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More cuts at county clinic

Stanislaus County supervisors Tuesday night approved another round of health services cuts that they said were needed to save a deficit-ridden clinic system.

The board vote was 4-0, with Supervisor Jeff Grover absent. The service reductions will begin in early December.

Despite cost-saving measures that began two years ago, the Health Services Agency is facing a $16.6 million deficit for 2007-08.

Tuesday night, urgent care, clinical laboratory and radiology services were on the chopping block. Dozens of county patients and county health care workers attended a public hearing as speakers urged the board to reconsider the cost- saving initiatives.

Bob Hagopian, who was treated for colon cancer at the clinics, said the clinical lab, in the former county hospital on Scenic Drive, is essential to patients in chemotherapy. Patients have blood tests done in preparation for the treatments at the clinic.

"It is critical that it is done," the Modesto resident said. "It has to be done the day before you have chemo."

Another speaker doubted cancer patients will get a timely turnaround on blood tests if they have to ride a bus to a commercial lab.

The county laboratory serves about 26,000 people a year, processing tests for clinic patients, veterans, jail inmates and other health agencies. County lab workers said it could save money if the flow of work were redesigned.

Without cuts, facing no health program

Frank Johnson, speaking from a motorized wheelchair, said people with no insurance receive attentive care at the county clinics. "Going to another lab, I don't think they will be treated with the same respect as they get at these clinics," he said.

At the close of the hearing, Supervisor Dick Monteith said the county had to take action to address the annual deficits in the agency. "If we don't address it, we are going to be faced with not having any health program," he said.

Board Chairman Bill O'Brien told county staff to require expedited test results for cancer patients when it contracts with a lab vendor. The Health Services Agency will contract with an outside lab to serve uninsured adults. Medi-Cal patients and others will have to find a lab on their own.

Steve Russo, a health care consultant advising the county, recommended closing the county's clinical lab, because there are a dozen commercial vendors providing lab services in the county. According to Health Service Agency staff, the agency lost $872,000 on lab services last year.

The county will close almost all of the agency's in-house radiology department. The agency says it lost $664,000 on radiology services in 2006-07, though former employees said last week the department was profitable before key staff members resigned early this year.

A small crew will still provide film X-rays for the county's orthopedic clinic.

Hours, income eligibility will change

In other cuts, the urgent care center at the Scenic Drive complex will operate more like an after-hours clinic. The center currently accepts patients 12 hours a day, much like a primary care clinic, Russo said.

The new hours will be 5 to 9 p.m. weekdays and noon to 8 p.m. weekends. Patients diverted to the primary care clinic can use a same-day appointment system, officials said. During late-night hours, patients would have to go to a hospital emergency room.

The county will tighten the income eligibility for the medically indigent adult program, a state-mandated program for adults with no insurance. Eligibility will be limited to those earning 200 percent of the federal poverty level or less. The income limit will be $20,424 a year for an individual and $27,380 for a two-person household.

The change will leave 175 program participants uninsured. Because their income was above 200 percent of the poverty level, those patients have been paying a sizable share of the cost of their treatment, Russo said.

Stanislaus County has been among 10 counties in California with an income limit above 200 percent of the federal poverty level for medically indigent patients.

In addition to the service cuts, the Health Services Agency announced other initiatives in September to address the annual deficits, such as establishing copayments in the medically indigent adults program and renegotiating commercial insurance contracts.

In a plus for the agency, the county clinics were designated as Federally Qualified Health Centers last month, which will boost reimbursements for Medi-Cal and Medicare patient visits.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.

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