BCHF: One Clinic or Two?
Last updated 3/4/2021 at 9:37am
When the only health care you can afford, or count on to provide adequate treatment whether long-term or occasional – can’t deliver, what do you do? In the case of the Borrego Springs Clinic, the Borrego Sun’s solution was to find out what’s going on at the Borrego Community Health Foundation (BCHF) that was preventing it from providing quality care and professionals with the expertise and 24/7 commitment to take care of Borrego Springs health needs. The Sun wanted to know why the Foundation, which was generating millions in new revenue annually, couldn’t afford up-to-date equipment, and at least, one full-time doctor at the Borrego Springs Clinic? Eleven months later, the mission remains the same.
This past year, the healthcare situation in Borrego Springs went from a continuous downgrading of services, to the crisis of having the only doctor absent for four months with no explanation; firing of the family nurse practitioner, the person filling in for the absent doctor; and the only mental therapist at the clinic. This was done during the beginnings of a pandemic. The excuse – the pandemic. Aging and lack of medical equipment and standard supplies compounded with the loss of professionals generated serious complaints about the clinic’s poor diagnostic and treatment capabilities, and caused the clinic to lose both patients and credibility.
Problem one: the clinic is part of a chain of clinics fueling Borrego Health’s incredible growth pattern into three counties under the administration of the Borrego Health officers and Trustees. The expansion led to BCHF becoming the fastest growing, non-profit health care provider in the United States and the most expensive from the federal government’s data. Borrego Health, as the non-profit is known, operates clinics, partnerships, contracts with private providers, has pharmacies, dental services, mental health services and specialty services for women, veterans, migrant farm workers, along with clinical services targeted to gay and transgender populations.
Unfortunately, the master mind of Borrego Health’s growth in revenue and patients was CEO Bruce Hebets. Formerly, a sergeant in the Harbor Police, he had neither the medical background, or administrative skills to oversee the vast empire he was building. Relying on friends, family, and people, who, like him, were more interested in making money than healing people, to serve as officers/administrators and managers was his biggest mistake. The larger the non-profit became, the more obvious the inadequacies of those in charge became.
But it wasn’t the inexperience and lack of expertise that finally brought the Foundation down. It was the prime motivator of greed that was shared by partners, trustees and employees.
All discussions of the clinics’ future role as Borrego Springs primary, health provider, are clouded by the current FBI/DOJ investigation into fraud, corruption and profiteering. In plain language, Borrego Health was abusing its non-profit status to make a profit at the expense of patients and taxpayers,’ footing the bill for the government subsidized insurance plans, and got caught.
Ultimately, the Federal Human Resources and Services Agency (HRSA) and the state Department of Health Care Services (DCHS) will decide the fate of the Foundation, pending the outcome of the investigations.
A victim for years of Borrego Health’s corruption, the future of the Borrego Springs clinic is unclear. One choice by HRSA is to keep Borrego Health intact with a new non-profit taking over. Or the federal government can split up the services, by category, like dental, pharmaceutical, and primary care and turn over to other non-profits with these specialties. Borrego Health could also be split up regionally by counties with local non-profit providers replacing the foundation. Or the government decision makers can keep Borrego Health intact, with fines and restrictions, pending on the outcome of the investigation, and begin a house cleaning from within. This is the current status.
Former CEO Hebets has passed, and his clone, Mikia Wallis, has resigned, apparently, along with a number of Hebets’ criminal cronies. A DHCS watchdog has been assigned to assure the organization adheres to California Medi-Cal rules and regulations. The state has also rescinded the order to withhold payments of Medi-Cal claims. The hold on dental reimbursements, however, is still in place. The state monitor has authority to reinstate the hold on claims, and to fire employees that he/she finds to have engaged in, or are continuing to engage in criminal activities.
Meanwhile, the community waits, wonders and wants a clinic. One with substantially more medical professionals, better services, and longer hours.
Enter the Borrego Valley Endowment Fund and Bruce Kelley. As Kelley reported in a recent zoom meeting of the Borrego Stewardship Council, the Endowment Fund has distributed Requests for Proposals (RFP’s) to a variety of health care operators to open second clinic in Borrego Springs.
A new dilemma: Two clinics in a small town that seemingly can’t support one clinic. Perhaps, the second-clinic plan is fueled by the loss of support for the Borrego Springs clinic, which could never seem to get its act together, and now finds itself entangled in a difficult legal situation, combined with community’s very real need for quality health care. Then, there’s years of frustration built up over how badly the clinic has been run, out dated equipment, and actual cases of failing to prescribe adequate care that has led to real human suffering and consequences.
