The takeover of the city and county’s health-care clinics began in earnest last week as the Travis County Healthcare District filed the federal paperwork to assume grantee status as the operator of the federally qualified medical clinics.
What does this mean for clients? Not much over the next 18 months, but when the transfer is complete in February 2009, the district promises a more responsive and efficient clinic system tailored to local needs. Shorter lines and longer hours? Cheaper drugs? Better service? Yes to all of those, says Carl Richie, who just began his term as chair of the district’s board of managers. “I think we’re in a position to probably give more attention to the health-care side of the equation as the health-care district,” Richie said. “In the city or the county, you’re talking about one among many other departments. For us, this is our whole focus.”
The district already manages the clinics under a contract with the city of Austin. But this filing, with the federal Health Resources and Services Administration, signals the district’s willingness to begin the lengthy process to “unplug” the clinics from the city and “plug into” the district, attorney Sally Henly explained in an update to the board of managers last week.
This is not as simple as handing over the keys and waving goodbye at the door. Between now and the target date for the clinics’ transfer to a 501(c)3 nonprofit corporation affiliated with the district, its staff will create backroom operations for the clinics, set up procedures for clinic operations, develop processes for areas such as financial reporting and contract management, and set performance benchmarks for the 18 clinics in the system. After all that, there are still legal and procedural requirements to be satisfied and decisions to be made. For instance, the district is likely to lease space for the clinics that are part of existing community centers. In that case, it might make more sense for the city to continue to provide janitorial services for the clinics. Each clinic is different, and each will require a thorough review, Henly said.
Betty Dunkerley was the City Council member most active in the clinic issue. Her task this last legislative session was to get the issue of proportionality addressed. Most of the 450 city employees – Austin runs both the city and county clinics – will move over to work for the district’s nonprofit corporation. Legislation this session ensured their accrued years of city service would go with them. “We worked very hard at the state Legislature to make sure [that] when they move over to the other organization, their years of service go with them,” Dunkerley said.
Dunkerley considers this next step – plugging the clinics into the district’s system – to be part of the maturing of the local public-health-care system and a natural step. The city’s onetime chief financial officer says she’d like nothing better than to see the clinics function and operate even better than they did under city control. “If they can do things more efficiently than we did it, that’s great,” she said. “My interest is health care in this community, and the more efficient we are, then the more people we can serve. Sometimes it is much easier to be efficient in a smaller organization, and if that’s the case, let’s hope they are a superperformer.”
This article appears in July 13 • 2007.