That was the question a few friends asked me recently. They hadn’t been able to find a comprehensive explanation of the issues anywhere, and they were wondering why the city was planning to transition these services, why the Council seemed to be in favor of the transition, and what steps remained to be taken before this proposal would either pass or fail.
They asked me if I could suggest something for them to read, but I wasn’t able to direct them to a source that could answer their questions. So, I wrote this.
This is my attempt to outline:
I hope that this information is helpful.
They asked me if I could suggest something for them to read, but I wasn’t able to direct them to a source that could answer their questions. So, I wrote this.
This is my attempt to outline:
- what has happened in the process thus far;
- what steps remain before the Council takes a final vote on the Fiscal Year 2017 Budget in which this plan is included;
- how I have come to my current position;
- an explanation of why I ultimately think this transition makes sense; and
- a few other thoughts, including some information about the golf course restaurant (scroll all the way down for that one—it’s last).
I hope that this information is helpful.
The Process Up to this Point and Moving Forward:
Important Dates Past and Future
Important Dates Past and Future
February-March 2016: The City Manager began to alert individual councilors to the possibility that as part of his budget proposal, he was exploring the possibility of closing the India Street Public Health Center and transitioning its services to the Portland Community Health Center
April 12, 2016: The proposal was brought before the Council’s Health and Human Services Committee (Councilors Ed Suslovic, David Brenerman, and Belinda Ray). Both the Mayor and Councilor Nick Mavodones were in attendance. Public comment was taken at this meeting, and questions were taken from members of the HHS committee and the Mayor. The City Manager, city staff, the Director of PCHC, and PCHC’s Chief Medical Officer were on hand to answer questions.
April 14, 2016: The Council’s Finance Committee (Councilors Nick Mavodones, Ed Suslovic, and Belinda Ray) reviewed several areas of the operating budget, including the Health and Human Services Department. As a part of the HHS review, the India Street proposal was discussed. Again, many questions were asked by the members of the committee as well as by Councilor Jill Duson and the Mayor, who were both in attendance. As the Finance Committee had many departments to review n addition to HHS, public comment was not taken until the end of the session, by which time many people had left. Indeed, there was only one member of the public remaining to offer comment, and that commentary was not related to the India Street proposal.
April 21, 2016: The Finance Committee met to take action on the City Manager’s proposed Operations Budget. Public comment was taken at this meeting, and many people testified. Also at this meeting, in response to questions and concerns raised by Councilors and members of the public, the City Manager brought forth an amendment to his original proposal. His original proposal would have transitioned all of India Street’s services to PCHC by December 31, 2016. His amendment, which was created in response to a proposal by Dr. Caroline Teschke, the Director of the India Street Public Health Center, altered the timeline of the transition. While the clinic’s Positive Health program and primary care services would be transitioned to PCHC by December 31, 2016 as originally planned, the proposal extended the deadline for transitioning the Needle Exchange and some associated services for up to another six months. The City Manager added funds back into the budget to keep the Needle Exchange and STD/HIV testing services open at India Street until June 30th, 2017. The funds that were added back in will raise the mill rate for taxpayers unless other savings can be found.
In addition, at this meeting, it was confirmed that city staff will report to the Council’s HHS Committee throughout the transition so that the Council will remain informed with regard to the efforts that are being made to assist patients, provide them with information, and help them transition their care if they so choose. Staff will keep track of the number of patients who are choosing to transition their care to PCHC, as well as those that choose other locations for their future needs.
May 2, 2016: The City Council had a First Read of the City Manager’s proposed Operating Budget. Normally public comment is not taken during First Reads, but the budget is an exception to this rule. Therefore, public comment was taken at this meeting.
May 9, 2016: The City Council will have a workshop on the entire Fiscal Year 2017 budget. This meeting is open to the public, but as it is a workshop, no public comment will be taken.
May 16, 2016: The City Council will have a Second Read of the City Manager’s proposed Operating Budget and take action. Public comment will be taken before the Council vote. Also, if Councilors have any further amendments to propose for the budget, they will be offered at this meeting and voted on by the Council before a final vote is taken on the budget. You can view the agenda here when it is published, which will be by May 14, 2016.
April 12, 2016: The proposal was brought before the Council’s Health and Human Services Committee (Councilors Ed Suslovic, David Brenerman, and Belinda Ray). Both the Mayor and Councilor Nick Mavodones were in attendance. Public comment was taken at this meeting, and questions were taken from members of the HHS committee and the Mayor. The City Manager, city staff, the Director of PCHC, and PCHC’s Chief Medical Officer were on hand to answer questions.
