As clinic competition heats up in Miami-Dade and Congress looks at trimming its payments to Medicare health maintenance organizations, the Humana-owned CAC clinics are expanding services -- keeping three clinics open weeknights until 10 p.m. and having doctors make house calls to certain seniors.

``We did focus groups, and the patients all expressed concerns about having to go to ERs or urgent care centers on nights and weekends, when they can wait three or four hours to be seen,'' says Mayda Antun, a doctor who is chief executive of the 10 CAC-Florida Medical Centers.

The CAC centers serve patients in the CarePlus Medicare HMOs.

The move comes as CAC's major competitor, Leon Medicare Centers, opens two huge new clinics in West Dade, built at a cost of $80 million. More competition is coming from Miguel ``Mike'' Fernandez, who sold the CAC-CarePlus system to Humana for $450 million five years ago and recently announced he plans to reenter the Medicare HMO market next year when his non-compete agreement with Humana expires.

Meanwhile, some congressional leaders are proposing to pay for healthcare reforms by reducing costs elsewhere, including cutting Medicare HMO payments, which escalated during the George W. Bush administration.

Under Humana's new schedule, the Bird Road, Westland and Little Havana medical centers are open 8 a.m. to 10 p.m. Monday through Friday, and 8 a.m. to 3 p.m. on Saturday and Sunday.

For house calls, CAC will focus on those who most need to be seen regularly and haven't been making regular visits. ``We monitor to make sure our patients are seen regularly,'' Antun says, because periodic visits with primary care doctors can help prevent major, expensive problems from developing.

About 95 percent of CAC patients get to a clinic at least once every six months, Antun says. Under the new plan, doctors will visit those who haven't come in recently -- particularly those with chronic conditions, those who are bed-bound or who recently were discharged from the hospital and haven't sought recommended follow-up care.