“The first rule of holes: When you're in one stop digging.”When I first read about the soon-to-open Fort Wayne Community Schools Walk-In Clinic for the benefit of employees enrolled in the district's health care plan, I thought that it might be a good idea for the city's largest employer. After all, clinic services in this town are a bit scarce with provider Redi-Med offering the bulk of such services here - divided between the general public and specific employer services.
― Molly Ivins
I have been reading about retail-based clinics at CVS, Walgreens and Walmart stores, which offer extended hours of service staffed with nurse practitioners and physician's assistants handling the bulk of routine work for a skeleton staff of physicians. These services are growing like gangbusters. In the Indianapoliis area, there are 11 Walgreen Take Care clinics, 14 CVS Minute Clinics and 5 Walmart sponsored clinics. They all charge about $79 (and your insurance card works) per visit to start and they operate seven days, with 12 hours of operation on weekdays. No Virginia, none of these retail giants operate a clinic in our area code for christsakes!
That aside for now, the more that I looked at the FWCS proposal, the more uncomfortable I have become with the new use for my tax dollars. The school district has contracted with NoviaCare to operate the two clinics composed of a Physician, a Certified Physician's Assistant and a Licensed Practical Nurse at each location. the clinics will be open for what appears to be eight hours per day, five days per week. The $1.1 million dollar contract that Noviacare negotiated is for personnel only. FWCS will rent one clinic for almost $30,000 and will remodel an already owned building off of W. Jefferson Blvd. Then of course, FWCS must buy the examination equipment, furnishing the stores, pay for utilities, supplies and (dumb to dumb dumb) contract for business insurance in the face of all the dangers that go with being associated with medical practices in this country.
Now let me illustrate what a fine deal that NoviaCare got. If these two doctors work 40 hours, for 48 weeks, see 4 patients per hour and bill $75 per hour (give or take) then that would equal $1.1 million. I seriously doubt that any physician in private practice even comes close to billing that many hours. The ultimate kicker here is that neither FWCS employees nor Anthem Insurance will have to pay out a single dime for these clinic services. What generous people we taxpayers are!
But ... but Mr. Gadfly, you forgot about the budgeted reduction of four million dollars for 2012 FWCS health care costs! We are going to save $5 million and spend $1 million -- that is one heck of good trade-off. Well ... it may not be so good of a deal. See, what happened here is that General Assembly voted to require employee contributions to be a minimum of 15% of health care premiums and FWCS had previously only charged 10%. In the 2009-2010 school year, the school district spent exactly $47,729,444 (whoa! that is an expensive plan) to fund provider payments because the district is self-funded for claims up to some very large number when an umbrella policy takes over. FWCS also admits to seeing a $2 million dollar increase in insurance costs each year, so the gross expectations for 2011-2012 would be in the $50 million range. So since the employees must pay an extra 5% of the premium -- that $2.5 million of the budget reduction.
On the surface, it might first appear that the clinic could indeed relieve Anthem from paying another $2.5 million. The math suggests that the 3,100 enrolled employees and their family members would have to make a total of 33,333 visits to the clinics which works out to be more than double the 15,360 total visits that can be handled by the two docs. Yeah, I know that employing PA's might increase somewhat the number of patients seen if the demand is there. However, Kathy Friend, the FWCS CFO says that the store lease on Old Auburn Road can be shortened if needed because of concerns about how many enrollees will use the clinic. In the real world, Center Grove School District reported zero savings for operating a single NoviaCare clinic in 2010 and are making noises in the press about saving $48,000 this year due to some convoluted logic that declares that the clinic reduced teacher time away from class.
Lest I be accused of overlooking the new HSA insurance program offered this year with the district contributing $1,500 for singles and $3,000 to families savings accounts, while substituting high deductible insurance coverage for catastrophic health issues. I agree that the 26% of the total enrolled participants migrated to this plan will make some dent in overall claims submitted, but I have no idea how much that would be. My opinion is that the HSA scheme should be adopted by the School Board as the only option offered. This would be the safest way to assure a budget reduction. Some people do not want to bothered with making new choices so they elect status quo if it is available.
What we do not know about future health care costs would fill an awfully big hole. Self-funding of insurance claims subjects the risk taker to large swings when expensive procedure after procedure and one permanent disability after another begin to pile up in a single year. Budgeting health care costs involves the same junk science used in playing the stock market.
If you recall, we began talking about the retail walk-in clinic popularity which is defying Obamacare at every turn. Wouldn't it make more sense for our largest employer and for interested school districts surrounding Fort Wayne to approach these retailers that appear to love this town to open some clinics so that all taxpayers could benefit? I wonder how much motivation a $10 million dollar tax incentive over 10 years would bring to the likes of CVS or Walgreens?
Don't hold your breath because this is all about what the teachers' union wanted and they wanted something to take to the membership to justify why they were seeing an increase in insurance premiums. Teachers' unions elect school board members to vote favorably on union benefit increases. No conflict of interest is ever acknowledged.