The Santa Cruz County Health Services Agency’s Consultants
Synopsis
The Santa Cruz County Health Services Agency (HSA) and the Santa Cruz County Board of Supervisors spent scarce financial resources for several questionable consultants. Santa Cruz County paid these consultants in large part with patient revenues and at the same time decreased indigent patient (Medi-Cruz) healthcare services.
Section 17000 (1933) of the California Welfare and Institutions Code required counties to provide healthcare for the poor. Prior to the advent of Medi-Cal in 1967, the county clinics and County General Hospital treated most of the poor. In 1973 Santa Cruz County closed the County General Hospital and created the Medical Care Program, which paid private hospitals and physicians for the uncompensated emergency care for the poor who did not qualify for or opted out of Medi-Cal (undocumented persons, transients, and inebriates). The Medical Care Program also paid for the maternity care of undocumented women. The two county clinics continued to see the poor for outpatient care. In 1982 the California state government restricted the Medi-Cal program to cover only those persons on welfare. This action increased the number of poor patients who did not qualify for Medi-Cal coverage. Thus, the state transferred the healthcare costs for the uninsured working poor, who no longer were covered by Medi-Cal back to the county governments and in exchange the state promised to help fund 70% of the program for the indigents who no longer qualified for Medi-Cal. In 1983 the Santa Cruz Board of Supervisors changed the name of the Medical Care Program to Medi-Cruz. Due to the enormous costs of providing healthcare for undocumented persons, in 1986 Medi-Cal started to pay for the pregnancy-related and emergency services for undocumented patients. When Medi-Cal reimbursements rates decreased after the 1980s, more and more private-practice
physicians refused to see Medi-Cal patients. In response to this problem, the Central Coast Alliance was established in 1996 as a managed care Medi-Cal program and some private-practice physicians agreed to see Medi-Cal patients. However, the Grand Jury recently surveyed the list of Central Coast Alliance providers, which indicated that almost all of the private-practice physicians no longer take new Medi-Cal patients. Thus, the number of Medi-Cal patients seen by the county’s two outpatient clinics has increased. The county clinics welcomed the state and federally funded Medi-Cal patients and saw fewer of the county funded Medi-Cruz patients.
Despite the escalating costs of medical care, the Board of Supervisors over the past twenty years allocated the same amount of money annually from the general fund for the Medi-Cruz program. As a result the HSA decreased the amount of health care available for Medi-Cruz patients by developing increasingly more stringent eligibility criteria. With the more stringent eligibility criteria for the Medi-Cruz program, the Medi-Cruz patients seen by county clinics decreased. The uninsured working poor who don’t qualify for either Medi-Cal or Medi-Cruz have increasingly turned up in the hospitals’ emergency rooms, which are forced by law to treat medical emergencies.
In response to budgetary concerns, the HSA’s proposed budget for 2003/2004 deleted a vacant physician’s position and a 0.7 Full Time Equivalent physician. The other clinic physicians gave up some of their hours so that the clinic physician who lost his job could continue to work in the county clinic.
In a June 17, 2003 letter to the Board of Supervisors the
Health Services Agency Physicians Association (HSAPA) decried the fact that a
physician position, rather than an administrative position, should be deleted
because “physicians do generate revenue when they see patients with insurance
and/or MediCal (sic).” The HSAPA outlined the human and economic costs of
proposed physician lay-offs.
The letter also pointed out that $598,000 had been paid to
“expensive” consultants for a report that “was essentially the same information
the clinic providers had already conveyed to management.” The
Board of Supervisors had authorized the report in question, which the HSA
presented to the Board of Supervisors on November 18, 2003. At that meeting a HSAPA representative once again
questioned the HSA’s use of scarce monies in the creation of another top-level
administrative position in the HSA, while decreasing the number of physicians
who treat indigent patients in the county clinics.[1]
The Grand Jury decided to investigate whether the Health Services Agency’s decision to use “expensive” consultants was the best use of the money that could be made available for indigent health care. This study will focus on three of these consultants.