In all fairness, there are many that depend on the clinic, who believe it’s great. This group of patients tend to be without actual comparisons with private providers. To the more sophisticated healthcare shoppers, a fresh start with new provider, promising a higher level of expertise and skilled practitioners, available 24/7 sounds like a good idea. However, it may be too good to be true.
The reality is that there are two populations in Borrego Springs: Those who can afford private insurance and prefer their own more costly, but experienced, out-of-town professional providers, who might be wooed to use a clinic with better credentials. They are a minority of the residents that includes seasonal visitors and renters.
Then there are elderly residents with multiple health problems, and those that cannot afford health care, which is the majority of the resident population, and dependent on the Borrego Springs Clinic. Even with government subsidized insurance plans, for the clinic to meet a higher standard of services, 24/7, it would require private donations and supplemental infusions of capital.
The presence of two clinics sets up a the very real potential of competition for limited dollars, without which both clinics would fail miserably to meet the higher standards envisioned for one or the other.
It’s unclear, exactly, who the new clinic would serve, and how it would be financed. However, details of what is planned, and how two clinics would supplement each other, rather than compete, are best left to Kelley and the Borrego Valley Endowment Fund to clarify.
The Borrego Sun began investigating Borrego Health with a goal to improve local services by identifying the problems that would lead to changes. Unfortunately, the Foundational principles of Borrego Health were not the best health care possible, and led to investigations of corruption and fraud, leaving the local clinic in limbo. Still seeing patients, but instead of having one hand tied behind its back, thanks to Hebets and his ilk, it now has both hands tied with the investigation.
The Sun believes that Borrego Health and the clinic can and should be rehabilitated to better meet the communities needs and desires. Like the old adage, don’t throw the baby out with the bath, the baby in this case is Borrego Health’s much prized and sought after federal non-profit status as a Federally Qualified Health Care Clinic (FQHC). A second clinic without a FQHC award would not be able to provide, even the minimal level of service to a majority of the local residents. It would also face a daunting financial obstacle without Medicare, Medicaid/Medi-Cal insurance reimbursements and grants.
A much-coveted award, there are only 1,300 FQHC’s in the United States, barely over 300 in California, and approximately six large corporations in San Diego County. This is the gold standard of government sponsored insurance for those in the poverty range, like Borrego’s working poor, living on hourly wages; single family households; and large Latino-x population, many of whom do not communicate in English. Then there’s the significant community of elders and disabled, living on limited government subsidies, who are chronically, comprised with health care issues, and have chosen to live in Borrego for its housing affordability.
The odds of having two clinics with this valued coverage in such a small community are not good. Besides, the higher reimbursements paid to FQHC’s, grants and preventative care are not available under other non-profit awards. The price for FQHC status is higher standards and regulations, including control and oversight by a board of directors or trustees.
Borrego Health’s FQHC status allows it to best meet the community’s demographics and low-income populations. Another important benefit under the FQHC status is funding for health prevention and well-being programs for children and youth.
Borrego’s families rely on this important aspect of health and dental care and physical screening. Borrego Springs Clinic must, not only have continued FQHC status, and support from the state’s Medi-Cal insurance and dental coverage to survive financially, but it’s a must have prerequisite for providing health care for the majority of permanent residents.
Also, since dental care, a major focus of the fraud investigations, was driving Borrego Health’s rapid income and growth, the Foundation’s new budget will be facing a major fiscal crisis. If the new DHCS monitor should find the Foundation’s behavior is still not complying with state regulations, payment of Medi-Cal claims could be suspended again, adding to future budget woes.
If the Borrego Springs clinic was to become a stand-alone, non-profit, in partnership with, or as a satellite, under Borrego Health’s umbrella, it would allow the clinic to continue to operate as a FQHC. There are precedents for such arrangements. An informal separation would also protect the clinic from the legal jeopardy the foundation faces. It wasn’t the Borrego clinic that committed fraud, it was the Borrego Community Health Foundation.
The next steps for the Borrego Springs Clinic to move from barely functioning to a first-class provider are: In addition to maintaining the FQHC status for Borrego’s clinic, the local operation must have authority to create a new and independent board of directors, separate from Borrego Health’s Board of Trustees.
One of the challenges, facing the Borrego Springs clinic, is the current chairman of the Borrego Health Board of Trustees, Dan Anderson. He has often spoken of his dislike for Borrego Springs, and desire to move the Borrego Health administration to Riverside, where he has a non-profit foundation, ironically named, Riverside Community Health Foundation.
