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Clinics Control the Costs

Govt. Agencies Save Money with In-house Health Clinics

By Christopher O'Donnell
Published: Monday, April 26, 2010 at 1:00 a.m. 

City of Lakeland officials emptied out a conference room in one of its administrative buildings a couple years ago and installed medical examining tables and EKG machines.

The meeting room became a four-room health clinic where city employees get basic medical services for free. Bringing medical services to its staff saved the city $1.1 million in health claims in just one year.

Now, a growing list of local government agencies including Sarasota County, the city of Sarasota and the Manatee County School District are considering opening clinics as they struggle with health care costs that have risen at double-digit rates in recent years.

Sarasota County, which insures about 5,000 workers, dependents and retirees, paid $29 million in medical expenses in 2009 and has budgeted about $31 million this year.

In Manatee, the school district paid out $37 million in insurance claims, up by $8 million from five years ago.

The district's health care fund is $6 million in the red.

"Health care is tough; we're all getting older and nothing is cheaper," said Steve Marcinko, Sarasota County manager of employee health and benefits. "There seems to be some savings out there and that's why we're really looking closely at it."

The clinic idea is simple. A government agency pays a fixed price to a medical company to run a clinic, usually located in a government building.

The company pays the salary of medical staff, typically a doctor, nurse and medical assistant.

When workers feel sick or want a checkup, they go to the clinic instead of their usual doctor.

Workers benefit because they pay no deductible or co-pay.

Employers save because they do not get doctor's bills. Also, workers typically spend less time out of the office in waiting rooms because clinics are in the workplace.

Significant savings can also be made by using the clinics for pre-employment physicals, bloodwork, drug and alcohol testing, and initial first aid for workers' compensation.

Clinic staff can dispense commonly used medicines bought in bulk, meaning lower prescription drug costs.

Charlotte County Public Schools converted unused classrooms and labs in its technical school into a clinic in January.

The district pays $600,000 to Healthstat, a Georgia-based company that runs more than 300 clinics nationwide. The money comes from premiums and money the district receives for running a wellness program.

Healthstat pays for a nurse practitioner, a receptionist and an office assistant who does lab work. It also pays for an overseeing doctor who is not based on site.

Staff there can prescribe from up to 40 generic drugs.

Officials plan to open more clinics in Englewood and Punta Gorda. They hope savings they make will allow them to lower premiums next year.

"Our claims were continuing to rise, which makes the premiums continue to rise," said Carrie Klum, manager of human resources and employee benefits. "Anyone who goes to the clinic, those claims will not be in our health insurance plan."

Port Charlotte High School teacher Bryan Bouton visited the district clinic Monday for a routine blood test to monitor his cholesterol and glucose levels.

Before the clinic opened, that required two trips to his doctor -- one for a referral and one to discuss the results -- and also a trip to a testing clinic. The two doctor visits would have cost Bouton $50 in co-pay costs and nearly two hours off work.

Now, he pops over to the clinic from the nearby high school and has the blood drawn in about 15 minutes. He will come back to the clinic after five days to go over the results. Neither appointment will cost him a penny.

"I like the clinic," he said. "I've never had to wait more than 5 minutes since I started coming here."

Julia Missura, a teacher's aide at Neil Armstrong Elementary School, visited the clinic to pick up free generic medicine for high blood pressure and acid-reflux.

"When I go to my doctor I leave work for three hours," she said. "This is great; this is my lunch hour."

Advocates of in-house clinics say the biggest savings will come from promoting healthier lifestyles that will prevent future illnesses and lost productivity.

Clinic staff detected the early stages of diabetes in Lakeland employees who were unaware they had the disease, said Karen Lukhaub, director of risk management and purchasing.

In Charlotte, school district workers get a $50 discount on insurance premiums if they agree to join a wellness program that requires them to fill out a health questionnaire and go for a blood test.

Workers then get advice on possible future health risks and how to avoid them.

Bob Goodman, manager of health benefits for Manatee County said clinics may work but government agencies need to focus on wellness programs if they want to produce significant savings.

Manatee County has five wellness centers where workers get advice on nutrition, regular exercise and managing conditions like diabetes.

"Most companies running these clinics do not have strong wellness programs," Goodman said.

Another concern is that clinics will take business away from family doctors and give those doctors an incomplete picture of their patient's illnesses and medical treatment.

Klum and other advocates say that should not happen since clinics only offer basic medical services. Charlotte workers are encouraged to maintain relationships with their family doctors and to send them copies of treatment records and test results.

Dr. Mark Droffner, who has practiced in Charlotte County for 20 years, said the clinic has not reduced patient visits.

But he said he is concerned that the clinic is not run directly by a doctor.

Some of his patients have been required by the Charlotte clinic to undergo health screenings he had already carried out, he said.

"I push preventative care. I make sure patients get the screenings they need," he said. "It fragments patient care when they start going elsewhere."

With around 5,000 employees, the Manatee County School District is that county's largest employer.

Officials there hope a clinic can make a dent in the $6 million deficit between premiums and claims.

"There's a lot of medical services we normally purchase out in the community that we are looking at giving to one company and having it under one roof," said Forrest Branscomb, district director of risk management.

This story appeared in print on page A1  Copyright © 2010 — All rights reserved. Restricted use only.
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