Interviewed:
Local healthcare administrators and staff.
Reviewed:
ECG Management Consultants, Incorporated reports and communications.
Santa Cruz County Health Services Agency reports to the Santa Cruz County Board of Supervisors.
Santa Cruz County Health Services Agency payments and County invoices pertaining to the consultants.
Santa Cruz County Health Services Agency budget reports.
Santa Cruz County Board of Supervisors minutes relating to the Health Services Agency.
Community Access Program (CAP) and Health Community Access (HCAP) grant applications.
Report on the Uninsured and Access to Health Care (January 23, 2001).
1.
In a November 9, 1999 letter of resignation, the HSA
administrator warned the Board of Supervisors
that it should exert greater fiscal oversight over the HSA. He stated, “Given that the budget of
the Health Services Agency is in excess of $70 million with approximately 85%
of the budgetary support coming from non-County sources, it is even more
essential that the health administration and fiscal management be closely
monitored.”
2. ECG Management Consultants,
Incorporated (ECG):
ECG serves as a consultancy firm
and is based in Seattle, Washington. It specializes in “hospital and physician
relationships, strategic and business planning, and the complexities of the
healthcare enterprise.”[2]
A. In the 2000-2001 Santa Cruz County Board of Supervisors’ budget hearings, the HSA argued for the need of a new software program to replace HSA’s COSTAR billing system and the set up of an Electronic Medical Records (EMR) system for the county clinics. The HSA pointed out that federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposed a deadline of October 16, 2003 for healthcare clinics to develop EMR systems. The Board authorized HSA to proceed with a new computer system for the clinics. To fund the system the Board authorized $535,000 from the state audit settlement of $2,156,430 to be placed in the County’s Technology and Productivity fund for use toward the computer upgrade. The state audit settlement resulted from HSA’s increased billings for county mental health psychiatrist visits under the Federally Qualified Health Center (FQHC) designation that the county clinics received starting in 1988 as a result of a healthcare services for the homeless grant. The state questioned the increased billings and had not funded its share of costs. The state allowed the increased billings using the FQHC designation, which resulted in the settlement of $2,156,430. Thus, clinic physicians generated most of this money, which was derived from Medi-Cal revenues.
B. The HSA also looked into creating a clinical practice management information system (MIS) network, which would incorporate the new computer system to link the two county clinics to the Santa Cruz County community clinics. The community clinics consisted of the four Planned Parenthood clinics (South, Westside, Cabrillo, Valley), Salud Para la Gente, Women’s Health Center, and Dientes. The linked clinics could share information from patient medical and pharmacy records, as well as laboratory and radiology results. The HSA contacted the Health Resources and Services Administration (HRSA) and a former HSA administrator for advice on how to proceed. HRSA and the former HSA administrator pointed out that the Oregon Community Health Information Network (OCHIN) based in Portland, Oregon was in the process of finalizing its vendor selection for setting up a community clinic network, which would link the EMR of the community clinics throughout Oregon. OCHIN had selected Epic Systems Corporation (Epic) as its software vendor. The HSA staff met with OCHIN and ECG representatives. ECG had acted as a consultant to assist OCHIN in setting up its MIS network. HSA learned that OCHIN had received its network financing through a federally funded Community Access Program (CAP) and Healthy Community Access Program (HCAP) grants.
C. In the 2001-2002 budget hearings, the HSA asked the Board of Supervisors to approve the hiring of ECG to assist the agency on the medical information technology upgrade project. The HSA pointed out that the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposed a deadline of October 16, 2003 for healthcare clinics to develop EMR systems. The HIPAA requirement for an EMR system did not extend beyond individual clinics and did not require a linked MIS between clinics.