April 14, 2016: The Council’s Finance Committee (Councilors Nick Mavodones, Ed Suslovic, and Belinda Ray) reviewed several areas of the operating budget, including the Health and Human Services Department. As a part of the HHS review, the India Street proposal was discussed. Again, many questions were asked by the members of the committee as well as by Councilor Jill Duson and the Mayor, who were both in attendance. As the Finance Committee had many departments to review n addition to HHS, public comment was not taken until the end of the session, by which time many people had left. Indeed, there was only one member of the public remaining to offer comment, and that commentary was not related to the India Street proposal.
April 21, 2016: The Finance Committee met to take action on the City Manager’s proposed Operations Budget. Public comment was taken at this meeting, and many people testified. Also at this meeting, in response to questions and concerns raised by Councilors and members of the public, the City Manager brought forth an amendment to his original proposal. His original proposal would have transitioned all of India Street’s services to PCHC by December 31, 2016. His amendment, which was created in response to a proposal by Dr. Caroline Teschke, the Director of the India Street Public Health Center, altered the timeline of the transition. While the clinic’s Positive Health program and primary care services would be transitioned to PCHC by December 31, 2016 as originally planned, the proposal extended the deadline for transitioning the Needle Exchange and some associated services for up to another six months. The City Manager added funds back into the budget to keep the Needle Exchange and STD/HIV testing services open at India Street until June 30th, 2017. The funds that were added back in will raise the mill rate for taxpayers unless other savings can be found.
In addition, at this meeting, it was confirmed that city staff will report to the Council’s HHS Committee throughout the transition so that the Council will remain informed with regard to the efforts that are being made to assist patients, provide them with information, and help them transition their care if they so choose. Staff will keep track of the number of patients who are choosing to transition their care to PCHC, as well as those that choose other locations for their future needs.
May 2, 2016: The City Council had a First Read of the City Manager’s proposed Operating Budget. Normally public comment is not taken during First Reads, but the budget is an exception to this rule. Therefore, public comment was taken at this meeting.
May 9, 2016: The City Council will have a workshop on the entire Fiscal Year 2017 budget. This meeting is open to the public, but as it is a workshop, no public comment will be taken.
May 16, 2016: The City Council will have a Second Read of the City Manager’s proposed Operating Budget and take action. Public comment will be taken before the Council vote. Also, if Councilors have any further amendments to propose for the budget, they will be offered at this meeting and voted on by the Council before a final vote is taken on the budget. You can view the agenda here when it is published, which will be by May 14, 2016.
My Process: Where I Started and Where I am Now
When I first heard about the possibility of closing the India Street Public Health Center and transitioning all of its services to the Portland Community Health Center, I had several concerns.
I recognized the value of the services provided at the India Street clinic and was aware that the staff members there possess a level of expertise in the areas of harm reduction and HIV Positive Health Care. I wanted to make sure that this expertise would not be lost in the transition. I also wanted to make sure that the clients of India Street, some of whom represent vulnerable populations, were not lost in the shuffle.
I know that it is difficult for people who are in tough circumstances to practice good self-care, let alone to make and keep appointments at a variety of facilities. It can also take a long time for people who are dealing with sensitive issues such as substance use disorder, being HIV positive, or having an STD to establish a trusting relationship with a healthcare provider, and I wanted to make sure that these relationships could continue.
As I asked questions about these issues, I learned that all of India Street’s services will indeed be transitioned and that none of them will be eliminated. Furthermore, PCHC has committed to interviewing every staff member at India Street and finding parallel positions for as many of those who seek employment at PCHC as possible. It is my hope that many of the excellent staff members at India Street will, in fact, make that transition.
During each of our hearings on this issue, PCHC’s Chief Medical Officer, Renee Fay-Leblanc expressed great admiration for the staff at India Street and said that she hopes many of them will consent to join the staff at PCHC. At present, PCHC does not offer a HIV Positive Health Care program, but as part of the transition process, the program will be established at PCHC, hopefully with the help of the very talented staff and specialists at India Street. If, however, they do not choose to make the transition, new specialists will be hired and more staff will be trained. There is, in fact, potential to expand this program with this transition.
Even after I was assured that all of India Street’s services would transfer, that as much of the India Street staff as possible would be supplied with positions at PCHC, and that a plan would be put in place to (as Councilor Jill Duson put it) basically walk every client of India Street over to PCHC in order to help them make the transition, I still had two concerns: the future location of the Needle Exchange and the continued “bundling” of associated services with the Needle Exchange so that people coming in to exchange a needle can benefit from being introduced to these other services.
