Modesto Bee Article
By Ken Carlson, Modesto Bee Staff Writer
last updated: March 25, 2009
Stanislaus Family Medicine Residency program has lost its federal funding and its future is in doubt. (Debbie Noda / The Modesto Bee)
Stanislaus County supervisors vented their frustration with a federal agency Tuesday, but approved $11.1 million to repay physician training reimbursements and keep the family practice residency program alive through June 2010.
The money is life support for the Stanislaus Family Medicine Residency Program, which recently lost its federal funding in what county officials called an arbitrary decision by the Centers for Medicare and Medicaid Services.
The agency that administers the Medicare and Medicaid programs determined that an administrative contractor mistakenly approved funding for the residency program for several years, after the program moved from the county-owned Stanislaus Medical Center to Doctors Medical Center in 1997.
The county will repay $9.63 million to CMS for funding received from 2001 to 2008. It also will spend $1.5 million on interim funding for the physician training. The county treasury will loan the money to the county Health Services Agency from a tobacco tax fund.
Doctors Medical Center, which shares the cost of training the residents, covered the other half of the $19.27 million recouped by CMS. It is appealing the government decision in hopes of getting the money back and restoring the federal funding.
Even though legislators such as Sen. Dianne Feinstein and Democratic Rep. Dennis Cardoza of Merced have tried to intervene on the county's behalf, the federal agency hasn't budged.
"It seems CMS has a mind of its own and is not willing to listen to Congress or common sense," said county board Chairman Jim DeMartini.
Officials say the loss of federal funding threatens serious harm to a county health system that annually serves more than 70,000 people who are poor or uninsured.
The 27 residents and 30 physician faculty members work in the county health clinics, providing care for patients covered by Medi-Cal and the indigent health program.
The residents also treat patients in the emergency department at DMC, deliver babies and work with other hospital patients.
Supervisor Bill O'Brien said that, at the expense of the health care for the poor, "somebody is building a résumé back in Washington, D.C., saying, 'Look how much money I can save for the federal government.' "
County staff said the CMS action reversed previous decisions to approve graduate medical education funding for the three-year residency program. CMS or an administrative contractor reviewed the reimbursement requests a number of times over sev-eral years and granted approval.
CMS officials said last week the Balanced Budget Act of 1997 contained no provisions for funding the program after the closure of Stanislaus Medical Center. The legislation capped the subsidies for physician training programs and placed limits on new programs.
The agency said it discovered the mistake in 2004. It discussed the issue with the county and DMC for the past 18 months before making a final determination in January.
The county is supporting DMC's appeal to the Medicare Provider Reimbursement Review Board. A successful appeal could return the money and restore the annual funding, but the process can take four years or more.
Patty Hill Thomas, county chief operations officer, said the government agency also is throwing up roadblocks to creating an expanded program that would qualify for funding. The existing program would have to close for a year and a new program open with a new director, new faculty and new residents, the agency has said.
In the past, the federal reimbursements offset about $2.7 million of the program's costs; the county and DMC equally shared the remaining $1.5 million in annual expenses.
Bee staff writer Ken Carlson can be reached at
kcarlson@modbee.com or 578-2321.
