VENTURA COUNTY NEWS : Health Clinics May Lose Millions in Repayment : Medicare: U.S. declares most of the county facilities must collect a lower rate than they have been charging. Flynn vows to fight the decision.

Federal authorities have disqualified 34 of Ventura County’s 43 health clinics from receiving a hospital-based Medicare reimbursement rate, putting the county at risk of losing millions each year.

Word that the clinics are entitled only to a lower rate comes just one month after the county agreed to pay $15.3 million as a result of the initial fallout from its failed mental health merger. The potential loss compounds the county’s fiscal woes, which could mean the end of crucial programs, including a county homeless shelter, and delay funding for a badly needed juvenile hall.

Although the county has appealed the clinic decision to the Department of Health and Human Services in Washington, Supervisor John K. Flynn is seeking the help of top-ranking officials as far up the political ladder as the White House.

“I’ve reached the end of my rope,” Flynn said. “I’ve already been in touch with [Tipper] Gore’s chief of staff, explaining the problem.” Vice President Al Gore’s wife leads a national campaign to improve services to the mentally ill.

Ventura County’s latest problem centers on the Health Care Financing Administration’s contention that most of the county’s clinics operate independently from the Ventura County Medical Center and should not be billing Medicare at a higher, hospital-based rate.

Federal officials contend that four-fifths of the clinics are too far--more than nine miles--from the medical center and therefore do not qualify for the hospital-based rate.

The county, however, maintains that the clinics are outpatient satellites of the public hospital. That designation qualifies the county to receive about $2 million more each year in Medicare reimbursements than if all the clinics were considered free-standing.

After failing to persuade federal officials that the county deserves the higher reimbursement rate, Flynn called for an emergency supervisors’ meeting soon to devise what he called a “battle plan.”

“We’ve been treating this too casually,” Flynn said. “We need to treat this like the serious issue that it is. . . . They’re not negotiating with us. They’re just dictating. Last I noticed, this country was based on democracy.”

Helen Gookin, a spokeswoman at the health care agency’s regional office in San Francisco, was unmoved by Flynn’s efforts. She said the agency decided several weeks ago that 34 Ventura County clinics were out of compliance and should not have been receiving the higher reimbursement.

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Federal review of the clinic organization resulted from last year’s failed attempt to combine the county’s mental health and social services departments.

Supervisors rescinded their decision to merge the departments in December, after federal officials made it clear that the 9-month-old superagency violated billing and organizational rules.

The botched merger touched off several state and federal audits of the county’s health care system, and one of those probes uncovered the dispute about clinic locations.

Gookin said it is now up to a federal appeals panel to decide whether the county should receive the higher reimbursement rate.

“It’s out of our hands,” Gookin said. “They [the county] took that action, and we’ll just have to see what” happens.

Flynn said the nine-mile rule was ludicrous and should not be enforced because it applies only in four western states.

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“HCFA doesn’t seem to recognize that most private [hospitals] do not accept Medicare patients,” he said. “Nor do they understand that the clinic concept of preventive medicine has saved the taxpayers of the United States millions of dollars.”

Placing clinics throughout the county ultimately saves money, Flynn argued.

“Let’s say you have a pregnant woman in her ninth month who has never seen a doctor because she can’t get to the hospital,” Flynn said. “She could have serious problems in the future, costing big money. So it’s really a cost-savings measure.”

But Gookin points out that under federal law, the clinics must be close to the hospital. It is up to each regional health care office to set the distance limit, she said.

The office in San Francisco oversees Medicare payments to county hospitals in California, Arizona, Nevada and Hawaii, where the nine-mile rule applies.

Gookin said it was not unusual for counties unsatisfied with regional rulings to solicit help from top-ranking politicians.

“That’s the county’s prerogative,” she said. “Any provider can go to their congressman or senator and say we don’t like a decision. It’s understandable and I’m not surprised.”

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But Mike Powers, deputy director of the county’s Health Care Agency, said he still hopes the federal agency will rescind its decision. He said he sent the federal agency a revised organizational plan for the clinics two weeks ago and is still waiting for a reply.

“As far as our agency is concerned, we’re still negotiating with them,” Powers said. “We plan to work with them as we always have.”