It's official: the Ravenswood Family Health Network has acquired the MayView Community Health Center Clinics. The move, announced in December last year, has been finalized. The Ravenswood Family Health Center has become the Ravenswood Family Health Network and expanded its footprint to include five locations: the Ravenswood Family Health Center, the Ravenswood Family Dentistry clinic, and MayView's current clinics in Palo Alto, Mountain View and Sunnyvale.
The combined sites employ about 300 staff, including more than 50 clinicians, and serve about 27,000 low-income patients, according to a press release.
But visitors to the former MayView clinics aren't likely to experience any key differences in their experiences at the clinics. The clinics are keeping MayView as part of their name, and all but three MayView staff members were retained, according to Ravenswood Family Health Network CEO Luisa Buada.
The MayView staff has moved over to the Ravenswood system and retained its seniority and benefits, with the same or better pay rates. "I think overall it has been satisfactory for everyone," Buada said.
While the Ravenswood network received federal funding, the MayView system did not; it had applied previously for federal funding and was denied. In acquiring the MayView clinics, the Ravenswood network won't be receiving additional federal funding.
The cost savings that will come from the acquisition of the MayView clinics will have more to do with creating some economies of scale, Buada said in an interview.
The clinics, she said in a press release, "have served geographically adjacent service areas that today can facilitate easier patient access and provide for expanded service opportunities."
The process also required the approval of federal and state authorities. While the Ravenswood network was in the process of acquiring the MayView clinics, they received support from the Santa Clara County Board of Supervisors, Santa Clara County Health and Hospital System, El Camino Hospital District, Stanford Health Care, the Silicon Valley Community Foundation, the Starlight, Sobrato, Sand Hill and California Healthcare foundations, and the Mountain View Voice Holiday Fund.
Kenneth Graham, CEO of the MayView clinics, will help the board wind down the corporation over the next several months.
"We are grateful for the volunteer and financial support provided by our communities to MayView clinics over the past 48 years," he said in the press statement.
Community clinics face uncertainty
Even while the acquisition process moved forward pretty smoothly, the clinics were thrown into a state of uncertainty when the coronavirus pandemic struck.
"It's very hard right now to figure out what the future's going to be like," Buada said. Predictions, she said, range from "everything is going to be fine" to "everything is going to be terrible."
"We had to pivot to be responsive," she said. The network has had to switch rapidly into telemedicine to offer visits by phone or video. These visits often take more time for physicians and assistants to arrange and conduct, and can offer lower reimbursement rates than in-person visits.
The clinics continue to offer in-person visits and COVID-19 testing to people by appointment. COVID-19 tests are done in the parking lot from visitors' vehicles to reduce exposure. People can also pick up prescriptions curbside at the East Palo Alto pharmacy.
In-person visits remain critical for some patients, especially those needing prenatal care, children under 2 years old needing vaccines and developmental tests, and patients with chronic disease.
The biggest problem the network now faces, however, is that people aren't coming in for routine visits.
Visits are down to about 40% of the usual patient volume, Buada said.
Halting routine visits can have negative health impacts on people with chronic diseases in particular. Because of the shelter-in-place orders, some patients that may have been stably dealing with chronic diseases could lose that stability, she said. For instance, the clinics provide regular blood testing to patients with diabetes, and some patients are now going many months without these tests.
The shift is also costing the network: The network of clinics lost about $1 million in March, and expects to lose about $1.4 million per month in April and May due to COVID-19, Buada said.
Part of this is because the state's reimbursement rate is lower for phone call visits in particular. The network receives only about 25% of the reimbursement by Medicare that a face-to-face visit would normally receive, Buada said. And video calls have a number of restrictions on when they can be used instead of a face-to-face visit. The network has had to figure out how to document these visits in a way that was billable; find a web application that would work; and try to ensure privacy – though the threat of privacy violations remains a concern – all in recent weeks, she said.
The network has received a federal paycheck protection loan that will help until the end of June, she added.
And yet, even while revenue is declining, more people continue to enroll in the clinics' services, since many are losing insurance due to job loss, she added.
The network's dental clinic is also closed to all but urgent needs, which only represent about 20% of the clinic's overall dental care services.
But if patients go too long without dental care, simple needs can become urgent; for instance, people can develop pain and abscesses that need immediate treatment. The dental clinic is rare in that it provides comprehensive dental care and general anesthesia dental surgery for kids and disabled adults, which is difficult to find for Medi-Cal patients, she added.
Dental work, in particular, can create unique risks when it comes to the coronavirus, Buada said. Tasks like drilling or polishing teeth can aerosolize droplets from a contagious patient, which can leave the virus in the air for longer than if it were in a droplet form.
Clinic leaders are still trying to figure out what equipment purchases and reconfigurations they need to do to safely provide dental care in the age of the coronavirus.
Open bays with multiple chairs in a room need to be closed; machines need to be purchased to pull aerosols out of the air; and UV lights should be acquired to kill microbes on surfaces, Buada explained. These expensive pieces of equipment could take months to get, and there's still a possibility that regulatory agencies could step in after the equipment has been bought and impose new standards or guidelines, she added.
"We're trying to be cautious, and yet, we don't want to let patients down," she said. "How can we start as soon as possible?"