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School Board cools on employee health clinic as costs vary wildly

STORY BY EILEEN KELLEY, (Week of October 18, 2012)

Indian River County School Board members appeared puzzled last week when they were presented with a huge drop in start-up costs for a proposed health clinic for school employees, and expressed frustration over the trickle of financial information they have been fed by school district staff.

Where they had been told in August that it would cost $1.2 million to get the health clinic up and running, last week they were told startup costs would only be $25,000.  But in fact, startup costs detailed in a proposal by CareHere, which would run the clinic, come to nearly $1.7 million.

After last week’s board workshop on the clinic, two board members expressed concerns about the clinic plan, citing cost estimates that couldn’t be pinned down and whether school district staff did enough due diligence when checking out CareHere.

CareHere, a Tennessee-based health-care company, would like to add the district to the roster of clinics that it manages. CareHere teamed up and formed a corporation with Crowne Consulting Group to run its 20 Florida clinics. Nationally, CareHere manages 100 clinics.

The board has been exploring starting a clinic as a way to reduce overall Blue Cross/Blue Shield costs for employee and retiree medical expenses.

Board members were told during an August workshop it would cost about $1.2 million to get the clinic up and running when they were briefed by the school district’s insurance broker from Brown & Brown and school staff.

Ray Tomlinson, the vice president of Florida operations for the CareHere/Crowne Consulting Group, was in the audience at the August workshop but was never called upon and never spoke up to say that any information presented in August might not be accurate.

Last week, he was back the school board meeting room but this time he was asked to take a seat at the table.  And that’s when the numbers started to look like some type of shell game.

When asked about the cost, Tomlinson said upfront costs would only be $25,000 to $30,000.

“Is this accurate?” asked board member Jeff Pegler.

Yes and no.

Yes, the cost would be $25,000 but that would provide only the bare basics like tongue depressors, surgical tape, blood pressure cuffs, a stethoscope, an examining table and stool.

But other costs would soon push the clinic cost up to nearly $1.7 million and that doesn’t include the six-figure cost of an X-ray machine.

What Tomlinson, district staff familiar with the proposal and consultants from Brown & Brown failed to mention during the Oct. 9 workshop was that there would also be an estimated cost of $132,000 for lab supplies.

There was also no mention of the $240,000 the district would need to stock the pharmacy shelves. Or the $579,600 that CareHere would bill as a management fee regardless of whether any of the 2,100 eligible employees and retirees use the free clinic.

CareHere arrived at the latter figure by saying it would charge the school district $23 per month per eligible employee, according to its proposal.

But Pegler and the other board members were not told that at the Oct. 9 workshop.

Neither were they told of other financial considerations that are outlined on page 26 of CareHere’s massive proposal to the health clinic selection committee: The estimated staff costs for the doctor ($125 an hour), a nurse ($35 an hour) and medical assistant ($25 an hour) to run the clinic 80 hours a week would be $769,600 a year.

So in the end, $25,000 would be the first of many checks the district would have to write to get the clinic up and going.

Even CareHere’s bottom line doesn’t include a potential six-figure purchase of an X-ray machine or the minimum of $10,000 that it would take to erect a protective barrier and be able to safely run an X-ray machine.

As the workshop ended, board members told school district staffers to yet again to come up with a more details the board can chew on before deciding whether to go forward with the plan that would turn an unused 24-foot by 38-foot concrete building at the district’s transportation department into a health clinic.

The board will meet again Dec 4 to discuss the issue, though it is likely the patience of a few members will have worn thin by then.

“I’m very frustrated and disappointed,” said Pegler.

When the idea was first floated about a year and a half ago, Pegler said he was all on board. “I wouldn’t vote for this right now.,” he said last week.  “We’ve had two very poor presentations.”

Pegler said it was wrong of the district’s consultants, Brown & Brown, as well as CareHere to throw out low-ball numbers when clearly $25,000 is not the actual start-up cost.

“I’m concerned that this is going to be a shell game to justify it in the long run,” Pegler said. “If they don’t get their act together, I don’t see this going anywhere.”

Board member Claudia Jimenez also left the workshop frustrated and not only because of the less-then-genuine figure of $25,000 suggested as the start-up cost.

She’s also concerned about the group CareHere, and says she is not certain it is the best group to run a clinic.

In early August, Vero Beach 32963 reported that city of Port St. Lucie terminated its contract with CareHere after many employees complained that CareHere doctors lacked a bedside manner, there was a high turnover of medical staff and the facility was not clean.

In another Vero Beach 32963 report in early September, Tomlinson said he agreed to break the Port St. Lucie contract but that any perceived problems were likely the result of local politics.

During last week’s board meeting, Ken Felten of Brown & Brown was asked what he had found out since the newspaper’s report. Felten told the board he did a Google search and found nothing to substantiate the claims of the Port St. Lucie analyst.

The words “Google search” didn’t sit well with Jimenez.

“I would have hoped they would have done more than Google it,” Jimenez said after the meeting.

Jimenez subsequently made phone calls and sent out e-mails.

“I’m hearing some of the same concerns and we have to follow up with due diligence,” she said.