After reviewing two proposals to run an expanded Gifford Health Center, the County Hospital District has decided to issue a new Request for Proposals. That pushes the timeframe to hopefully have new services up and running at the center out to next fall.
The initial proposal process was to have wrapped up by the end of January, but it turned out the two proposals that came in were calculated with widely differing patient volumes. Trustee Allen Jones sent the proposals back to correct the “apples-to-oranges” issue, but ultimately, on the advice of the hospital district’s attorney, the board decided to restart the selection process and issue a new RFP instead.
Now a new wrinkle has come up in the RFP process: one of the potential applicants may have a problem providing free care, a requirement imposed by the hospital district.
Jones, who is spearheading the expansion project, wants treatment to be free for those uninsured medically indigent patients whose care the hospital district underwrites. But Treasure Coast Community Health, one of the two applicants, is a federally qualified health center.
That designation enables the clinic to receive federal funding, but it comes with requirements, including asking some patients to contribute financially to their care. That “skin in the game” requirement, as Treasure Coast’s CEO Vicki Soulé described it, may not be compatible with the free care Jones envisions at Gifford.
The Health Resources and Services Administration “requires a sliding fee scale discount fee be used for all patients who are uninsured or underinsured, up to 200 percent of Federal Poverty level,” Soulé said.
While that issue is resolved, the board is looking to the public for final input before the new RFP is issued. Services at the clinic would include primary and urgent care for adults and children; mental health counseling, including substance abuse treatment; and an onsite lab.
Healthy Start, the pre- and post-natal care organization, and We Care, a volunteer specialist physician group, can continue to be housed at the clinic, but would be supervised by the chief operations officer appointed to oversee the health center.
The board also discussed the inclusion of an onsite eligibility coordinator who would guide patients through the hospital district’s rules for qualifying for free care. That coordinator or a second staffer could serve as a navigator to connect patients to other services in the community.
The board still must decide on extended hours for the clinic as well as lease terms. Currently, the Department of Health leases the district-owned center for $1 a year. The Department of Health is the second applicant that wants to run the expanded center.
Management of the center will be contracted by the hospital district, not unlike the arrangement with Indian River Medical Center, now “managed” by Cleveland Clinic. The funding agreement will include performance metrics still to be determined in the RFP.
Jones suggested the formation of a collaborative group that would include a hospital district trustee and a representative from each of the organizations at the center, plus representatives from the Gifford community. The group would meet regularly to review the center’s performance.
With the question of whether to charge patients a co-pay still up in the air, Jones made clear he expects district-qualified patients – those patients who have no insurance including Medicaid or Medicare, and whose income falls below 150 percent of federal poverty guidelines – to receive free care.
Other patients, including those with private or government insurance, would be charged on whatever fee scale is used by the organization providing services
Jones, designated by the board to lead the Gifford Health Center expansion, offered a tentative start date of Oct. 1 for the new services.
“We’ve gotten advice and had a lot of public meetings,” Jones told the hospital district board at the January chairman’s meeting. “Once we get a draft [of the RFP] we’ll review it and develop it as well as get comments publicly from everybody, not only trustees, but every interested party.”
Once the RFP is finalized, posted, and responded to, an evaluation committee will analyze the proposals.
“We’ll take it item by item in the RFP so we’re as close as possible to an apples-to-apples comparison,” he told the board. “But we’ll also have the ability to use our judgment for what’s best for Gifford.”
That caveat is a nod to Gifford community leaders who have strongly supported continued operation of the clinic by the Department of Health. That state agency has run the center since it opened in 2003.
Of late, though, the Health Department has been strapped for funds, forcing closure of adult primary care at the Gifford center. In addition, as a government agency, the Health Department lacks the financial clout of Treasure Coast Community Health. A nonprofit company run by a volunteer board, Treasure Coast opened 20 years ago and now has seven locations in the county.