Last February, a consultant hired by Ventura County concluded that the county's six public clinics were choked by red tape and burdened with too many administrators and an inept billing system. The consultant recommended a major overhaul.
Eight months later, change has yet to sweep the clinics, despite numerous committee meetings and pleas from clinic doctors who say they spend too much time doing paper work and too little treating patients.
Ventura County Health Care Agency administrators, however, say improvements are just around the corner. A committee formed about 5 months ago is considering an innovative proposal to let doctors run their own clinics, much as they would in private practice.
Shift of Responsibility
Physicians would assume responsibility for hiring and firing, day-to-day operations and many of the administrative tasks now handled by the Ventura-based health-care agency.
The plan, which may come before county supervisors as soon as next month, is expected to be tested during a 6-month to 1-year pilot program at West Ventura Clinic, said Dr. Richard Ashby, the assistant medical director for the Ventura County Medical Center.
"This could really make the clinics more effective and provide better patient care," said Dr. Katherine Stewart, of the Colonia clinic in Oxnard. "The way the clinics are run, there are little inefficiencies that add up every day."
The "semiprivate clinic" proposal is the latest attempt by Ventura County to improve its public health-care system, which suffered a severe blow last year when county officials discovered a $12-million health-care agency deficit. The agency's annual operating budget is $173 million.
That deficit was later blamed on years of poor management, sloppy accounting and computers too antiquated to handle the volume and diversity of billings.
At the time, the county considered dismantling key parts of its public health system--including its satellite clinics in Ventura, Oxnard, Moorpark, Simi Valley and Santa Paula that served as the chief source of medical help for thousands of elderly, disabled and indigent residents.
Instead, the Health Care Agency cut its patient load 8% by pruning 200 of its 1,200 jobs and trimming 35 of the Medical Center's 145 beds. It also upgraded its computer system in an effort to collect overdue bills.
Officials say the measures worked. By spring, the county congratulated itself for averting a crisis and said it expected to post a $1-million operating surplus for 1988.
But while the figures indicate a full recovery, clinic doctors and nurses say there have been hidden human costs. Clinic patients today face longer waiting times, fewer doctors and slightly steeper prices.
And medical professionals say there may be another, more dangerous cost that is not visible to health-care finance officials.
"I see people waiting a longer time to come in for a problem," said Dr. Joanne Baumer, one of two doctors at the West Ventura Clinic. "I see people letting urinary tract and vaginal infections go for weeks. They say, 'I can't come in--it costs too much.' "
Baumer recalled a young woman with a urinary tract infection who asked for a prescription by telephone so she could avoid the office visit fee. Baumer refused. Two weeks later, the woman finally came in, but by this time the infection had spread to her kidneys and could have caused serious damage if it had gone untreated, Baumer said.
Or the family with "big, weeping sores," one of the worst outbreaks of impetigo that Baumer had seen. The father noticed blisters on the face of his 4-year-old son but did not bring him in because it was too expensive, Baumer said. Ten days later, the father showed up at the clinic with two other sons in tow. All four were then infected.
"This is a very easily and cheaply treated disease," Baumer said.
A standard clinic visit runs from $40 to $50, Ashby said, which is comparable to fees at private urgent-care clinics that demand payment with service. Most patients at the public clinics are subsidized by Medicare or Medi-Cal, and some lack insurance coverage. In any event, doctors say even a $5 increase can be enough to deter the very poor from seeking treatment.
When the West Ventura Clinic opened in 1983, an office visit cost $35 to $45, and Baumer believes the modest increase now keeps some poorer patients away. She and Dr. John Ford, the only physicians in the modular building on Ventura Avenue, the main artery in the county's poorest census tract--have urged the Health Care Agency to establish a sliding scale for medical services. The system would reduce costs for simple, routine procedures and raise costs for more complicated and time-consuming ones.
At another county clinic, a registered nurse who did not want to be identified agreed with Baumer's assessment and suggestions.