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Clinics, despite complaints about Jackson Health System, may continue partnerships

In the past year, two health clinics — one in Little Havana, the other in Overtown — have rebelled against Jackson Health System, with their boards complaining the huge public hospital system isn’t serving their neighborhoods well enough. But the clinics may have no other option now.

The Dr. Rafael A. Peñalver Clinic in Little Havana, which publicly split from Jackson a year ago and partnered with a doctors’ group to provide services, learned last week that the doctors were losing money and pulling out of the deal. On Tuesday, the clinic’s board agreed to open negotiations with Jackson about returning to the facility.

In Overtown, the board of the Jefferson Reaves Sr. Medical Center voted last summer that it, too, wanted to find someone other than Jackson to manage the clinic. The Miami-Dade County Health Department, which has overall responsibility for the facility, rejected that attempt last month, saying Jackson would continue to handle services there.

The situations at the two clinics have intensified criticism that Jackson, which receives more than $300 million in county tax money annually, is not doing enough to fulfill its mission to serve the poor and uninsured. Jackson executives respond that they have done a lot to improve their performance, especially in the past six months, as the system’s finances have improved.

“There’s been a new push on primary care,” said spokesman Edwin O’Dell. That includes creating a new clinic on the Jackson Memorial campus and improving operations at places like the Reaves clinic.

But Darryl Reaves, chairman of the advisory board for the center named after his father, is unconvinced: “Jackson just doesn’t get primary care,” he said. He complained that in recent years, Jackson closed down the clinic’s pharmacy, ended sonogram and X-ray services and stopped providing dental care.

At Peñalver, Executive Director Boris Alvarez complained in October that when Jackson was in control, patients had to wait four to six weeks to get an appointment. After Gold Coast Physician Partners came in a year ago, patients were often seen within a day and no later than three days after they requested an appointment. At the time, he said the difference was like “night and day.”

Then, on Nov. 16, Gold Coast announced it was “unable to generate sufficient revenues from operations to continue services,” and that it planned to leave Peñalver in 60 days.

Alvarez did not return a reporter’s telephone call Wednesday. Gold Coast also did not respond to a request for comment, but Jackson Chief Executive Carlos Migoya trumpeted the development on Wednesday in a memo to county commissioners.

“Clearly this is an exciting opportunity for Jackson to reclaim its footprint in one of our community’s central neighborhoods,” Migoya wrote. “Primary care is an essential part of our mission and — because it feeds our other programs and services — a critical part of our growth strategy.” He said his management team would open discussions with Peñalver’s board about forming a new partnership.

Board member Rafael Peñalver, whose father’s name is on the clinic, said he was happy Jackson was back in the picture. “I don’t think any entity other than Jackson can provide the safety-net services, particularly for the uninsured.”

Peñalver said Gold Coast’s financial failure at the Little Havana clinic was “predictable” because the facility’s primary purpose is to serve those who are able to pay little or nothing for care.

Gino Santorio, Jackson’s new vice president of ambulatory care, said that during the last year Jackson was at the Little Havana clinic, the system lost about $1.7 million on its operations there.

Jackson executives know from direct experience that primary care clinics are money-losers for the system — $34.6 million in fiscal year 2010-11, according to the audited report. While the system was hemorrhaging money from 2009 through 2011 — losing $419 million in three years — Jackson cut back on primary care, including closing two clinics.

Santorio said services are improving at Reaves. He said 20 percent more patients have been seen in the past three months and the average time for a patient from walking in the door to leaving the clinic is now three hours, one minute — down from four hours, 17 minutes.

What’s more, Jackson recently received a $4.7 million grant from the Centers for Medicare and Medicaid Services, and about $2.4 million of that would go into improved operations at Jefferson Reaves.

One of Darryl Reaves’ main complaints was that Jackson expected patients to go to Jackson Memorial Hospital to visit the pharmacy or obtain X-rays and sonograms — a major inconvenience for the many poor residents who do not have cars.

Jackson’s Santorio noted that the main campus is only 1.2 miles from the clinic, and Jackson provides 10 to 15 van trips a day between the facilities. Miami trolleys also connect the buildings.

Reaves also complains that patients are slowed down because the clinic is a teaching facility for a family-practice residency program, and the residents have to consult frequently with the attending faculty of the University of Miami.

Robert Schwartz, head of UM’s family-practice program, said the Overtown patients often have complicated cases including diabetes, congestive heart failure, kidney problems and chronic high blood pressure.

UM’s presence means better care for Overtown residents, Schwartz said, because of additional programs that the medical school brings, including a $1 million annual gift from the United Health Foundation for an innovative program to provide care for diabetics.

During the past year, Jackson executives have been meeting with Darryl Reaves and his board to discuss problems. Reaves said he was never satisfied, and the board voted to seek an outside provider to replace Jackson and UM.

That’s when Lillian Rivera stepped in to say the board did not have the power to do that. Rivera is the administrator of the Miami-Dade County Health Department, which despite its name is part of the state health agency. The Peñalver and Reaves clinics sit on City of Miami land, but the buildings were built with state funds, and Rivera’s department retains administrative responsibility.

“It’s in the best interests for our community to remain partners with Jackson,” Rivera told The Miami Herald, because the partnership creates a continuity of care, from clinic to hospital. The Affordable Care Act emphasizes integrated care organizations as a way to avoid duplicated tests and reduce other healthcare costs.

Rivera said she had permitted Peñalver to seek an outside provider in 2011 because Jackson was struggling and not showing much interest in primary care. But she said that she had recently seen a “tremendous improvement” in Jackson’s behavior toward the clinics.