CLICK HERE TO READ SUNDAY HEALTH -- DOMINGOS DE SALUD COMPILED FROM HEALTHCARE.GOV
RIP Vicki Palmieri, First Known Martyr to PBC HealthCare District :: Discontinuity of Care was a contributing factor in Vicki's death. I took her to the clinic first in midsummer of 2013, because she was homeless, living at a bus stop, and had developed a terrible cough. The district took months to approve her for services, and even when she was finally approved, she found it difficult to get approval for the tests that doctors at Delray Beach Medical Center wanted to do. Under an agreement that was in force at the time, DBMC was not supposed to withhold care from any referred Brumback patient, but it was withheld anyways. More delays. By the time she was finally diagnosed, the picture was grim. Late stage metastasized lung cancer was spreading through her body. Crazy things. The district wanted Vickie to prove she was homeless. They gave her forms for a police officer to fill out confirming her homeless status. The cops wouldn't touch it. Finally a social worker at Boca Helping Hands completed the paperwork. One silver lining to a terminal diagnosis is instant qualification for Medicaid and a small SSI check, and Vicki was able to rent a little garage apartment, and finally start treatment. At least she was able to spend the last days of her life with some minimal comforts, so we were thankful for that. Vicki died in September of 2015. I promised Vicki I would tell her story.
<-- CL Brumback Board of Directors Meeting, AUG 30 - 2016
<---- Finance Committee Meeting Precedes BOD Meeting |
Very distressing that the HCD should put the lives of so many in jeopardy by putting so many patients into a system that is already undercapacitated to maintain continuity of care for the patients already in the system. More distressing that not one member of the clinic Board of Directors would perceive the danger. Executive Director of the Clinics Chris Irizarry drops the bomb about adding 4000 patients to the clinics roll, and nobody seems to bat an eye. Listen on the player (above left) at about the 41 minute mark, and again some other comments at about the 47 minute mark.
NEW AND EXISTING PATIENTS MAY BE IN JEOPARDY AS A RESULT OF HCD MOVE ADDING THOUSANDS OF ENROLLEES EN MASSE
"This is a dangerous and hasty move that will most certainly lead to lapses in Continuity of Care for patients already enrolled with the Clinics, and the 4900 new patients, and it is distressing that no-one on the board seriously questioned the logistics, economics, or medical ethics of this move." -- Mike Trout
"Recently, over 900 FloridaBlue patients were "steered" into Primary Care arrangements with the CL Brumback Clinics, primarily funded by the Palm Beach County Healthcare District, a special taxing authority that every property owner in PBC contributes to. The problem is that the Clinics are already strained for resources -- there is a shortage of doctors for the existing patient load, let alone adding such a large new group to the burden.
As an aside, there really isn't any reason why the HCD and the Clinics should be so strained of resources -- indeed, the taxing authority receives over $240 million a year from Palm Beach County taxpayers, although in comparison a relatively paltry $12 million or so constitutes the budget of the Clinics, which technically are a separate and independent entity (though that independence may sometimes seem illusory given the District's overbearing influence on all clinics business) also receive some funding from the federal government because of their status as a federally qualified health center (FQHC). You can review the HealthCare District financials here.
At last months meeting of the CL Brumback Board of Directors meeting, Brumback Director Chris Irizarry rather nonchalantly announced that some 4000 patients in the Health Care District's "Option 1" care plan would be moved from private primary physicians into the clinic program. (The HCD should consider tripling the number of primary care physicians to begin to adequately meet the medical needs of so many new patients.) The HealthCare district has over 150 employees, less than approximately 10% of whom are primary care physicians, to the best of my knowledge.
Neither the public, nor the 4000 patients affected had been advised of these upcoming changes at the time of the last Board of Directors meeting. It is unclear whether the private practice physicians have been apprised of the changes that will affect their patients.
This is a dangerous and hasty move that will most certainly lead to lapses in Continuity of Care for patients already enrolled with the Clinics, and the 4900 new patients coming on board, and it is distressing that no-one on the board seriously questioned the logistics, economics, or medical ethics of this move.
The CL Brumback Primary Care Clinics operate as a Federally Qualified Health Centers group, and the "Prime Directive," so to speak of an FQHC is that it is supposed to be an organization that is "patient driven."
Unfortunately, the Clinics do not make a serious effort to inform all patients of their part in this relationship, or even notify patients regularly (or at all) of the Public Meetings where clinic policy and procedure are determined.
As a Public Meeting, any member of the public or the press may attend and record any proceedings of the meetings.
