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Leading the Way on Health Care

by Indy, published

It's just the type of program the Obama administration should have wanted to hear about during yesterday's health-care forum in Los Angeles, because it's a great example of innovative ways to meet health-care needs.

The nationally accredited family medicine residency sees 230,000 patients a year through a public-private partnership. It trains 27 physicians a year, many of whom remain in an under-served county with a 16 percent unemployment rate and 20 percent of its people on Medi-Cal. Graduates of the program have a 100 percent success rate in passing board exams on the first try. Most of the doctors - 75 percent - remain in California after they're trained.

It's too bad the federal government on one hand refuses to admit the program exists but on the other wants a California county and a private hospital to repay millions of dollars in funding the feds contributed over almost a dozen years.

Confused? So are officials in Stanislaus County, where the board of supervisors reluctantly voted recently to pay $11.1 million to keep its medical residency program going through June 2010.

"They're telling us it's an excellent program and that they have no problem with it continuing," County Director of Legislative Affairs David T. Jones said. "They're just not going to fund it."

"They" would be the Centers for Medicare and Medicaid Services in the Department of Health and Human Services.

The agency long had funded the residency program, continuing the contributions after it became a joint venture between the county and Tenet Healthcare's Doctors Medical Center when the county closed its hospital in 1997 and contracted with Doctors for indigent care.

The residency program, which has existed in one form or another since 1935 and currently is academically accredited through the University of California at Davis, involved out-patient training at county-run clinics and in-patient training at Doctors.

The feds had no problem with that until last summer, when officials decided that the county should have officially closed the old residency program and created a new one in 1997. CMS declared that the program had not existed since 1997 and told the county and Doctors to pay back $19.1 million.

County officials asked a CMS official to point to federal regulations requiring that. "We were told, 'You're not going to find it in the regs. It's all in my head, but it's not inconsistent with the federal regs,' " Jones said.

So the county went back to work, hastily drawing up a new program that expanded the private partnership to two other hospitals in the county. Officials could have it ready to roll by 2010, Jones said.

"CMS loved that model," Jones said. "But they told us we had to shut down everything for one year. Fire all the faculty and start over."

So on one hand, the feds say the program doesn't exist and demands that $19.1 million be repaid. But on the other, they say the county has to shut down the program it doesn't acknowledge before it can start a new one.

"We're dealing with a rogue agency here," Jones said.

Even though the county already was facing a $35 million budget gap, it has no choice but to come up with the $11 million to keep the program going, Jones said. If the residency ended, 30 family-care physicians who form its faculty would have left the county. "And where would those 230,000 patients have gone?" Jones asked.

The county plans to again ask CMS to reconsider, and it has the support of groups statewide.

"President Obama has made primary care and prevention the centerpiece of his health reform plan," the California Medical Association wrote in a letter to CMS. "To achieve these goals, we will need family physician residency training programs like the crucial one in Stanislaus County. Preservation of this quality family medicine physician training program is consistent with the president's national health care goals."

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