Tuesday, June 28, 2011

COSA Responds on Health Clinic

Retired Police Chief Russell Smith followed up on issues raised regarding the City Health Clinic for employees and retirees.  He asked Human Resources and Risk Management Director Lisa Marley if services had been reduced to urgent care only and why retirees hadn't been notified.  Marley responded with history on the role of the clinic.:

The first public declaration of the change in Clinic operations was made during the December 1, 2009 Council Meeting, where the discussion was about reverting back to acute care versus family practice, in order to devote time to employee wellness.  Complaints were being heard that patients were unable to secure appointments at the Clinic.  Upon review of the diagnoses it was determined that many appointments were for follow-up and long term care treatments that were better treated by a primary care physician.  Dr. Gordy Day was consulted for a list of the types of treatment that would be suitable for an acute care clinic. 

I believe she means urgent care, as hospitals provide acute care.

The next public discussion was during the November 16, 2010 Council Meeting when the representative of CareHere presented to Council.  The Council took no action of this agenda item.

Which makes that point irrelevant.

In December 2010, the City Manager and I met with employees and retirees during a series of week-long meetings informing them of the impending changes to the health insurance and the way that the self-insurance fund works.  Discussion included the fact that the City would be sending an RFP for bids on the operation of the Clinic.  During that discussion it was explained that the Clinic had morphed from the acute center it was created to be, to a family practice operation. It was discussed at that time that the RFP would ask for bids to operate an acute center because of the difficulty getting an appointment at the Clinic.  One of the meetings was held on December 1, 2010 from 7:00 PM until 9:00 PM specifically for the retirees.  Although the City Manager was unable to attend that meeting, I covered the same material as the daytime meetings, which included the Clinic discussion. 

The City specified the nature of clinic services via the RFP.

The RFP went out for bids in December 2010, and once a selection was made, it was presented to Council at the February 1, 2011 meeting.  Again discussion included acute care and the need for available appointment slots.  Community had made it clear that they would operate on a walk-in basis and would evaluate appointment scheduling if the patient load required.  Employee wellness would be handled through the hiring of a Wellness Coordinator and therefore would not interfere with the slots for seeing patients.
Community responded to mandatory elements of the City's RFP.  The City changed the scope of services relative to prior service offerings.  Note, the Wellness issue also arose in December 2009, but remarkably little progress has been made.

A series of questions were voiced by employees following the announcement that Community would be operating the Clinic.  The questions and answers were posted on the City Intranet page.  When the Clinic was approaching the date that Community would take over the operation, an email went out to employees reiterating the types of treatment that would be covered at the Clinic.  At no time did I conclude that retirees were not informed of this change.  In hindsight, perhaps the questions and answers could have been posted on the Internet versus Intranet page.
Hold onto Marley's position on communicating with retirees.  It comes in handy later.

Since Community took over on May 23, 2011, they have been informing patients, who either come in or call, of the change in operations.  They are accommodating patients who do not have a primary care physician by writing prescriptions for maintenance medications to tide patients over while they seek care elsewhere.  They are also assisting by providing a list of primary care physicians who are accepting patients.

A meeting is scheduled this week with the Community leaders to discuss the range of treatment available at the Clinic.  The County patients are also disappointed with the adjusted treatment.  The City is anxious to come to an agreement on an increased level of treatment available at the Clinic.
Clinic customers include County employees, also unhappy with lesser service.  It seems the City is ready to revisit their December 2010 RFP specs.

Here's the beauty of Marley's defense, which stated "at no time, did I conclude that retirees were not informed of this change."  Informed retirees occurred by what method?

Human Resources does not have a master list of emails for retirees, neither does it have an accurate listing of mailing addresses for retirees.  Any mass mailings to retirees result in one-third being returned for bad addresses.  I have spoken this week to an employee who is going to approach the Retiree Association to either get a complete list of emails or identify someone who can be the contact with HR for these types of notices in the future.
No letter to show, no e-mail to forward.

Thank you.
A June 27 e-mail to employees showed action on identified concerns:

City and County leaders met with the Community hospital leaders this week to discuss the concerns we’ve heard regarding maintenance type medications not being filled through the Clinic.  We have agreed that anyone who is on a maintenance type medication and only needs their levels checked and medications refilled will be able to get that service through the Clinic.  It will be the Clinic who will review your levels and determine whether or not you are still being properly maintained by your medication, or if your levels have changed to such an extent that you need further attention by a physician to get your levels regulated.  If you need specialized attention or a greater degree of medical management, you will be referred to a physician.  Once your levels are stable again, you will be able to continue with medications prescribed through the Clinic. 

Due to this added treatment through the Clinic, it may be necessary for the Clinic to return to an appointment system.  Community will evaluate this need and let us know.  Based on the needs of the patients we will continue to adjust and make changes as needed.  Thank you for your continued patience as we work to make the Clinic a better benefit for all.

Patient's patience is required.

Disclosure:  Information in this post did not come from Russell Smith, but from another equally reliable source

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