The next PUBLIC meeting of the CL Brumback Clinics Board of Directors meeting is next Tuesday, September 27, at 2:45 pm at the Healthcare District headquarters boardroom."
Location: Health Care District Board Room
Map: 2601 10th Avenue North, Suite 100
Palm Springs, Florida 33461
-- Mike Trout
You NEED NOT be a resident of Palm Beach County to access adult or pediatric primary care services at CL Brumback, or ANY Federally Qualified Health Center in the country, although there are programs available through the PBC Health Care District that are available only for PBC residents, who contributed to the Districts FY 2015 budget of approximately $269,000,000 (million) through a special property taxing authority (representing an average contribution of $207 for every resident of Palm Beach County).
FQHC's (Federally Qualified Health Centers) offer Primary Care Services to communities across the country. While Community Health clinics have existed for over 50 years, FQHCs are expected to play a more central role in the primary care market under the ACA. Funding for Community Health Centers is slated to increase incrementally over the next few years.
FQHC's are not all created equal. Some are better funded than others (an important activity for center supporters is to engage in fundraising and volunteer recruitment -- activities which strengthen the core offerings of a Center). Some are newer, some have been in existance for years. Grants are available through the Health Resources and Services Administration for facility improvement through an application and approval process.
You will find dedicated public health stewards in all Health Centers. If your HC is struggling to fulfill it's mission, maybe what is missing is YOU. Get involved. Learn about the unique structure of a Federally Qualified Health Center, and it's mission to be an organization that is PATIENT CENTERED and PATIENT DRIVEN.
FQHC's (Federally Qualified Health Centers) offer Primary Care Services to communities across the country. While Community Health clinics have existed for over 50 years, FQHCs are expected to play a more central role in the primary care market under the ACA. Funding for Community Health Centers is slated to increase incrementally over the next few years.
FQHC's are not all created equal. Some are better funded than others (an important activity for center supporters is to engage in fundraising and volunteer recruitment -- activities which strengthen the core offerings of a Center). Some are newer, some have been in existance for years. Grants are available through the Health Resources and Services Administration for facility improvement through an application and approval process.
You will find dedicated public health stewards in all Health Centers. If your HC is struggling to fulfill it's mission, maybe what is missing is YOU. Get involved. Learn about the unique structure of a Federally Qualified Health Center, and it's mission to be an organization that is PATIENT CENTERED and PATIENT DRIVEN.
KUDOS: To Commissioner Angeleta Elting Gray for her leadership in the process of expanding the Scope of Services in Adult and Pediatric Dental Care in the CL Brumback Clinics, through her dual memberships on the Boards of the CL Brumback Clinics and the Health Care District Board of Commissioners. Contact your closest clinic for Dental appointments.
CLINIC LOCATIONS AND INFORMATION
Palm Tran Bus Schedules Walk In or Make an Appointment English Kreole Spanish Spoken
Primary Care Clinic Delray Beach 225 South Congress Ave Delray Beach, FL 33445 (Click on Address for Map) Phone: (561) 279-2665 (All Day & After Hours) Hours: 8 a.m. to 5 p.m. Weekdays 8 a.m. to 7 p.m. Wednesday 9 a.m. to 1 p.m. Saturday Primary Care Clinic West Palm Beach 1150 45th Street West Palm Beach, FL 33407 (Click on Address for Map) Phone: (561) 842-7383 (All Day & After Hours) Hours: 8 a.m. to 5 p.m. Weekdays 8 a.m. to 7 p.m. Tuesday 9 a.m. to 1 p.m. Saturday |
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-= WHAT TO BRING =-
- PROOF OF ADDRESS is required, with or without insurance (There is NO residency requirement to be a patient at the Clinics, but some programs offered through the Clinics co-applicant Health Care District of Palm Beach County may only be available to county residents.)
- IF YOU HAVE MEDICAL COVERAGE, please bring a copy of your insurance, Medicare, or Medicaid card
- RECORDS from other doctors and/or hospitals
- COMPLETE LIST of all medications you currently take
- COPIES of your Lab, X-Ray, and special procedure reports
- WHAT'S WRONG WITH YOU? Bring a list of ANY and ALL health concerns
- If you wish to apply for our Sliding Fee Scale, please bring one of the following items:
- Most current tax return, or three most recent pay stubs
WHAT'S WRONG WITH THIS PICTURE? :: The building above (Delray Brumback Clinic) was purpose designed as a Health facility, with 34 examination rooms. Dr Brumback might be sorely disappointed to find that in 2016, only a very small percentage of these examination rooms are being utilized for the purpose intended. With a budget of over $11 million, for all the clinics, Delray Clinic has LESS than one FTE (Full Time Equivalent) MD currently on staff.
