Clinic Keeps Pace as Healthcare Evolves

Laguna Beach Community Clinic added a new associate medical director to its roster in Dr. Jorge Rubal, though Rubal is far from new to the clinic.

While a medical student at UC Irvine, he completed a rotation in family medicine at the clinic in 2005 and continued to volunteer after finishing his residency. After several years in family practice in Pasadena, Rubal moved with his wife and son to Laguna Beach and joined the clinic fulltime as its third family medicine physician.

While building his practice, Rubal will also be heading up an expensive clinic initiative driven by national health-care regulations, a government mandate to convert patient medical records to an electronic format.

The fulltime presence of Rubal at the clinic as well as the impact of federal healthcare reforms that went into effect this year has the clinic’s longtime director, Dr. Tom Bent, bubbling with excitement. Despite an increasing administrative workload billing insurers as more clinic patients take advantage of the Affordable Care Act, Bent said, “healthcare reform is an incredible benefit for our patients.”

A majority of the clinic’s patients are the working poor; restaurant workers, teens, artists and entrepreneurs who live at the federal poverty line defined as an annual income of $18,819 for a family of four and $12,015 for two. Half the clinic’s patients live or work in Laguna Beach

Bent takes pride in the quality of care provided by the clinic, which has come a long way since its free-clinic founding in 1970. Today, patients pay for services on a sliding fee scale based on their ability to pay. And the clinic’s revenue is supplemented by foundation grants and government contracts to provide MediCal and Medicare services.

The clinic treats 500-600 urgent care patients a month for a range of maladies and handles 16,000 patient visits per year. The typical payment by a patient is $20 while the average cost of care per patient visit is $162, according to a clinic report.

To be sure, healthcare reform is already impacting the source of the clinic’s revenue, though the net effect isn’t yet clear. Funding from a county health care program has declined as patients move into other programs, but payments to the clinic from Cal Optima are increasing because of an expansion of Medi-Cal benefits, according to a report presented at a January meeting of the clinic’s board.

And one of the clinic’s reliable benefactors, the Ryan White Foundation, which had subsidized services for 127 HIV AIDS patients, cut payments to just 38 patients recommending they get treatment elsewhere to take advantage of newly available insurance.

Clinic officials anticipate that their HIV AIDS patients will want to continue with the doctors they know. Despite the loss of foundation funds, the clinic adheres to its policy to “never send anyone away,” said Roya Cole, the clinic’s board president.

The shifting revenue sources require a constant juggling act to balance the clinic’s $2.3 million budget, which reported a 4% loss in the fiscal year ending June 30, 2012, the most recent financial reports available on Guidestar, a non-profit database.

Even so, “the clinic continues to go the extra mile” for their patients, “especially for those who don’t have insurance,” said Richard Cain, the clinic’s chief financial officer, who adds that this will “absolutely be a big fundraising year.”

The clinic’s staff uses a somewhat unique approach, what Bent calls a “patient-centered medical home.” Focusing on the whole person, the family practitioners can provide a comprehensive treatment plan for their patients by calling on volunteer doctors in a range of specialties that include urology, neurology, cardiology, pediatrics, and endocrinology. Rarely is a patient referred away from the clinic.

Bent points out that all the staff members are authorized to do what it takes to get their patients the care they need. If a patient qualifies for funding from a government program the clinic helps to arrange that. “We are all social workers as well as doctors and nurses,” he joked.

The clinic has also earned a reputation of leadership in the treatment of patients suffering from HIV AIDS thanks to Dr. Korey Jorgensen, who after years as a clinic volunteer joined the staff full time in 1990 to start the HIV treatment program. The clinic provides anonymous testing with results in 20 minutes. In addition to Jorgensen, full time staffer Dr. Chau Ngo is also certified in HIV treatment and is a diabetic care specialist as well.

To keep everything going, “we all wear many hats,” says clinical director and registered nurse Adrian Sayegh. Administrative costs account for less than 10% of the budget according to Bent who also notes that while salaries make up the biggest portion of the budget, the clinic doctors are earning less than their peers in other settings.

And clinic administrators readily agree the organization would not succeed without the contributions of time, money, supplies and services of individuals and businesses in the community. The clinic’s largest annual fundraiser, the Cinco de Mayo Fiesta, takes place this year on May 4 and continues to be well supported by the community. This past week, the clinic’s legacy donors were thanked at a luncheon.

Bent, who has been involved in the clinic since 1982, left a full time faculty position at UC Irvine to become medical director in 2002 and in 2005 he took on the title chief operating officer. He hopes more medical practices adopt the patient-centered medical home approach because he believes it is an essential foundation for healthcare reform.