These two concerns—the future location of the Needle Exchange and the guarantee that associated services will be “bundled” with it—are two pieces of the proposed plan that we're still working on. However, with the extended timeline proposed by the City Manager on April 21, 2016, and with the understanding that the Council’s HHS Committee will receive regular reports and updates from city staff throughout the transition, I am much more comfortable with the proposal, and I am confident that we will come up with not only a good location for the Needle Exchange and its associated services, but a plan that ultimately will provide greater access to all of these services throughout Portland.
Incidentally, at this point in time there is a team in place to help plan this transition. The transition team includes staff from India Street and the City’s Department of HHS as well as staff from PCHC.
I recognized the value of the services provided at the India Street clinic and was aware that the staff members there possess a level of expertise in the areas of harm reduction and HIV Positive Health Care. I wanted to make sure that this expertise would not be lost in the transition. I also wanted to make sure that the clients of India Street, some of whom represent vulnerable populations, were not lost in the shuffle.
I know that it is difficult for people who are in tough circumstances to practice good self-care, let alone to make and keep appointments at a variety of facilities. It can also take a long time for people who are dealing with sensitive issues such as substance use disorder, being HIV positive, or having an STD to establish a trusting relationship with a healthcare provider, and I wanted to make sure that these relationships could continue.
As I asked questions about these issues, I learned that all of India Street’s services will indeed be transitioned and that none of them will be eliminated. Furthermore, PCHC has committed to interviewing every staff member at India Street and finding parallel positions for as many of those who seek employment at PCHC as possible. It is my hope that many of the excellent staff members at India Street will, in fact, make that transition.
During each of our hearings on this issue, PCHC’s Chief Medical Officer, Renee Fay-Leblanc expressed great admiration for the staff at India Street and said that she hopes many of them will consent to join the staff at PCHC. At present, PCHC does not offer a HIV Positive Health Care program, but as part of the transition process, the program will be established at PCHC, hopefully with the help of the very talented staff and specialists at India Street. If, however, they do not choose to make the transition, new specialists will be hired and more staff will be trained. There is, in fact, potential to expand this program with this transition.
Even after I was assured that all of India Street’s services would transfer, that as much of the India Street staff as possible would be supplied with positions at PCHC, and that a plan would be put in place to (as Councilor Jill Duson put it) basically walk every client of India Street over to PCHC in order to help them make the transition, I still had two concerns: the future location of the Needle Exchange and the continued “bundling” of associated services with the Needle Exchange so that people coming in to exchange a needle can benefit from being introduced to these other services.
These two concerns—the future location of the Needle Exchange and the guarantee that associated services will be “bundled” with it—are two pieces of the proposed plan that we're still working on. However, with the extended timeline proposed by the City Manager on April 21, 2016, and with the understanding that the Council’s HHS Committee will receive regular reports and updates from city staff throughout the transition, I am much more comfortable with the proposal, and I am confident that we will come up with not only a good location for the Needle Exchange and its associated services, but a plan that ultimately will provide greater access to all of these services throughout Portland.
Incidentally, at this point in time there is a team in place to help plan this transition. The transition team includes staff from India Street and the City’s Department of HHS as well as staff from PCHC.
Why I Think This Move Ultimately Makes Sense
Even with my concerns about the location of the Needle Exchange and the bundling of services, I do believe it makes sense to transition all of India Street’s services out of a clinical health setting managed by the city and place them under the umbrella of PCHC, the nonprofit Federally Qualified Healthcare Center (FQHC) that the city helped to create starting in 2006. PCHC was founded for precisely this purpose at that time because of changes in healthcare policy at the state and federal level and concerns about the long-term sustainability of healthcare programs provided directly through the city.
FQHCs are increasingly being favored when it comes to qualifying for federal dollars and grant funds. They also receive higher rates of insurance reimbursements. The India Street clinic, which was at one time 85% grant funded only qualified for 43% in grant funding for the current fiscal year. What’s more, India Street may not continue to qualify for funding via the Ryan White Grant, which funds the excellent HIV Positive Health Care program offered there. Without that grant, the current 43% level of grant funding would drop even further.
Obviously, as more grant funding is lost each year, and as insurance reimbursement rates continue to favor FQHCs over city clinics, the cost to taxpayers will only increase over time. This is what I mean when I say that there have been concerns about the long-term sustainability of city directed healthcare services for a while now, and again—it was for precisely this reason that PCHC was created. The writing was on the wall even back in 2006.