D. The HSA contracted with ECG without getting bids from other companies. ECG signed the first of two contracts with Santa Cruz County on August 28, 2001. The cost of the first contract was not to exceed $130,000. ECG’s rates were $375/hour for the project officer, $270/hour for the project manager, and $185/hour for their associate. This contract stipulated that ECG would provide consultant services to the HSA related to development, analysis, evaluation, and selection of a MIS for the county clinics.
E. In October 2001, ECG initiated the MIS vendor selection process. HSA staff (at an expense of $2,000 per person) and ECG consultants attended a Medical Group Management Association conference in San Antonio, Texas.
F. In November 2001, ECG and the HSA narrowed the choice of vendors to four: Companion Tech.; McKesson, Inc.; Medical Manager Health Pro; and NextGen, Inc. In that same month the HSA sustained a loss of revenue from a decrease in federal and state money to FQHC clinics and the repeal of the utility tax for the unincorporated areas of Santa Cruz County.
G. In December 2001, the four vendors presented and demonstrated their products in Santa Cruz. In January 2002, NextGen returned to present its full product demonstration.
H. In March 2002, the HSA proposed expanding ECG’s role to include a study on management assistance “to implement operational and organizational solutions that will enhance efficiency and improve clinic performance.” The proposed fees would be $34,000/month for an estimated time period from four ($136,000) to six ($204,000) months.
I. On April 9, 2002, the HSA argued before the Board of Supervisors that cost reductions to the clinics could be achieved through ECG’s evaluation of clinic productivity and efficiency. The board approved the expansion of ECG’s study. The HSA stated at the same meeting that the primary mission of the agency was to protect the community from communicable diseases and health issues that threaten the community.
J. On October 24, 2002, the second contract expanded ECG’s scope to include the clinics’ practice management system consultation, clinics’ operations assessment, clinics’ operations implementation, and contract facilitation and negotiation, with hourly rates from $185 to $410. The additional cost of $85,000 brought the total to $215,000, which would come from the $535,000 allocated earlier by the Board of Supervisors.
K. On May 7, 2002, the HSA submitted the CAP grant application to the Health Resources and Services Administration (HRSA) for the first year of funding. The application stated “we have prepared the safety net clinics and hospitals to cooperate on an unprecedented level by implementing common EMRs and clinical messaging, improving both the efficiency and quality of care provided to the County’s safety net clinics.” NextGen was listed as the HSA’s software vendor. HRSA approved the $1,403,450 grant, which included $601,000 for information technology software.
L. On September 24, 2002, the HSA informed the Board of Supervisors of ECG’s recommendations to improve clinic/Medi-Cruz finances and services. At that same meeting, it was noted that reduced funding resulted in reductions in the care capacity for Medi-Cruz patients.
M. On November 5, 2002, the Board of Supervisors approved an additional contract amendment for ECG, which added $268,000 for consultation, clinic software and operational charges. The cost of ECG’s services now totaled $483,000. ECG’s original estimate of $130,000 had now increased by $353,000.
N. On January 10, 2003, the Board of Supervisors approved an additional ECG contract amendment for ECG’s consultation on clinic operational charges, which amounted to $95,000. The total cost for ECG’s consultancy services now reached $578,000, which exceeded the $535,000, the Board of Supervisors had allocated for an upgraded EMR system.
O. On August 25, 2003, the HSA applied for and received approval from the Health Resources and Services Administration (HRSA) for the Healthy Communities Access Program (HCAP) grant, which funded years two and three after the first year of funding of the CAP grant. HSA’s practice management system vendor changed from NextGen to Epic software. The OCHIN network had agreed to add the Santa Cruz County community health MIS network to its Epic system, which eliminated the need for the NextGen system. However, as of January 2004 due to delays in the set-up of the OCHIN network, the Santa Cruz system is not in operation. Negotiations are underway to determine the costs of the linkage to OCHIN.
P. Both the CAP and HCAP grants required in-kind funding which has not been arranged as of January 2004. The CAP grant money for the MIS has been partially spent on the set-up of the Axoltl physician messaging/dictation/ pharmacy/lab system.
