L.A. County to keep healthcare clinics open -- for now
The Los Angeles County Board of Supervisors on Tuesday shelved at least temporarily a cost-cutting plan to shut all but one of the county’s healthcare clinics and reduce services at its six comprehensive outpatient health centers, ordering health executives instead to explore other ways to save money.
As healthcare advocates for the poor applauded, four of the five supervisors questioned whether the proposal would hurt the indigent and uninsured people who depend on the county for their healthcare and warned that private clinics might not have the ability to treat displaced patients.
Supervisor Don Knabe cautioned that the proposal could send thousands of patients to hospitals in search of care, potentially crippling an emergency room system that is chronically overcrowded.
“We should be opening more clinics instead of closing clinics,” Knabe said. “All you’re going to do is . . . overburden the emergency room system.”
County healthcare officials responded to the criticism by saying they would review alternatives to plug the health department’s budget deficit, which is expected to reach at least $195 million in the fiscal year starting July 1.
The department estimates that the shortfall could grow to as high as $1.6 billion within four years. The county blames the deficits on federal and state reimbursements failing to keep pace with healthcare costs for the indigent and uninsured.
In addition to calling for alternative budget-cutting plans, the board voted to hire independent experts to analyze the potential effect of reducing the county’s role in providing primary care.
Supervisor Zev Yaroslavsky also criticized healthcare officials for not proposing more cuts to administration and hospital costs. He said a county consultant had reported that Martin Luther King Jr. Multi-Service Ambulatory Care Center could operate with 200 fewer employees.
“There’s not the kind of urgency about some of these cuts that would cost nothing in terms of services,” Yaroslavsky said. “And yet here we have a proposal that appeared to many of us that it was going to cut services.”
Dr. Bruce Chernof, the county’s director of health services, said after the board discussion that his department had already asked county hospitals to find $60 million in savings and planned to cut $20 million in administration costs.
“At the end of the day, it’s not fair to ask the facilities to save money and not expect the administrative side of the organization to do some of the work,” he said.
The clinic-closing plan was proposed to help balance the department’s books. Under the proposal, the county would close 11 of its dozen clinics and end primary care treatment at its comprehensive health centers. The clinics and comprehensive centers get about 400,000 primary care visits a year, most from uninsured patients.
County executives told the board that they never intended to cut services but rather to privatize the county’s clinics. The proposal would have saved the county $73 million a year but also involved spending $25 million of that on contracts with private nonprofit clinics to help provide services to displaced patients.
“We’re not cutting services,” County Chief Executive William T Fujioka told the board. “If we don’t make these changes, we know that this deficit, as bad as it is today, is only going to get worse.”
Supervisor Mike Antonovich defended the plan, saying there was no proof that it would result in reduced healthcare services for patients.
“You’re kind of shooting the messenger before us today,” he told his colleagues.
Some private clinic operators and their representatives told the board they were prepared to work with the county not only to help cut costs but also to improve care for the indigent. But some healthcare advocates warned against shutting county facilities.