Health

Tuesday, Dec 11 2012 06:55 PM

County could move residency program to Clinica

BY CHRISTINE BEDELL Californian government editor cbedell@bakersfield.com

County supervisors may save Kern Medical Center's highly touted -- but financially perilous -- family medicine residency program by moving it to a new Clinica Sierra Vista health center planned for east Bakersfield.

That is the program's best hope for survival because no other local hospitals or major healthcare providers have expressed interest in joining a communitywide residency system or offering the significant financial help needed to support the existing one, the Kern County Board of Supervisors heard Tuesday.

That's despite the fact doctors expressed outrage when Kern Medical Center CEO Paul Hensler decided in February not to take a new class of family medicine residents and possibly shutter the whole program later because the county hospital loses millions of dollars on it each year, currently about $4.5 million.

The doctor training program is essential, supporters said, because many graduates choose to practice here at a time the valley desperately needs primary care physicians. The outcry convinced the Board of Supervisors in March to continue the program, ensuring its life for at least three years. Family medicine residency is a three-year program, with six physicians in each class.

On Tuesday, the Board of Supervisors heard from Hensler and a consultant who has been evaluating the residency program and options for continuing or scrapping it.

The consultant, Kiki Nocella, met or attempted to meet with officials from all the local hospitals and other major health providers about their interest in joining a multi-group residency program, helping support the existing one or some alternate option, Hensler said.

There also was an "all hands" meeting of healthcare providers on the topic in October, he said.

Significant commitments of help, except from Clinica, have not materialized, Hensler said.

"No one has been running toward us with their checkbook out yet," he said.

Hensler said a major recipient of the doctors who graduate from the residency program wouldn't meet with Nocella. He wouldn't name that entity, but Nocella had just reported that of the 66 graduates from 2000-2011, 27 are still in Bakersfield and 10 of those work for Kaiser Permanente.

Leslie Golich, public affairs director for Kaiser, told The Californian she told Nocella she could facilitate a meeting, but no request for a meeting came though her office. Golich said she'd still be happy to arrange a meeting.

In an email from Golich to Nocella, though, Golich wrote: "We will not be able to provide any funding for the program but could possibly provide a 'shadow' rotation through our specialty services."

Robin Mangarin Scott, spokeswoman for Mercy Hospitals and Bakersfield Memorial Hospital, quoted Memorial CEO and President Jon Van Boening as saying the county never presented him a plan or official request for financial help.

Nocella said that's true, but no one from those hospitals attended the all-hands meeting where help would have been requested.

And Jarrod McNaughton, vice president of marketing and development at San Joaquin Community Hospital, said his hospital doesn't have the clinic infrastructure for a family practice residency rotation. He said his hospital suggests the county explore starting a new program that would attract higher government reimbursement rates for residents before asking local hospitals for a subsidy.

The hospital officials, however, seemed open to continued talks with the county. They did not attend Tuesday's meeting.

The Clinica deal could, in fact, put the program on firmer financial footing.

Clinica attracts higher reimbursement rates on MediCal and Medicare patients, operates under higher productivity levels and would "give a 'fresh start' to the existing program," a report delivered by Nocella said. Hensler said the arrangement with Clinica could cost the county more like $1 million or $1.5 million, still a loss but significantly less of one than now.

The supervisors voted to explore additional talks with Clinica. They also asked Hensler to draft an opinion piece to run in The Californian explaining why the residency program benefits the community and why hospitals should support it.

Supervisors also asked Hensler to again reach out to hospital officials.

If the deal with Clinica goes through, the residents would work at a health center Clinica plans to build on East Niles Street. Construction is slated to start in late spring or early summer of next year and be finished about nine months later.

Clinica CEO Steve Schilling said the deal with the county would be an extension of his 40 years of effort to bring doctors to this community and keep them here.

It'll be particularly critical when health care reform fully kicks in and far more people have coverage, he said.

"We can't lose training programs that have the potential to bring new health officials to our communities," Schilling said.

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