FQHCs are increasingly being favored when it comes to qualifying for federal dollars and grant funds. They also receive higher rates of insurance reimbursements. The India Street clinic, which was at one time 85% grant funded only qualified for 43% in grant funding for the current fiscal year. What’s more, India Street may not continue to qualify for funding via the Ryan White Grant, which funds the excellent HIV Positive Health Care program offered there. Without that grant, the current 43% level of grant funding would drop even further.
Obviously, as more grant funding is lost each year, and as insurance reimbursement rates continue to favor FQHCs over city clinics, the cost to taxpayers will only increase over time. This is what I mean when I say that there have been concerns about the long-term sustainability of city directed healthcare services for a while now, and again—it was for precisely this reason that PCHC was created. The writing was on the wall even back in 2006.
A Few Other Thoughts
One thing that it is important to remember is that everyone involved in this transition—the staff of the City’s Department of Health and Human Services, the director and the staff at India Street, and the director and the staff at PCHC—are all committed to providing excellent health care services for everyone. Indeed, neither India Street nor PCHC turn people away based on an inability to pay.
The Board of Directors at PCHC includes patients, and therefore as the transition gets underway, patients from India Street will be invited to join the PCHC Board and help to determine the future direction of the clinic.
I’ve heard a rumor that the developers of the Luminato Condominium project are behind this proposal in some way. That is absolutely untrue. I’m not sure how this particular piece of misinformation was started, but it is inaccurate and irresponsible.
The Board of Directors at PCHC includes patients, and therefore as the transition gets underway, patients from India Street will be invited to join the PCHC Board and help to determine the future direction of the clinic.
I’ve heard a rumor that the developers of the Luminato Condominium project are behind this proposal in some way. That is absolutely untrue. I’m not sure how this particular piece of misinformation was started, but it is inaccurate and irresponsible.
Finally, The Golf Course Restaurant
As for the golf course restaurant, I realize it looks like an egregious misuse of money when you look at just that one expense line in the budget, but the restaurant also generates revenues. In fact, it comes very close to paying for itself. For the upcoming year (Fiscal Year 2017), the restaurant is expected to cost $392,590 to run. However, it is also expected to generate $361,000 in revenue, which means the net cost to the city is actually just $26,540.
In the current fiscal year (2016, which runs until June 30th), the golf course restaurant has cost $312,000 so far and brought in revenues of $254,073. That's a difference of $57,927 with two of the busiest months still to come.
During budget talks in the city, there was a discussion about potentially closing the restaurant during the winter, but as the restaurant has only been operating year round for a short time, it was decided to give it more time to build up its year round business. The hope is that with a little more time, it will generate more revenue than expenses and actually be a benefit to the city.
So, when it comes to looking at the budget, as you can see it's not as simple as cutting the golf course restaurant and transferring $400,000 to India Street. Cutting the restaurant would likely only net about $27,000, and it would also mean cutting the jobs of all of the restaurant staff, as well as having a ripple effect on some local producers. (While the restaurant hasn't been able to procure all of their goods locally because of cost, they have been placing an emphasis on buying local whenever they can.)
Also please note that the restaurant is not available only to golfers. It is open to the public, and it is open year round. Many people in the Riverside area appreciate having a place to go out to dinner that doesn’t require them to drive onto the peninsula, so it is actually a nice amenity for that neighborhood. Of course, if the year round business does not pick up and the restaurant continues to operate at a small loss, it will likely go back to being open only in the summer months, when it is, in fact, profitable.
In the current fiscal year (2016, which runs until June 30th), the golf course restaurant has cost $312,000 so far and brought in revenues of $254,073. That's a difference of $57,927 with two of the busiest months still to come.
During budget talks in the city, there was a discussion about potentially closing the restaurant during the winter, but as the restaurant has only been operating year round for a short time, it was decided to give it more time to build up its year round business. The hope is that with a little more time, it will generate more revenue than expenses and actually be a benefit to the city.
So, when it comes to looking at the budget, as you can see it's not as simple as cutting the golf course restaurant and transferring $400,000 to India Street. Cutting the restaurant would likely only net about $27,000, and it would also mean cutting the jobs of all of the restaurant staff, as well as having a ripple effect on some local producers. (While the restaurant hasn't been able to procure all of their goods locally because of cost, they have been placing an emphasis on buying local whenever they can.)
Also please note that the restaurant is not available only to golfers. It is open to the public, and it is open year round. Many people in the Riverside area appreciate having a place to go out to dinner that doesn’t require them to drive onto the peninsula, so it is actually a nice amenity for that neighborhood. Of course, if the year round business does not pick up and the restaurant continues to operate at a small loss, it will likely go back to being open only in the summer months, when it is, in fact, profitable.
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