County cuts health staff

Source: The Register-Guard, Eugene, Ore.self storageDec. 27--Faced with over a year of lagging revenues, Lane County Health and Human Services is making significant staff cuts in its mental health care division, which typically provides services to low-income and uninsured individuals and families.The county is laying off four permanent employees and five part-time employees in the division -- all but one of whom provide frontline clinical care. It is also eliminating seven budgeted but vacant division positions: four frontline positions and three administrative posts.Additionally, the county is laying off one mental health clinician and one administrative assistant in its community health centers.All the layoffs will occur by Jan. 1.The staffing cuts are particularly acute in the mental health division: between layoffs and eliminated vacant positions, the division is cutting its permanent budgeted staff by more than 8 percent, its frontline budgeted staff by almost 17 percent, and all of its part-time staff.That means patient caseloads will increase for the remaining clinical staff, and the division could face difficulties in accommodating new patients next year.The county's health care services often are used by some of the area's more vulnerable children and adults, those without health insurance or on the Oregon Health Plan, the state's version of Medicaid, which provides health insurance to low-income people. The mental health division provides outpatient care and hospital aftercare for individuals with persistent or acute illnesses, among others. It also provides assistance with the civil commitment process and runs a methadone treatment program.The cuts follow an 18-month period where actual revenues for the mental health care division and, to a lesser extent, the county-run community health centers have come in significantly lower than projections, according to county officials.Over that period, the mental health division has completely spent down a budgetary reserve of $3.7 million, the equivalent of almost 30 percent of the division's annual revenues, the county's budget shows. Of those reserves, $226,000 was used to match a $500,000 federal grant to remodel the division's facilities on Martin Luther King Boulevard -- an upgrade designed to better integrate physical health and mental health services.In the current fiscal year that will end next summer, revenues for the mental health division are expected to be down $3.6 million -- or 29 percent -- from early projections made last spring. Revenues for the community health clinics are projected to be $2.9 million -- or 18 percent -- lower.For much of their revenue, both divisions rely on reimbursements from the state for services the county provides to patients on the Oregon Health Plan.Therefore, when the county sees fewer patients or provides them fewer services, the divisions' operating revenues shrink accordingly.Karen Gaffney, acting director of Lane County Health and Human Services, says the two divisions' financial struggles are the result of "several things unfortunately coming together at the same time."The mental health care division has suffered from "lower productivity" in the billable services it provides to patients, Gaffney says, which was in part the result of implementing a new electronic patient records system for clinicians to use.The division was also hit by a $800,000 loss from its regular state funding, money that previously helped cover the cost of treating people without health insurance. With the state accepting more people onto the Oregon Health Plan, it has curbed its funding for people who lack insurance.The community health centers lost several primary care doctors and nurses over the last year, Gaffney says, and has had trouble replacing them. Losing those providers translated to lost revenue for the centers, she added, because it meant they could provide fewer medical services, including those eligible for state reimbursement.Similarly, the centers faced unanticipated delays in implemen迷利倉ing a new software system. Gaffney said that almost all the primary care provider positions in the health centers have now been filled, however.Because of cash-flow issues related to the slowed revenues, Gaffney recently requested that the Lane County commissioners let her borrow up to $2 million from the reserve funds of another division in the Health and Human Services Department to potentially cover expenses in the two troubled divisions until next summer.With no discussion, the commissioners unanimously approved the request on Dec. 17. No funds have yet been borrowed by either division, Gaffney said.The staffing reductions and other cuts will trim projected expenses in the fiscal year that ends next July by $1.7 million in the mental health care division and by $1.5 million in the community health centers. For most of this calendar year, significant cuts have been to "nonessential" materials and supplies in the mental health care division, according to county officials.The timing of the staffing reductions raises questions, given that 2014 is expected to see a swell in the number of individuals with both private health insurance and on the Oregon Health Plan, as a result of the implementation of the federal Affordable Care Act.Gaffney says that the Oregon Health Plan expansion should help increase revenues for the county-run health care divisions. But the level of the increase is currently uncertain, and the revenue gains may take time to materialize.The staffing reductions are necessary to address the immediate revenue shortfall, she said."As a community and state, we are still very much in the middle of health care transformation, as providers of clinical services across (the) state are needing to 'retool' in order to be effective and efficient in the new health care environment," Gaffney added in an email."Our old models of service delivery are shifting in order to meet the changing demands. When we ultimately complete this transition, I believe we will be better able to meet the community need -- right now, though, is a difficult time."An employee of the mental health division who will be laid off by the end of the year and who requested anonymity said the layoffs were unexpected.While there had been discussions about the need to find savings in the division this year, there hadn't been discussion of layoffs prior to Thanksgiving, the employee said.The employee expressed concern that the department was making cuts to frontline mental health care providers, those responsible for generating revenue for the division."Cutting the billing team is going to hinder our capacity to bring new (patients) in," the employee said.With existing patients alone, the employee said, some county mental health specialists would see their individual caseloads jump to more than 100 patients as a result of the staff layoffs -- based on calculations the employee made."At that point, you're just putting out fires, rather than providing long-term patients with the attentive day-to-day care patients need," the employee said.Gaffney said the Health and Human Services department still is accepting referrals for new patients at the moment.She said individual caseloads for the remaining mental health clinicians are in the process of being reviewed, so firm numbers for 2014 caseloads are not yet available.She acknowledged, however, that before the staffing reductions, the mental health division was "in average zone" for caseloads."We will be on the high end now," she said.However, Gaffney said that maintaining access for new patients to the county's health care services "is a top priority for the department.""Once we are financially stable, we will continue to grow as the community demands," she said. "Our staff understands that this is a very serious situation and I trust they will do what they can to increase revenues."Copyright: ___ (c)2013 The Register-Guard (Eugene, Ore.) Visit The Register-Guard (Eugene, Ore.) at .registerguard.com Distributed by MCT Information Services迷你倉