Sonoma County Grand Jury • 2005-2006

Through the Healthcare Looking Glass Healthcare in Peril June 27, 2006

Published: June 27, 2006 9 pages
View Original PDF

Findings and Recommendations 13 findings

F1
In a recent survey by the Sonoma County Medical association, 47% of doctors surveyed are considering discontinuing their practices within the next five years.
No recommendations for this finding
F2
Specialty care providers in some specialties are scarce. Consumers may wait for 6-8 weeks for an appointment.
No recommendations for this finding
F3
Hospitals are caught in a fiscal squeeze. Higher costs for patient care are not keeping pace with flat reimbursement rates.
No recommendations for this finding
F4
There is only one contractually obligated hospital to care for the uninsured in Sonoma County.
No recommendations for this finding
F5
The county funds help to support eight (outpatient) community clinics in our county. Each operates as a separate entity, duplicating administrative and billing services. Each clinic operates with different payment options.
Related Recommendations (1)
R3
The grand jury recommends that the Board of Supervisors create an independent, interdisciplinary agency that oversees healthcare resources, coordinates communications, and problem-solves among healthcare providers to conserve resources in the county.
F6
One community clinic closed its doors to new patients. It never reported to anyone that it was “full to capacity.”
No recommendations for this finding
F7
Some ERs (Sutter and Kaiser) can arrange an appointment to provide follow-up care. 6
No recommendations for this finding
F8
The resident M.D. training program has been downsized. These practitioners have historically provided care to low income and uninsured patients. Many of the resident physicians will not stay in Sonoma County to start medical practices because of the high cost of living and the low reimbursement rates.
No recommendations for this finding
F9
The Jewish Community Free Clinic sees patients that cannot afford care elsewhere. They report that patient numbers are steadily increasing. This indicates that the concept of the “safety net” for medical care is not working.
Related Recommendations (1)
R1
The grand jury recommends that within the next year, the Board of Supervisors organize a healthcare symposium with stakeholders to discuss approaches to healthcare issues in Sonoma County. The grand jury recommends that the Board of Supervisors attempt to coordinate with Sonoma State University on such a symposium.
F10
Fewer employers are providing health insurance as a benefit.
No recommendations for this finding
F11
Eligibility for assistance programs is based on income according to federal poverty guidelines. The high cost of living in Sonoma County is unsustainable for workers at poverty level.
No recommendations for this finding
F12
One community clinic has a waiting list of 200 patients for mental health counseling services.
No recommendations for this finding
F13
Dental services for people with low income, Medi-Cal, or without insurance are very difficult to obtain. Conclusions The healthcare organization in Sonoma County is broken. The healthcare providers are overburdened and are not able to offer reorganization changes. Sonoma County does not have an organized healthcare system. Because there is no organized system, costly services are duplicated and patient information exchange is impeded. The outpatient clinics serve as a “safety net” to provide primary healthcare when that care cannot be obtained otherwise. There is no mechanism that can determine when the outpatient clinics have reached their limit in accepting new patients and when a new clinic should be formed. There is no provision within the county for establishing a new primary care clinic or a network of clinics. If there were adequate healthcare services, then the “free clinics” would not have a need to exist. The free clinics do not openly advertise their existence, but even so, their capacity is stretched to the limit. The Board of Supervisors is only partially addressing the problem of the lack of healthcare for the uninsured when it sends money to the local clinics and subscribes to the CMSP program. The Board may wish to investigate and support changes involving the mentioned issues. By encouraging the creation of an organized system, taxpayers would ultimately benefit. It is reassuring to think that Alice escaped the underground insanity of Wonderland with its cat and rabbit that kept disappearing. She was able to return to a safe and stable above-ground world. It is time for the citizens of Sonoma County to seek a safe and stable solution to the problem of healthcare access. There are alternatives to CMSP. One such program exists in Santa Cruz County. Perhaps other models are available for comparison. Commendations 1. Emergency room personnel do attempt to refer patients to medical assistance programs if patients identify that they are in need. 2. Application Assistants are available to help with assistance forms. 3. Multiple language translation is available in all clinics. 7 4. Volunteers and local healthcare providers donate their time, and local medical and nursing students staff the Jewish Community Free Clinic. 5. Sonoma State University has an extensive consortium and program that is studying the problems of healthcare in Sonoma County. 6. Redwood Community Health Coalition is a coalition of outpatient clinic representatives in Sonoma and neighboring counties that meet monthly to discuss problems of mutual concern.
Related Recommendations (5)
R2
The grand jury recommends that the Board of Supervisors develop written critical pathway system concerning healthcare access in Sonoma County.
R3
The grand jury recommends that the Board of Supervisors create an independent, interdisciplinary agency that oversees healthcare resources, coordinates communications, and problem-solves among healthcare providers to conserve resources in the county.
R4
The grand jury recommends that the Public Health Department and the Board of Supervisors work to develop a central information center for consumers.
R5
The grand jury recommends that Information Services Department create an Internet link on the official Sonoma County website to give general information about CMSP and the clinics that will accept this program.
R6
The grand jury recommends that Human Services and the Board of Supervisors research alternatives to current CMSP that will be more accessible to consumers and cost-effective to taxpayers. Required Responses to Findings None Requested Responses to Recommendations Sonoma State University – R1 Redwood Community Health Consortium – R3 Required Responses to Recommendations Board of Supervisors – R1, R2, R3, R6 Public Health Department – R2 Public Health Department – R4 Information Systems Department (ISD) for the County of Sonoma – R5 Human Services Department – R6 8 Access to Healthcare Facilities? It depends!!---Who are You? Comparative $$$ $$ $ $$ Cost Emergency Urgent Free Primary Specialty Care Care Clinics Care Care (Single (Single Visit) Visit) Children Yes Yes Unnecessary Yes Yes Employed Yes Yes Unnecessary Yes Yes, with Insurance with limits Employed Yes Yes Yes Notes 1 and Note 2 5 without Insurance Medicare Yes Yes Unnecessary Note 1 Note 3 Covered Indigents Yes Yes Yes Yes Yes Undocumented Yes Yes Yes Notes 4 and Notes 4 and 5 5 Prison Inmates Unlimited --- --- Unlimited Unlimited Free Free Free Veterans and Coverage Coverage Coverage Dependents Note 6 Note 6 Note 6 Note 6 Note 6 Notes: 1. May be difficult to receive care in a timely manner 2. If paying, may be seen without primary care referral 3. Requires primary care referral 4. Requires payment 5. CMSP coverage possible 6. Eligibility for VA benefits depends upon individual circumstance 9

Conclusions 1

Commendations 6

No Responses Found 3

Government entities assigned to respond to this report. No response documents have been linked in our database.

County of Sonoma Agency
Sonoma County Board of Supervisors Elected County Office
Sonoma State University University