Here's one of the countless reasons it really stinks to be poor and in need of healthcare services: medical schools today graduate massively disproportionate numbers of specialists (so disproportionate that only 30% of docs do primary care), but if you're uninsured and low-income, finding a specialist who will see you is a virtual 'Where's Waldo' hunt.
Mainstream news reports bemoan the glut of specialists and what it means for the cost of healthcare in the US, but if you're poor and uninsured these news stories are a sort of bizarre slap in the face. There is no glut of specialists in low-income communities; just the opposite.
Three cheers, then, for Operation Access - the program that in Contra Costa County and throughout the Bay Area connects the uninsured and indigent to outpatient surgical and specialty services provided pro bono by volunteer doctors, nurses, and hospital systems.
In 2009 alone, OA estimates that these volunteer medical professionals donated $1.8 million in charity care, representing a lifeline for community clinic patients and others who wouldn't otherwise have a place to turn for orthopedic care, hernia surgery, and other outpatient specialty surgeries.
On the 17th of this month, OA held its first GI diagnostic event - providing much-needed non-routine colonoscopies to 4 community clinic patients. For our part, the Clinic Consortium, under a Specialty Care Access grant from Kaiser, last year surveyed clinics throughout the county and found hurdles to diagnostic GI services a major problem for our patients. These are services that community clinics don't provide in-house, but that patients have tremendous difficulty finding on referral. This spring, we spent days behind the scenes coordinating the community clinic and OA systems in preparation for the GI event. By all accounts it was a rousing success, and hopefully the first of many!
Certainly there's no shortage of demand by low-income uninsured patients for specialty services. OA's pool of volunteers has shot up 317% since early 2009, but it's still nearly at capacity, bursting at the seams as community clinics and others refer patients in need.
The work goes on. In the mean time, if you see one of those news stories pondering the overabundance of specialists, consider taking a moment to drop a letter to the editor. Tell 'em what's really going on in our communities, and pass on OA's phone number.
Contra Costa County released its Recommended 2010-11 Budget late last week, and let me tell you, this is 428 pages of the most riveting, edge-of-your-seat, nail-biting reading that you will ever dare do.
Okay, not really. It's a budget, after all. Turns out it's got more charts and figures than cliff-hanging subplots.
For Health Services, a $7.2 million reduction breaks down into a $3.2 million (3 FTE) cut to the hospital, a $1 million hit to public health, and a $1.5 million blow to mental health. Not the stuff of a Stephen King classic, rest assured.
But actually, if you kinda turn your head and squint your eyes and use your imagination, it's possible to pull out some themes from this unwieldy tome. Here are the ones that popped for me:
Banking on "Lean" production practices. Around $650,000 in projected savings to the county hospital would come from applying "lean methodology" to cardiac, surgical, and behavioral health services. This is something that CCRMC CEO Anna Roth has been spearheading: taking the sort of fat-cutting, end-product focused production strategies that Toyota brought to the car industry and applying them to hospital operations.
Flattening the administration. Exactly $600,000 in savings would come from eliminating 4 administrative positions at the health plan and redistributing their work to remaining staff. Ditto $300,000 in mental health. This seems in line with what County Administrator David Twa has been talking about when he promotes flattening the county's organizational structure to make it less administratively top-heavy.
Mental health service cuts: Many of the actual reductions in patient services seem to fall in the mental health category. These include increased wait times for medication visits for the seriously mentally ill; decreased access to after-hours care at mental health sites; increased wait times for medication for children; and reductions in the number of authorized mental health visits to private outpatient providers.
Modest shift of general purpose revenue away from health/social services. On page 7 of the budget the CAO catalogs changes in the percentage of general purpose revenue dedicated to each department. Health Services went down from 29.1% to 28.6%. Employment and Human Resources from 6.2% to 5.8%. Modest but noticeable decreases. On the other hand, the Sheriff-Coroner climbed from 19.6% to 20.4% and the DA from 3.7% to 4.3%.
So there's the budget as I see it. Pulp fiction it is not, but you have to give it credit for being so well foot-noted. And, despite what are sure to be slow sales and low readership, there will of course be a sequel, due out sometime after May, provisionally entitled, "Other stuff we have to eliminate because the state is in even worse financial shape than the county is, and they're down-streaming their cuts to us."
That one, I'm afraid, really might be Stephen King scary.
As this article by Lisa Vorderbrueggen in the Times rightly reports, while some Democrat members of Congress spent their spring breaks back in conservative districts bracing for tea party assault, our region's representatives came back to the warm embrace of a fired-up, grateful public.
At least that was the vibe at last night's town hall/reception for Congressmen George Miller and John Garamendi in Martinez. It was triumphal, and happy. There was levity. Miller and Garamendi donned doctor's coats and stethoscopes (presented by Jane Garcia of La Clinica and Cheryl Johnson of Brookside clinic) and hammed it up for the crowd. It felt like election night when your candidate wins. It was genuine political fun.
Community clinics owe a big thanks to both Miller and Garamendi - not to mention Pelosi and Obama - for their work and votes on healthcare reform. We're set to double the number of patients we see (nationwide) over the next 5 years. We're set to hire more primary care docs who are benefiting from loan forgiveness programs that incentivise community work. We're set to build new sites and expand our current ones.
Who says Congress never gets anything done?