Q. In the meantime, an additional charge by ECG amounted to $19,565. On November 19, 2003, the HSA presented to the Santa Cruz County Board of Supervisors the implementation of recommendations of ECG to increase the productivity of the County clinics. The Board of Supervisors accepted the findings of the report.
R. The original ECG timeline targeted a completed practice management system conversion and implementation by July 2002, which has not been met. The HIPAA deadline of October 2003 has passed and very few of the national healthcare entities are in compliance.
S. As of January 2004, only two of the community clinics, Salud Para la Gente and the Women’s Center Clinic, have agreed to link with the county clinics. More than half of the community clinics (the four Planned Parenthood clinics and Dientes) have not signed up to be part of the network.
4. A former HSA Administrator and a former HSA Medical Director
The former HSA administrator now acts as
an independent healthcare consultant based in Oregon. The
terms of her January 5, 2001 contract with Santa Cruz County indicated an
hourly rate of $125. This consultant
was to be reimbursed at this rate for hours worked and for travel time between
Portland, Oregon and Santa Cruz. Additionally the contract states, “Compensation for
necessary per diem, travel, mileage and other costs necessary to accomplish the
work done under this agreement is included in the CONTRACTOR’S hourly rates. Travel to California
shall be at COUNTY direction for purposes of supporting COUNTY issues.”
The former HSA medical director
contracted with the county to be paid $80/hour as a consultant.
The appendix delineates the yearly payments and work projects of the former HSA administrator and the former HSA medical director.
5. A Summary of the Cost of the Health Services Agency’s Three Consultants
|
YEAR |
ECG
|
Former HSA
Administrator |
Former HSA
Medical Director |
Yearly Total
|
|
2000-2001 |
$130,000 |
$13,125 |
$49,320 |
$192,445 |
|
2001-2002 |
$85,000 |
$59,844 |
$61,620 |
$206,464 |
|
2002-2003 |
$268,000 |
$88,281 |
$60,840 |
$417,121 |
|
2003-1/2004 |
$114,565 |
$12,250 |
$13,120 |
$139,935 |
|
Total |
$597,565 |
$173,500 |
$184,900 |
$955,965 |
6. Funding Sources to Pay the former HSA
Administrator and the former HSA Medical Director:
A.
The source of the funds to pay for the former HSA
administrator and the former HSA medical director is less clear than that for
ECG. The HSA gave
these answers on the funding sources for these consultants who were identified
as independent contractors: “Each year in the budget there are line items for
various [independent] contractors.” The former HSA administrator and the former
HSA medical director “had contracts approved by the Board [of Supervisors].” “In building the budget, HSA identifies and
puts in amounts for ongoing [independent] contractors. These amounts were in
the original budgets and augmented if needed for new activities with
appropriate approvals from the CAO’s [Chief Administrative Officer] office
and/or Board if using new appropriations or transfers. Contractors are never
allowed infinite amounts of funds. These are negotiated and approved in
advance.” The grants written by the
former HSA administrator “(CAP, HCAP, and others) include routinely 10% for
administration.” Given
that the former HSA administrator “brought into Health [HSA] approximately $3.5
million in funds, she was able to pay for her time out of admin
(administration) funds.”[3]
B.
According to the HSA, the former HSA medical director may have
“charged some of his time to the Bioterrorism grants but otherwise to our
central admin [administration] distribution. Central admin is charged out to
all of our funding sources through the programs. Approximately 15% of the funds
are County and the rest are Medicaid, Medicare, grants, and various state and
federal allocations.”
7. Over the past 20 years, the Board of
Supervisors has allocated the same amount of money to the Medi-Cruz program.
HSA has developed increasingly more stringent eligibility criteria for
Medi-Cruz patients.
1. The Board of Supervisors ignored the fiscal-oversight warning in the 1999 resignation letter of a former HSA administrator.
2. The Board of Supervisors did not adequately oversee HSA’s decision to utilize the services of a costly out-of-state consultant (ECG) without seeking competitive bids.
