There's no dulling the pain of state health cuts

YAKIMA, Wash. -- Hospitals, neighborhood clinics, nursing homes and other public health care providers are still assessing the damage from budget cuts approved by the state Legislature, but nearly everyone agrees that services will be hurt at a time when demand is expected to grow.

"Right now it feels like almost 35 years of building a safety net for our community's fragile and most vulnerable residents is being dismantled with a stroke of the pen," said Anita Monoian, chief executive of Yakima Neighborhood Health Services, a clinic near downtown Yakima that bills on a sliding scale based on income.

The 2009 Legislature cut about $1 billion from health care in an effort to close a nearly $9 billion budget shortfall. One-quarter of that will come from rural clinics, such as Neighborhood Health, Yakima Valley Farm Workers Clinic and Central Washington Family Medicine.

But there is some good news buried in the bleakness.

Unlike the $1 billion state deficit of 2003, public health districts came out relatively unscathed, which is fortunate timing given the swine flu outbreak, said Dennis Klukan, Yakima Health District administrator. The Health District's $6.2 million budget is a combination of federal and state funds plus fees collected from inspections of restaurants and wastewater systems.

"It wasn't a turn out-the-lights and shut-the-door budget for us," Klukan said recently.

The cuts begin to take effect June 30.

Hospitals and clinics around Yakima County will be particularly hit by lower rates of reimbursement for Medicaid -- health care for the poor.

At the same time, more than 5,000 people in Yakima County will be dropped from the state's Basic Health Plan, which subsidizes insurance premiums for low- to moderate-income families, according to the Washington State Hospital Association. Statewide, 38,000 people will be dropped.

Basic Health cuts are sure to send more people to hospital emergency rooms for routine care, which in turn shifts the cost onto private-paying customers, said Cassie Sauer, spokeswoman for the hospital association.

Hospitals that offer services heavily dependent on Medicaid reimbursement, such as obstetrics, will also see cuts. Nearly 75 percent of the births in the county are reimbursed by Medicaid compared with 50 percent in other areas of the state.

Yakima Valley Memorial Hospital, the only birthing center in the city, is in the process of "analyzing everything from A to Z," said Rick Linneweh, chief executive. The hospital is staring at a $9 million to $10 million cut in state funding over the state's two-year budget period.

"There are two principles on our table: to try our hardest to keep people employed and to keep an array of services available," Linneweh said.

Yakima Regional Medical and Cardiac Center will feel a pinch, but because its services target a patient population that is likely to have full insurance, the cuts will be smaller than Memorial's.

Regional nevertheless will "look diligently" at expenses, said Tim Thornell, chief operating officer.

The hospital also sees an opportunity to boost revenue at its inpatient rehabilitation unit, where stroke and other seriously ill patients work to recover normal function.

"It's a great service line and the only one in the Valley. We know there are more patients who could benefit from it," Thornell said.

Regional's sister hospital, Toppenish Community -- which offers obstetrics -- will lose about $2 million. Both hospitals are owned by Health Management Associates of Naples, Fla.

The state is trying to shave some costs from obstetrical services by cutting reimbursement for routine Caesarean sections. Nationally, an increasing number of women are forgoing vaginal delivery for the relative comfort and predictability of surgery, even when it's not medically necessary.

"We should not pay higher for an elective C-section when you can do it naturally," said Dr. Jeffrey Thompson, chief medical officer for the state Medicaid program.

Dr. Mike Maples, chief executive of Community Health of Central Washington, said the cuts will set clinics back in their effort to perform more disease management rather than seeing the greatest number of patients possible.

National health care reform can't come a moment too soon, he added.

"I'm optimistic that in 18 months with health care reform that things will be back in place," Maples said.

Outside of hospitals and clinics, health care providers like Central Washington Comprehensive Mental Health and Southeast Washington Aging & Long Term Care say they'll likely let open positions go unfilled rather than cut services.

Nursing homes say they will have to cut staff or reduce the number of beds available in order to absorb lower reimbursement rates. Families will find fewer options for caring for their elderly relatives, said Gloria Dunn, administrator of Landmark Care Center in Yakima.

"We will have stepped back 50 years in time and quality to when nursing homes were frightful places," Dunn wrote in a recent letter to the editor of the Yakima Herald-Republic.

Steve Hill, director of community services for Yakima County, said reduced funding eventually makes services more expensive.

"When we fail to serve those in need, they end up in the jails or the ER," Hill said.

* Leah Beth Ward can be reached at 509-577-7626 or lward@yakimaherald.com.

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