t do that, they ruled last summer. Your program officially does not exist. Give us back the money we’ve paid over 11 years.

OK, so show us in the regulations how we should have done it, Jones said county officials asked.

“You’re not going to find it in the regs,” Jones said officials were told. “This is all in my mind. But no where is it inconsistent with the regs.”

The county spent last summer trying to come up with a new program and went back to the feds in the fall with a plan that incorporated two additional hospitals. “They basically said, ‘Thanks for playing, but we’re saying no’,” Jones said.

The one option the county was given was to close the existing program for a year, get rid of all the current residents, fire all the faculty and start over. Except Jones says it would take several years to find new faculty and get the program running again.

The county plans to take another run at the feds as soon as a health secretary is in place. The head of the Centers for Medicare and Medicaid Services also is a political appointee, and that position has been vacant for some time, Jones said.

“We are wondering if it’s going to take intervention on the highest levels to solve this,” Jones said.

Copyright 2009 Debra Legg. All rights reserved.

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