The sluggish economy affects more than just for-profit businesses and La Clínica Del Cariño community health center is just one of many local and statewide charitable organizations feeling those effects.

According to board member Susan Gabay, since the 2008 downturn LCDC in Hood River has gone from having a patient mix that included 51 percent uninsured patients to a current rate of 69 percent uninsured patients.

“People are losing their jobs or losing their insurance,” said current LCDC Dental and Medical Director Elizabeth Aughney, a former dental director who has taken on medical director duties after the elimination of a stand-alone position in the center’s medical department.

The change in total patient insurance status at LCDC translates to a huge drop in revenue for the partially federally funded clinic, and the drop in income has necessitated two job duty consolidations along with additional operational changes.

According to Gabay, with LCDC serving over 10,000 local patients, the changes must be made judiciously, with a priority given to maintaining high-quality care for existing patients and supporting those new patients the clinic must enroll in order to meet grant requirements.

“In the 21 years I have served on the board, we have had to reduce staff a number of times when our expected revenue or grants don’t come through or we have an economic downturn,” said Gabay. In the present situation, LCDC brought on an interim CEO, Jim Ferguson, to help assess the fiscal impacts and direct restructuring.

“If expenditures are higher than our revenue, we have to adjust based on that,” said Ferguson, a CEO with a resume indicating prior experience in health care organization “turnarounds.”

In addition to merging the medical and dental director position, thereby eliminating the administrative physician salary from the budget, a clinical services manager position was also eliminated under Ferguson’s guidance. But expenditure reduction is not the only planning tool being used to fortify LCDC’s bottom line.

“Instead of being in competition with each other our community health care partners are all working together,” said Ferguson. “We are looking at ways to make health care delivery more cost effective for the entire community.”

One of the most recent efforts to address that goal can be seen in the successful implementation of the new Gorge Access Program, a community partnership between the Hood River Department of Public Health and local providers, which enrolls uninsured patients who do not qualify for the Oregon Health Plan.

The new program refers enrollees, who qualify at up to 200 percent of the federal poverty level, to other primary care health providers who participate in the voluntary program. GAP is administered through the health department and has allowed 91 patients, since its inception, to receive ongoing primary care. The community cost savings come from fewer emergency room visits and earlier disease intervention — preventing more debilitating illness and treatments later on.

“In this last year, because of GAP, we are no longer the only game in town for uninsured patients,” said Aughney. The increasing numbers of patients who lack insurance is, according to Aughney, “a community problem that is now more of a community-wide solution.”

The health center has also recently submitted a request to increase its reimbursement schedule through the Medicaid program; the health center’s last increase was awarded in 2008.

In addition to revenue adjustments, Gabay notes that some unfilled positions will remain unfilled and job duties within the organization are also being shifted.

The belt-tightening in Hood River, however, is not the only picture La Clinica needs to communicate. In fact, within a few months a brand-new LCDC facility will be opened in The Dalles.

The new 20,000-square-foot building, located at West 10th and Webber streets, is nearing completion and was made possible through a $5.86 million capital improvement grant from the federal Health Resources Services Administration. LCDC has already been providing services to The Dalles patients for nearly 10 years through a facility leased from Wasco County.

With the new facility addition and a mission that now includes service to a nearly equal mix of non-Hispanic community members and migrant or seasonal workers, LCDC is looking forward to an expanded image.

After 26 years as La Clínica Del Cariño, a new name and logo will be rolling out soon.

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