BROOKSVILLE — Faced with a short staff and a budget showing signs of a fragile recovery, the Hernando County Health Department will begin closing its Brooksville office three days each week.
The office, at 300 S Main St., currently provides general clinical services Monday through Friday. Starting June 4, the office will be open for services on Tuesdays and Fridays. On Monday, Wednesday and Thursday, all services will be provided at the department's new 57,000-square-foot building on Forest Oaks Boulevard in Spring Hill.
The obvious effect is a longer trip on those days for clients who live in Brooksville and points east. Department administrator Phil Spence calls it a necessary — though likely temporary — reaction to the rough economic climate that hamstrings the department's ability to bolster its ranks.
The situation grew worse recently after several nurses left "for greener pastures," Spence said. At least some of those vacancies will be filled.
"We're kind of running our staff ragged, and we have no backups if anyone calls in sick on any given morning," Spence said. "That is not only causing stress on our staff, it's causing the clients to have to wait longer."
The move does not come with a reduction of hours for staff, Spence said, but will significantly reduce or even eliminate the potential for overtime pay and comp time.
In fact, Spence said he expects the move to improve the department's overall level of service in two critical ways. By marshaling resources to the Spring Hill office three days a week, the department should be able to schedule appointments sooner and reduce clients' wait times once they arrive.
There are a few ways to achieve those goals, Spence said. One is to see more clients on a walk-in basis or on the same day they call for an appointment.
Another is to increase the number of double appointment bookings to help counter a client no-show rate that hovers around 25 percent to 30 percent. That will be a safe strategy only on the days when the clinical services team is all in one place, Spence said.
The department is also working to streamline its appointment process and improve the automated phone system.
Like its counterparts throughout the state, Hernando's Health Department has suffered financial hits on several fronts in recent years. Medicare reimbursements and state and federal funding continue to decrease while the county's high unemployment rate drives more residents to seek services priced on a sliding income scale.
Last fall, just days before staffers were to start moving in to the new Spring Hill facility, Spence's predecessor announced 10 layoffs that extended to all areas of the department. When Spence arrived as interim administrator in November, the department's reserve fund had dipped into the red by about $227,000. The state wants departments the size of Hernando's to keep reserves of about 7.5 percent of the total budget.
The long-term health of any department is dependent on having the right mix of clients. Some have insurance, some are covered by Medicare or Medicaid, and some are under-insured or uninsured. Fees for the last category are levied according to a seven-tier scale based on income. Indigent patients pay nothing. No one needing care is turned away.
One of the main strategies in Spence's corrective action plan is to attract more patients who can pay or have insurance so that revenue can subsidize services for poorer patients. Ideally, the money could even cover the cost to expand services.
The biggest area of concern has been the department's dental clinic. In February, roughly 65 percent of the patients were eligible for free services. The department has seen some progress in its initiative to attract children, whose dental services are covered by Medicaid, Spence said.
There are signs that the department's fiscal health is on the mend.
By the end of last month, the budget had crept into the black by a little more than $400,000, or nearly 5.9 percent of the department's $7 million budget. The fund will take a hit this month with an extra pay day, but the department is still on target to meet Spence's goal to have a reserve fund equal to 4 percent of the total budget by June 30, the end of the fiscal year.
The department received about $780,000 from the county this fiscal year. Spence sent a letter to the County Commission late last month notifying the board of the impending changes.
Commission Chairman Wayne Dukes said he has faith in Spence, a veteran health department administrator with a proven track record.
"Because we're in a situation where funding is extremely tight, sometimes you have to make those kinds of choices, and I respect his choices," Dukes said.
The department will start a marketing campaign this month to notify clients and the public of the changes.
"As soon as we're comfortable that we've got the right processes in place to continue on the upward trend," Spence said, "then we're going to look at bringing on more staff and opening Brooksville for five days."
Tony Marrero can be reached at (352) 848-1431 or firstname.lastname@example.org.