-= BILLING =-
Patients' financial responsibilities are based on their financial classification, services received and insurance co-payments. Statements are mailed monthly for unpaid account balances. For additional information, please call one of the clinics.
Federally Qualified Health Centers (FQHCs) that receive HRSA funding or those that meet all the requirements of HRSA funded health centers but do not receive funding ("FQHC Look-Alikes") must provide access to services without regard for a person's ability to pay. They must also meet certain requirements regarding schedules of fees and discounts (often called a sliding fee scale) for the services they provide to ensure that the cost of services not covered by insurance are discounted on the basis of the patient's ability to pay.
Ability to pay may be determined SOLELY by a patient's annual income and family size according to the most recent U.S. Department of Health & Human Services Federal Poverty Guidelines, and in conformity with HRSA regulations. (No so-called "asset test" may be used in determining eligibility for free or discounted services.)
Federally Qualified Health Centers (FQHCs) that receive HRSA funding or those that meet all the requirements of HRSA funded health centers but do not receive funding ("FQHC Look-Alikes") must provide access to services without regard for a person's ability to pay. They must also meet certain requirements regarding schedules of fees and discounts (often called a sliding fee scale) for the services they provide to ensure that the cost of services not covered by insurance are discounted on the basis of the patient's ability to pay.
Ability to pay may be determined SOLELY by a patient's annual income and family size according to the most recent U.S. Department of Health & Human Services Federal Poverty Guidelines, and in conformity with HRSA regulations. (No so-called "asset test" may be used in determining eligibility for free or discounted services.)
-= CURRENT SLIDING FEE SCALE AT CL BRUMBACK PRIMARY CARE CLINICS =-
WHAT'S WRONG WITH THIS PICTURE? :: The CL Brumback Sliding Fee Schedule is very NON-Transparent. This notice posted in service windows indicates a discount (Sliding Fee Schedule), but does not disclose the 'list' cost of provider encounters, nor does it differentiate between different professional capacity levels, i.e., whether a patient is visiting an RN, an ARNP, or a Physician. From a consumer standpoint, it's problematic. Prospective patients have left the clinic without obtaining health services because they could not determine their personal liability. Additionally, this notice may be evidence of a violation of the spirit and letter of HRSA rules regarding the establishment of 'Nominal' charges. The rule states, "A nominal charge must be a fixed fee that does not reflect the true value of the service(s) provided and is considered nominal from the perspective of the patient." Nominal as defined in Google Search dictionary: "(of a price or amount of money) very small; far below the real value or cost." From the standpoint of many poor patients, $20 doesn't sound particularly 'nominal' at all, especially juxtaposed with the clinics' $36 per patient per month capitated fee for UNLIMITED primary care visits, as established by agreement between the Health Care District and the Brumback Clinics.
UPDATE :: The Healthcare District has reduced payments from $36 per patient per month to $18.
WHY HAVE PATIENT COPAYS NOT BEEN SIMILARLY REDUCED?
BY THE HEALTH CARE DISTRICTS OWN ARITHMETIC a majority of Clinic patients are 'members' of an HCD Capitation program that pays for Unlimited primary care visits at the rate of $18 per patient per month, reduced from $36 per enrollee per month (this is a REMARKABLE achievement, even given the Clinics VERY LIMITED SCOPE OF SERVICES). This was recently reduced from $40 a month, presumably based on efficiencies cited by the Health Care District and management of the Brumback Clinics, and should represent a starting price point for public taxpayer partners. Rather than reduce compensation to the primary clinics, the Health Care District SHOULD have expanded the scope of services in the clinics. It's widely accepted that comprehensive and regular primary care has a positive impact on Public Health, so every incremental expansion of scope of services should translate to gains in the campaign for the so-called Triple-Aim of Better Care, Lower Costs, and Better (Health) Outcomes.
If indeed the Health Care District of Palm Beach County has figured out a way to provide UNLIMITED primary care visits at a cost of $18 per patient per month --- the WHOLE WORLD should be interested in how that is done. And patients who are taxpayer partners with the Health Care District, but do not qualify for any subsidies, should be asking how the District could be charging as much as $200 for a visit, which may not even include seeing a doctor.
If indeed the Health Care District of Palm Beach County has figured out a way to provide UNLIMITED primary care visits at a cost of $18 per patient per month --- the WHOLE WORLD should be interested in how that is done. And patients who are taxpayer partners with the Health Care District, but do not qualify for any subsidies, should be asking how the District could be charging as much as $200 for a visit, which may not even include seeing a doctor.