As chairman, Anderson has packed the board with a majority of Riverside cronies, thus ensuring votes on critical issues would favor Riverside’s interests, not Borrego Springs.’ Additionally, Anderson, who manages two Riverside clinics, using Borrego Health’s FQHC status, also receives $800,000 from leasing offices to BCHF managed clinics. Anderson is compromised in a number of ways, including the fact the Riverside Community Health Foundation, which he has capitalized on as an extension of Borrego Health, is also a heath care investment company, with off-shore accounts.
Anderson continually claimed, “Everything is fine at Borrego Health,” despite investigations uncovering questionable activities by the Borrego Sun. The uncomfortable publicity led him to order an internal investigation, which confirmed serious violations of federal regulations and laws. The internal report went so far as to recommend firing all the current officers. Something Anderson did not do. Unfortunately, even after the FBI/DOJ raids, Anderson and other spokespersons continue to tell the public and employees that “Everything is okay, not to worry. Sure, there were some problem dentists under contract with Premier Health. But it’s not affecting Borrego Health services.”
This duplicitous public relations response to the investigation dares to support the myth that, “Borrego Health is continuing to provide the same quality care their patients have come to rely on,” despite common knowledge that the care in Borrego Springs has not been adequate for years. The right move, the right action, which might have spared the dilemma facing Borrego Springs, would have been for Borrego Health to acknowledge the leadership and profiteering problems, and failure to provide, and promise to make corrections. Sadly, Anderson and Borrego Health chose the wrong public solution, which was to ignore, pretend, and lie.
All of which justifies a new independent board for Borrego Springs. A board willing to be transparent and up front with the community, and work with the state and federal governments to clean house of the decision makers responsible for the current legal landmines.
The Borrego Springs board, in addition to meeting the FQHC requirement that 50 percent of the board members are clients of the clinic, (a requirement Borrego Health ignored), should capitalize on the expertise of the nationally recognized medical experts and administrators, who have volunteered to serve in such a capacity such as Dr. Carrolee Barlow, M.D., Ph.D., and Dr. Paul Teirstein, M.D.
Dr. Barlow is a renowned expert in neuroscience, neurodegeneration and rare diseases, and is currently the Chief Medical Officer of ESCAPE Bio. Her previous work spanned clinical care, laboratory and clinical research, academia, and industry. She is the former CEO of the Parkinson’s Institute and Clinical Center, and holds a faculty position in the Laboratory of Genetics at the Salk Institute for Biological Studies in La Jolla California.
Dr. Teirstein, chief of cardiology at Scripps Clinic, La Jolla, is also the clinic’s director of International Cardiology. He has additional responsibilities at the nationally-recognized Scripps organization as director of the Scripps-Prebys Cardiovascular Institute for Scripps Health.
Individuals respected nationally, not only bring medical expertise and lend credibility to the clinic, but are also beneficial in recruiting high caliber medical professionals to fill important positions at the clinic. Certainly, a representative from the Borrego Valley Endowment Fund on the clinic board would fill a need for cooperation among those concerned with health care delivery. The addition of a Patients Advocate, representing the Latino-x community would provide cross cultural safeguards and improved communication. And, unlike the Borrego Health Board of Trustees, the Borrego Springs Clinic board must meet its requirements to provide leadership, and not serve as a rubber stamp for the CEO.
Along with the traditional committees established by boards, a Grievance Committee for Borrego Springs patients and employees would help ensure a climate of commitment to preventing, rather than ignoring abuses.
The next step is development of a business plan incorporating revenue for actual patient visits. The plan identifies the maximum highest level of services, versus what is realistically fundable within the coming years. In addition to expanding to 24/7 care, elements must address ways to add services that generate profits, and attract the privately insured. According to Dr. Barlow, a local laboratory, handling a range of tests would be one example. Identifying revenues and donations to subsidize service and equipment gaps in the ideal vision for the clinic would also be a necessary part of any business plan that’s truly invested and able to move the clinic towards a maximum level of service.
In the meantime, the Borrego Springs Clinic must be able to recover all local receipts of payment from Borrego Health to underwrite its operations. And, must immediately identify and access multiple private, and alternative government funding sources to raise the level of care; survive income shortages caused by the pandemic; and hold on dental reimbursements.
Because the community desires and needs to add a 24/7 urgent care component, the clinics staff and trustees must also pursue plans and funding to make this happen, sooner, rather than later.
It’s time to bring back the specialists: The clinic should begin contracting with medical specialists on a monthly, or, economically-feasible, rotating basis. These would be professionals whose diagnosis and treatment cannot be handled by the medical staff, and require face to face assessments, as opposed to telehealth. Examples are obstetrician and gynecologic services, dermatological services, and male prostrate examinations.
So, Borrego, there’s an opportunity to move forward. In fact, proposals for two opportunities. What transpires remains to be seen.