November 16, 2010

Commissioners say ‘no’ to more money for Hatteras health clinics


In a vote that all but ensures closure of one health clinic on Hatteras Island, the Dare County Board of Commissioners on Monday unanimously agreed to continue to provide $100,000 to subsidize medical care on the island.

Dare County Manager Bobby Outten said that the county does not have the additional $200,000 that Greenville-based University Health Systems of Eastern North Carolina said is needed to keep HealthEast Family Care clinics operating in both Avon and Hatteras.

“What they’ve told us is that they’ll close one of the offices,” Outten said on Tuesday. “It’s their decision which office.”

Outten said he expects UHS officials to respond in the coming weeks with a plan that will detail shutting down one facility. 

With no “knight in white”on the horizon, he said, the board decided it was better to give more time to face up to the inevitable rather than wait until its December meeting to vote.
“We would love to maintain the status quo,” Outten said. “But since we can’t do that, our goal is to disrupt the health care as little as possible.”

November 12, 2010

Keeping both medical centers open on Hatteras appears less likely


Squeezed budgets and escalating costs make it increasingly likely that Hatteras Island is going to lose one of its health care clinics.

Dare County Manager Bobby Outten said this week that other health providers have shown no interest in taking over operations of HealthEast Family Care in Avon or HealthEast Family Care in Hatteras , currently run by Greenville-based University Health Systems of Eastern North Carolina.

“We’ve pretty much exhausted all of our possibilities,” he said. “We haven’t found a suitor, if you will.”

After UHS told the county in July that it could no longer afford to keep both clinics open without additional revenue, Dare officials made proposals to The Outer Banks Hospital, Albemarle Hospital and Sentara Healthcare. But there were no bites.

“Economically, I’m guessing, it just wasn’t their market,” Outten said.

An update on the status of the clinics will be presented to the Dare County Board of Commissioners at its meeting on Monday, Nov. 15, he said.

The health system, which runs Pitt County Memorial Hospital in Greenville and is partner in The Outer Banks Hospital in Nags Head, provided three scenarios to the county in July:

UHS would completely leave Hatteras Island.

The county would continue to pay about $100,000 a year to provide for reduced on-call services and keep one clinic open, but with after-hours nursing care discontinued.

The county would pay $300,000 annually to keep both clinics open, with reduced on-call services and a cut in after-hours nursing care.
With UHS requesting the county’s answer by Jan. 1, Outten said that he expects the board will make a decision at its Dec. 6 meeting, the last one of the year.

Warren Judge, the board’s chairman, said that the county is committed to providing “good and dependable” health care to islanders, as well as visitors.  The county, he said, is grateful to UHS for the quality care given by the clinics’ three doctors.

“It’s regrettable with changing economic dynamics, it’s beginning to appear that a contraction of facilities is a real possibility,” he said.

“But it does not mean that there will be a contraction of services.” 

Judge said that it is premature to say what the board will decide, but he said he anticipates that a reasonable agreement can be made with UHS.

“We’re not naive to the fact that there’s going to be changes,” he said, “but we’re certainly optimistic that we’re going to work out the best possible deal.”

The Hatteras clinic is situated on federal land, which was donated to the county on the condition that it would be used only for a health facility.  But Judge said he is confident that if that clinic is closed, the county will be able to maintain the terms of the agreement with the federal government.

The health system has said that the cost-saving measures were necessary to address a $400,000 to $500,000 budget deficit.

Whatever the county’s decision, there will not be any abrupt bolting of doors on New Year’s Day, said Travis Douglass, vice-president and executive director of University Health Systems physicians, the company that contracts with UHS doctors.

There will likely be a 90-day to 120-day transition period, he said, to implement the changes.

“There’s a lot of logistics,” Douglass said.

Since each of the three options had specific costs associated with them, Douglass said that there is little room for the county to negotiate on issues like after-hours care.

But he said if one clinic closes, existing numbers of staff would not be reduced, and hours at the remaining clinic would be expanded.

Douglass said that even though UHS has not been charged any rent for the Hatteras clinic, and the county pays for most of the utilities and upkeep, the fact is that irrespective of direct costs, neither clinic generates enough revenue.

Many patients lack medical insurance, he said, or they are covered by Medicare or Medicaid, which provide lower compensation than private insurance plans. At the same time, it is expensive to attract primary care doctors.

Considering that Hatteras Island is relatively isolated and rural, he said, it is “atypical” to have three primary care physicians on staff.  In many parts of the rural North Carolina, he said, patients drive long distances for primary health care,.

“No doubt it’s a difficult challenge,” Douglass said. “It’s part of the paucity of care we have across the state.

 “We’re hopeful that health care reform is going to help. It’s not a Dare County problem ---- it’s an issue everywhere.”

Outten, the county manager, said that under a prior agreement to cover some clinic costs, $100,000 had already been budgeted for this fiscal year, and he anticipates that the county will be able to “continue spending what we’ve been spending.” But he said that an additional $200,000 is unavailable in the budget, and is unlikely to be found for some time.

Belt-tightening may be necessary, he said, but that does not mean the county has diminished its commitment.

“The sentiment of the board,” Outten said, “is there has to be health care on Hatteras Island.”

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