Schenectady County

Health clinic scaling back staff

Hometown Health is taking some bitter medicine to correct a steady loss of money from treating a lar
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Hometown Health is taking some bitter medicine to correct a steady loss of money from treating a large population of Schenectady County residents with little or no insurance, officials said.

Hometown is integrating its pediatric department into its family practice department, effectively reducing staff, to keep the struggling community health center open.

The changes are part of recommendations of a federal auditor, brought in two months ago to help stabilize the health center’s operations. Hometown is part of the community’s safety net of primary care providers for people with little or no insurance.

Over the last two months, at least five medical care providers have left Hometown, either on their own or through layoffs. The latest to leave is Dr. Kevin Karpowicz, a well-respected pediatrician and Hometown’s former vice president of medical services. Hometown accepted Karpowicz’s resignation Friday; he had said he planned to resign in April. The board will pay his salary through April.

Karpowicz had no comment Monday, but in a Jan. 9 article in The Daily Gazette, he said patient care was taking a back seat to Hometown’s financial troubles.

Hometown spokesman Joe Gambino said the board’s acceptance of Karpowicz’s resignation was not linked to the article. “Kevin decided to leave and we accepted it,” he said.

The changes have upset some staff, who say Hometown administrators are jeopardizing patient care. Hometown officials say consolidation is necessary to keep the facility afloat and that patient care remains good.

The state Department of Health, which oversees Hometown’s operations, said it received no patient care complaints in 2007.

The Rev. Michael Hogan, chairman of the Hometown Board of Trustees, said, “We have a lot of confidence we are here to stay and that we have extraordinary and competent providers who want to be here.”

Hogan said Hometown is following recommendations of an auditor serving as a consultant with the federal Bureau of Primary Health Care. The auditor said Hometown was overstaffed for the number of patients it sees annually and should restructure to save money.

Hogan did not provide details on Hometown’s past and proposed staffing levels despite repeated requests. “We are revamping the whole thing. We are being proactive and are not sitting around,” he said.

The auditor told Hometown it has a persistent cash-flow problem caused by reimbursement delays, Hogan said. “But we always will and that needs to be addressed specifically,” he said.

The auditor has been working with Hometown for the last two months, the result of concerns from Washington that the federally designated community health center would become financially insolvent, Hogan said.

Hometown’s restructuring should be completed this month, Gambino said. “Staffing will be adequate to deal with the patient load, as recommended by federal auditor,” he said.

Hometown uses a mixture of physicians and mid-level providers including nurse practitioners and physician assistants to handle the patient load. The state Department of Health requires physicians to supervise no more than six mid-level providers; Gambino said Hometown is within guidelines.

STAFF ANXIOUS

Hogan said he visited Hometown Monday and spoke with staff about the changes. “I really understood there was terrible pain involved. There is a real concern they have about their own jobs and about the patients. There may not be enough communication with them,” he said.

Gambino said Hometown’s 2007 budget is approximately $8 million. It receives approximately $1 million from the federal government, an amount that has not increased in at least a decade, and the remainder from insurance, primarily Medicaid, and grants. He said the 2008 budget will be less than $8 million.

To save money, Hometown will close its satellite primary care center at Ellis Hospital in February. It also canceled a nearly $1 million contract with Schenectady County to provide medical services to jail inmates. Hometown sought a 10 percent increase in the contract and a $200,000 annual subsidy; the county offered a 3 percent increase and no subsidy.

Hometown will keep its primary center open at 1044 State St.

Hogan said Hometown is “trying to get the government to give us a little more money. We are treating more uninsured people than ever before, and that has really put us in a very, very bad financial position.”

Gambino said Hometown saw a 6 percent increase in the number of total uninsured in 2007, and a 40 percent increase in the total number of uninsured visits. Hometown saw 22,000 patients and had 70,000 visits.

Meanwhile, Rep. Michael McNulty, D-Green Island, said he spoke with Hometown CEO John Silva last week and promised to direct more federal money to the facility. He said he obtained $400,000 in 2003 and $500,000 in 2005 for Hometown.

The state gave Hometown half of a $400,000 grant last week. The state also plans to help Hometown in another way through a new program. The program designates Hometown as a “presumptive eligibility health care center.”

Gambino said that under this designation, when a child comes in and doesn’t have health insurance, “we presume the family is eligible for health insurance.”

Hometown can then treat the child and receive payment for services after the fact, provided the family is indeed eligible. Based on the patient population it treats, the presumption is likely to be fulfilled, Gambino said.

Gambino could not estimate how much the state program would help Hometown’s finances. However, he said if Hometown captures just 10 percent of the $3 million in uncompensated care it provided in 2007, that would be substantial. “We are hoping for more, such as 50 percent to 80 percent,” he said.

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