3. ECG’s consultancy took money away from indigent patient care:
A. The $535,000 used to pay for ECG’s fees came from patient revenues paid by the state.
B. ECG’s fees exceeded the amount allocated by the Board of Supervisors and came to almost
$600,000.
C. As ECG’s costs escalated, the HSA with the Board of Supervisors’ approval reduced Medi-Cruz eligibility.
4. The HSA and the Board of Supervisors have failed in their attempt to create a countywide medical information system network because more than half of the clinics decided not to sign on.
5. The HSA utilized ECG’s services for a study of clinic efficiencies and productivity instead of listening to the providers of care in the county clinics and utilizing available inexpensive healthcare practice management literature.
6. The HSA devalued the work of county employee grant writers by arguing that the former HSA administrator’s work alone was responsible for “approximately $3.5 million” in grant money. County employees wrote these grants and the former HSA administrator acted as an advisor. The HSA could have used the Oregon network’s applications as a template, rather than hiring the former HSA administrator. The 10% administrative allocation in the grants could have been retained by the county to help pay for county employees’ salaries, rather than a consultant’s.[4]
7. The list of projects worked on by the former HSA administrator and the former HSA medical director could have been performed by HSA employees.
8. Some of the former HSA medical director’s compensation came from funds derived from patient revenues, which could have been used for indigent medical care.
9. The Medicare reimbursement project done by the former HSA medical director largely benefits private physicians because county clinics see very few Medicare patients. The HSA and the Board of Supervisors accepted the argument used by the Santa Cruz Medical Foundation (SCMF) that an increase in Medicare reimbursement rates would increase physician retention in the community and would benefit the HSA. The SCMF did not guarantee increased county indigent care, if the former HSA medical director helped its campaign. By working with the SCMF, the HSA spent county monies to enrich SCMF, not the county.
10. The HSA deleted two county physicians’ positions, while spending almost a million dollars on consultants.[5] The shift of the chief of clinical services to the position of chief of detention services left the county clinics with no chief until that position is filled.
Recommendations
1. The Board of Supervisors should spend more time overseeing HSA’s spending recommendations.
2. A priority should be to prevent decreased medical care available to indigents.
3. The current HSA administrator and current HSA medical director could have done most of the work performed by the hired consultants. The HSA should give credit to and utilize more of the skills of the county’s information technology and grant-writing employees, rather than hiring consultants.
4. The HSA should stop utilizing the services of ECG, the former HSA administrator, and the former HSA medical director.
5. The HSA stated to the Board of Supervisors that the HSA’s primary mission is to protect the community from communicable diseases and health issues that threaten the community. If so, the HSA should be more concerned about medical care of the indigents of Santa Cruz County.
6. The HSA and the Board of Supervisors should review more carefully proposals from the Santa Cruz Medical Foundation.
7. The Health Services Agency Physicians’ Association should be commended for pointing out the human and economic costs of physician lay-offs.
|
Entity |
Findings |
Recommendations |
Respond Within |
|
Santa Cruz County Board of Supervisors |
1 - 7 |
1 - 7 |
90 Days (September30, 2004) |
|
SCC Health Services Agency |
1 - 7 |
2 - 7 |
60 Days (August 30, 2004) |
The current HSA administrator provided the following information:
The consultant’s payment invoices gave total hours worked per month, but did not list how much time was spent on each project. The items in italics relate to the setting-up of MIS network.
B. Work projects listed by the consultant:
· Researched information on the Oregon Community Health Information Network (OCHIN) and advised the HSA on efficiencies of community clinic partnership.
· Reviewed and provided the history on the County’s contract with local hospitals for access to medical care for indigents.
· Attended a meeting with the three local hospitals to discuss the current status of the charity care agreement and possible amendments.
· Attended negotiation meetings with Sutter Hospital regarding its level of past charity care and alternative methods of meeting that contract.
