Why Stanislaus County is weighing its future in offering health care services

A severe water leak damaged one-fourth of the Health Services Agency building on Scenic Drive in Modesto, Calif., on June 14, 2016. The county closed the building Monday and temporarily moved clinical services and 100 staff members to other locations.
A severe water leak damaged one-fourth of the Health Services Agency building on Scenic Drive in Modesto, Calif., on June 14, 2016. The county closed the building Monday and temporarily moved clinical services and 100 staff members to other locations.

Stanislaus County could end its long history of providing direct health care services for the poor.

Tuesday, county supervisors will consider exploring options for ending the county’s role as a provider of clinical services for some of the poorest county residents.

The county closed its hospital on Scenic Drive in 1997, but the Health Services Agency has continued operating primary care, specialty and physical rehabilitation clinics. Those health centers today are seeing a declining number of patients, top officials said.

The county has three health clinics and a specialty care center in Modesto, and clinics in Ceres, Hughson and Turlock. Leaders could explore arrangements with outside organizations for taking over care of those patients and possibly expanding access to clinical services for low-income residents.

Any proposals that emerge in the next several months are certain to shake up patients, doctors and employees who work in clinical services for the Health Services Agency.

According to a county report, the number of patients served at the primary care clinics has fallen from 47,119 in 2012 to 30,837 last year. Over the same period, the cost of serving patients has risen from $591 per person to more than $900 per patient. The clinics are operated at a loss, requiring a $3.1 million annual infusion from the county general fund, and that support is likely to increase as the county’s overhead costs go up, the report says.

The decline in county patients runs contrary to the surge of adults – about 65,000 in Stanislaus County– who enrolled in Medi-Cal through the expansion of Medicaid eligibility under the Affordable Care Act.

Mary Ann Lee, county health services director, said the county clinics serve fewer patients because of a shortage of primary care providers in the region. In other words, there are fewer doctors and mid-level providers available for patients who try to make appointments at county clinics.

The county had 40 full-time equivalent providers for the primary care clinics in 2006 but had only 29 in 2017. “There is a lot of need for primary care providers in the whole community,” Lee said. “So we have had a difficult time with recruitment and retention.”

The county has mentioned possible arrangements with other safety-net providers, which have grown recently, in particular, Golden Valley Health Centers and Livingston Community Health Centers. Livingston moved into Stanislaus County with new clinics in Waterford and Patterson, while Golden Valley has primary care health centers in Merced and Stanislaus counties.

Lee said it’s premature to tell how an agreement with an outside organization would work. She could not say whether an outside entity would operate the county clinics, whether all of the clinics would stay open or if employees in the clinics would keep working for the Health Services Agency.

If county leaders give the green light Tuesday evening, the Health Services Agency would seek proposals from organizations interested in taking over clinical services from the county.

“We will have to wait and see what proposals come in,” Lee said. “Our patients are important to us and we have responsibilities to continue to provide for them. We are going through a process with regard to continued access in our community. Our concerns is that we continue to care for our patients.”

Leslie Cook, a Hughson resident and long-term patient, said she would be afraid of losing a health care provider at the Hughson clinic who understands her medical needs.

“Every time I start with a new doctor they want to re-diagnose me,” said Cook, who has a lung condition and bulging discs in her spine. “I don’t have any knowledge of Golden Valley. My uncle uses them and he complains about them all the time.”

A Golden Valley spokesperson said the Merced-based organization could not comment on any interest in working with the county. Golden Valley representatives plan to attend Tuesday’s meeting to glean more information.

The idea of the county taking a limited role in health care services, or getting out entirely, arose from a visioning and planning process that began after a plumbing failure flooded the former county hospital facilities on Scenic Drive in 2016, temporarily shutting down operations and causing some health services offices to move.

The county hired Pacific Health Consulting Group to review the county’s array of health services and future facility needs of the Health Services Agency. The agency has about 500 employees, with about 150 full- and part-time positions in the clinical services division

The consultants suggested that health clinic services be turned over to other nonprofits and that the Health Services Agency focus more attention on state-mandated public health responsibilities.

The report for Tuesday’s meeting recommends the county continue with support for the residency programs overseen by the Valley Consortium for Medical Education and seek additional partners for the family medicine and orthopedic residencies.

The report suggests that health service offices move out of the old county facilities on Scenic Drive and relocate to County Center III off Oakdale Road, near the coroner’s office.

Dr. Kathleen Kearns, program director of the family medicine residency, which has 36 doctors-in-training in the county clinics and Doctors Medical Center, said she will meet with the residents to answer any questions they have, though she may not have all the answers.

If county leaders seek proposals from outside health care providers, “my guess would be (the residents) will be working in the same clinics but perhaps those facilities would be under different ownership and operation,” Kearns said.

The county Board of Supervisors will meet at 6:30 p.m. Tuesday, in the basement chambers of Tenth Street Place, at 1010 10th St., downtown Modesto.