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Health Department facing loss of one-third of staff

STORY BY MEG LAUGHLIN (Week of January 23, 2014)
Photo: Dr. Patricia Lewis examines one-week-old Edward Williams

Miranda Hawker, county Health Department chief, stood in front of about 100 worried employees and community activists at the county commission auditorium on Friday afternoon and delivered bad news.

The Indian River County Health Department is facing at least a million-dollar reduction in Medicaid reimbursements for 2014, she said, which means an already burdened Health Department staff will be reduced by 15 to 17 more people, as services are consolidated. Furthermore, 13 positions already vacant will not be filled.

All told, the county Health Department will continue functioning with about a third of its staff gone.

The bad news is not limited to the Health Department, which is only the harbinger of things to come across the healthcare spectrum in Indian River County.

“All of these things are kicking in at the same time, which feels kind of like death by paper cuts,” said Hospital District Chairman Tom Spackman.

The Hospital District’s seven elected trustees direct property tax dollars to county organizations that fund indigent care, and most of that money comes from the barrier island.

As a result of the more than $1 million in Medicaid cuts, the Health Department and its offshoot, We Care, which arranges specialty pro bono physician treatment for indigent patients, will be approaching the Hospital District for more dollars, along with the Indian River Medical Center.

Just last week, Indian River Medical Center announced that it needed $535,000 more than the $8 million budgeted  from the Hospital District in fiscal year 2014 because of a backlog in processing indigent patients and an increase in their numbers.

Also, the hospital’s financial needs are likely to increase even more this year, as it faces big cuts in Medicaid reimbursements and reduced fees from outpatient services.

This year, the Hospital District is directing about $12 million in county property tax dollars to the medical center and six other healthcare organizations in the county. The hospital will get over $8.5 million of the money and the Health Department will get about $1.9 million.

In an effort to not approach the Hospital District for more money, the Health Department recently reached into savings for $700,000.

“But we can’t keep drawing on our reserves if we want to remain in a healthy cash position,” said Hawker.

Among the changes about to take place, the Health Department is combining services at its main clinic on 43rd Ave. and its Gifford Health Center on 28th Court, meaning the main clinic’s pediatric services will merge with Gifford’s, and the two clinics will operate as one at the Gifford center.

Also, adult primary care services will be combined with the Gifford center’s primary care moving to the main clinic.

The consolidations will mean staff cuts but an improved cash position. The merger will also mean longer wait times, which is likely to increase the number of indigent people going to the hospital emergency room for treatment, which could force the Hospital District to increase reimbursement payments to the hospital.

“With all of this happening, the question has to come up: Is it up to the Hospital District to fill in the gaps?” said Hospital District administrator Ann Marie Suriano. It is a question that will be repeatedly asked at Hospital District meetings over the next few months.

Meanwhile, the Indian River County Health Department is moving forward with the reductions that Hawker outlined at Friday’s gloomy meeting.

“We weren’t happy with the bad news, but we really appreciated that Miranda put the truth out there without flinching and answered all of our questions honestly, “said Freddy Woolfork, who runs the Gifford Youth Center and serves on the Gifford Health Council, which advises the Health Department.

“We’ll try to do the best we can with what we have,” said Hawker.