Fiscal Year 2001/02:
A. Compensation: $59,843.75
B. Work projects listed:
· Consulted on the creation of the Safety Net Coalition, assisted with launching first meetings, including invitees, agendas, and minutes.
· Distributed the CAP grant requirements and initiated planning process for submitting an application to the HRSA.
· Continued work on Sutter Hospital charity care agreement including participating in negotiation meetings, preparing summaries of the parties’ positions, drafting and revising a letter of agreement between the county and Sutter Hospital.
· Provided for reducing county’s costs for Medi-Cruz services and increasing efficiencies.
· Facilitated strategic planning meeting of HSA managers, wrote-up results, and decisions.
· Provided FQHC certification options for community clinics and on available grants.
· Met with community clinics, county managers, and developed data for the Homeless Persons Health Expansion.
· Wrote a summary of the nursing shortage in Santa Cruz County and the potential impact on HSA.
· Acted as an advisor to plan the Summit on the Uninsured, attended the Summit and moderated one of the panel discussions.
· Consulted on long-term care issues related to Medicaid program.
A. Compensation: $88,281.25
B. Work Projects listed:
· Acted as an advisor on CAP grant and post-award notification.
· Wrote an executive summary, edited other sections of the first CAP six month evaluation report for HRSA.
· Analyzed the pros and cons of using OCHIN to provide expanded MIS for the HSA and the community clinics, including developing and analyzing cost analysis.
· Arranged and facilitated the full-day site visit of county and community managers with OCHIN executives.
· Advised on hiring a full-time contractor as the Health Improvement Partnership Executive Staff person.
· Researched federal and state Provider Loan Repayment Programs for county health care providers working in a Health Professional Shortage Area and prepared a memo.
· Consulted with community clinic executives on the Federally Qualified Health Clinic (FQHC) certification process including rate setting process and liaison with state Department of Health Services.
· Consulted with the Women’s Health Center on budget issues threatening the clinic and the role of FQHC reimbursement.
· Researched the Frequent Users of Health Services (FUHS) grant opportunity. Planned and conducted a strategic planning meeting for grant design involving Mental Health, Public Health, Medi-Cruz, the clinics, Drug and Alcohol, The Alliance, Dominican and Watsonville. Secured and analyzed data on frequent users from a variety of sources. Developed a budget (including sources of required matching funds), drafted sections of the grant, and edited the final grant. Wrote/edited responses to FUHS’s questions. Consulted/assisted with provision of a successful site visit from FUHS representatives.
· Consulted on Healthy Kids Insurance program’s relationship to HSA-operated programs (CCS, CHDP).
Fiscal Year 2003/04 (as of
January 2004)
A. Compensation to date: $12,250
B. Work Projects listed:
· Consulted on CAP grant renewal process including new requirements for two-year grants and goals for next years’ grant. Edited final draft of application. Continued work on the CAP grant implementation and write/edit second six-month evaluation report for HRSA.
· Consulted on FQHC certification options and issues for community clinics.
· Finalized rates for Women’s Health Center and Dientes.
· Prepared a paper on “Single Payer” Health Insurance.
· Consulted on the development of Healthy Kids insurance plan including preparing a letter of intent to apply for Robert Woods Johnson (RWJ) Community Funding Partners grant for $200,000.
The Former HSA Medical Director’s Total Compensation for 2000-2003: $184,900
The monthly invoices for payment
specified hours worked, but did not identify the number of hours worked on each
project.
B. Work projects listed:
· Planned and facilitated the closure of the county-run prenatal clinics, with the establishment of that service at Sutter Hospital, and transferred the contract for obstetric services from one obstetric group to another.
· Represented the HSA as a member of the Santa Cruz County Medical Society Board of Governors.
· Worked on the United Way’s Community Assessment Project as a member of the Steering Committee and chair of the Research Committee.
· Represented the HSA on the Pajaro Valley Community Health Trust.
· Participated in the planning and development of the Diabetes Collaborative.
