DAVID ROSENFELD

Orange County has a gem of a program on its hands. Its formula of leveraging federal dollars with consistent contributions from its county government has helped to create nine new health clinics since 2000.

The 11 clinics total – just two run solely by the county – are among 20 local healthcare providers that together create the Orange County Primary Care Access Network (PCAN). They now provide a medical home to 88,000 uninsured and underinsured patients, up from 5,000 patients in 2000 in a county that has a total of about 200,000 uninsured.

But without increased commitment from the state legislature and if the statewide property tax measure passes in January, Orange County officials say their aggressive plans to bring health services to more of the uninsured could be halted. At the same time, other counties such as Pasco County where a PCAN is just getting off the ground could be dead in the water.

On Jan. 29, voters will decide whether to double the homestead exemption from $25,000 to $50,000. The ballot referendum also includes other property tax breaks, including exemptions for business owners and mobile homes.

“Everyone is so proud of this model,” said Larry Jones, director of Orange County’s department of health and family services. “But there’s nothing on the capitol books that would suggest additional clinics. If the voters entertain some of the models that could be on the ballot in January, we would see a ratcheting down of funding.”

The way it works now, Orange County provides $12 million mainly derived from property taxes to leverage federal dollars. Those $12 million come back to the county as about $15 million. Instead of using that money to run county health clinics directly or administer a health plan like many other counties do, Orange County uses the funds to infuse Federally Qualified Health Centers either to help them get started or continue operating.

Rather than spending about $2,400 per patient through county administered health services, the county spends about $240 per patient on equal, if not greater, services. It’s a formula that’s capitalized on federal matching funds.

The health clinics also stay afloat by receiving federal grants, payments from Medicaid, fees charged on a sliding scale, limited insurance payments and donated services worth $4.3 million in 2007.

Local hospitals have seen dramatic drops in Emergency Department (ED) utilization, said Maureen Kersmarki, regional director of government affairs and public affairs of Florida Hospital.

The most recent data came in 2003, when area hospitals saw a 32.2 percent drop in non-urgent ED visits. By subtracting what it costs to treat people at the clinics versus what it costs for a visit in the ED, the hospital estimates there is a $400,000 savings.

The trick, says Kersmarki: “It’s not pouring money into this; it’s leveraging dollars that are already there.”

With its profound success, the Orange County PCAN has sparked similar initiatives in other counties throughout Florida, such as Pasco County, where an influx of new state dollars has expanded hours at one clinic on the east side and brought plans to open two more clinics on the west side.

Another aspect is building a base of volunteer physicians. Orange County has about 27 specialists and 1,200 physicians willing to volunteer some of their time. Pasco County, just in the beginning phases of recruiting doctors, has about 10 specialists on a list so far, said David Johnson, director of Pasco County’s health department.

In the 2007 legislative session, lawmakers came through in support of several PCANs. Sen. Mike Fasano (R-New Port Richey) co-sponsored a bill that brought a $3.5 million special allocation to expand PCAN services in Orange, Pasco, Manatee, Sarasota and DeSoto counties. In addition, Pasco County secured $7.7 million to build a 35,000-square-foot regional hurricane shelter that will also serve as a health clinic on the west side of the county.

About 18 percent of Pasco County residents – roughly 72,000 people – are uninsured while even more lack adequate health insurance.

“It’s an opportunity where the timing is right and it’s in line with our mission to promote and protect everyone in Pasco,” Johnson said.



January 2008