· Participated in the establishment of the Oral Health Collaborative.
· Participated in the project to add fluoride to the water supply in Watsonville.
· Acted as a consultant to the HSA administration regarding medical marijuana.
· Worked on Hepatitis C education, worked to establish the Hepatitis C coalition of physicians in order to plan and develop a community-wide medical response to Hepatitis C.
· Represented the county on the California Chlamydia Coalition, participated in the development of the state’s Chlamydia Action Plan.
· Represented the county for the California Tuberculosis Elimination Task Force, and the California Adult Immunization Coalition.
· Established and led the committee of Emergency Medical Care Commission to review the then-current ambulance contract with American Medical Response.
· Assisted in jail and juvenile medical services.
A. Compensation: $61,620
B. Work projects listed:
· Assisted in creating the Safety Net Coalition.
· Assisting in creating the Health Improvement Partnership Council.
· Participated in the Community Foundation of Santa Cruz County’s focus group on health issues, participated in the subsequent planning for the summit on the uninsured, continued to participate in the planning and development of the Healthy Kids program, made presentations to community groups, and worked to ensure provider participation.
· Assisted in trying to increase the physician Medicare reimbursement rates.
· Assisted in the California Endowment grant application, which resulted in $500,000 for a two-year program at Salud Para la Gente.
· Continued work on the following projects: Santa Cruz County Medical Society Board of Governors, Pajaro Valley Community Health Trust, Diabetes Collaborative, Oral Health Collaborative, Watsonville fluoride issue, jail and juvenile medical services, medical marijuana, California Chlamydia Coalition, the state’s Chlamydia Action Plan, California Tuberculosis Elimination Task Force, California Adult Immunization Coalition, and United Way’s Community Assessment Project.
A. Compensation: $60,840
B. Work projects listed:
· Assisted in the development the of county’s plan for providing smallpox vaccinations to medical and public health personnel.
· Updated and redrafted the HSA Illness and Injury Prevention Plan and Blood borne Pathogen Plan.
· Assisted in working to increase Medicare reimbursement to Santa Cruz County physicians.[6]
· Continued work on the following: Santa Cruz County Medical Society Board of Governors, California Chlamydia Coalition, the state’s Chlamydia Action Plan, California Tuberculosis Elimination Task Force, California Adult Immunization Coalition, Community Foundation of Santa Cruz County’s focus group on health issues, Healthy Kids program, Pajaro Valley Community Health Trust, Diabetes Collaborative, Oral Health Collaborative, Watsonville fluoride issue, United Way’s Community Assessment Project, jail and juvenile medical services.
Fiscal Year 2003/04 (as of
January 2004):
A. Compensation to date: $13,120
B. Work projects:
· Continued to participate in the planning and development of the Healthy Kids program, made presentations to community groups and worked to ensure provider participation.
· Continued to assist in obtaining an increase in physician Medicare reimbursement rates.
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[1] It is not clear that another position was created. The Santa Cruz County Health Services Agency indicated to the Grand Jury that there was a vacancy in the position of chief of detention services and that the chief of clinical services was “helping out because she used to fill that position.” The Health Services Agency subsequently reassigned the chief of clinical services to the position of chief of detention services. Thus, the chief of clinical services position became vacant and a search for a new director has been instituted.
[2] ECG Web site.
[3] The Health Services Agency gave the Grand Jury two figures. The second figure was $6,160,000 with no explanation. The correct figure is closer to $3 million. The CAP and HCAP grants awards totaled $2,582,870.
[4] On another occasion, the Health Services Agency did not give full credit to the employee who wrote a report for the HSA.
[5] $955,965.
[6] The Santa Cruz Medical Foundation (SCMF) convinced the Health Services Agency and the Board of Supervisors that the Medicare reimbursement project would benefit the HSA. The physicians at the county clinics see very few Medicare patients. An increase in Medicare reimbursement rates will usually increase medical insurance rates paid by the county for its employees and its residents who have private insurance.