Patients praise care, but changes must be made to reduce turnover and improve financial management

Read the executive summary on this page and download the pdf for the full report. 

Integrated Clinical Services Primary Care Audit Report (1.79 MB)

Watch the Integrated Clinical Services Primary Care audit presentation to the Board of County Commissioners

What We Found

Multnomah County operates a Community Health Center program, also known as a Federally Qualified Health Center (FQHC), within Integrated Clinical Services (ICS), a division of the Health Department. The focus of our audit was on the primary care clinics within the Community Health Center. In our interviews with patients, they praised the care they received.

However, provider workload and turnover are uneven across the system, especially at the Mid County Health Center. Turnover should be addressed as it reduces patient access to providers, increases the workload on remaining providers, and is costly.

ICS needs a high-level financial decision-maker as part of the leadership team to help make operational decisions that impact the system financially.

Why We Did This Audit

This audit was included in the audit schedule by the previous Auditor. Auditor McGuirk continued the audit because ICS provides important services to our community.  In particular, primary care clinics provide health services for people who experience barriers to accessing health care, including people who are experiencing poverty, uninsured, and/or homeless.

What We Recommend

ICS senior leadership should:

  • Develop a provider retention plan and begin implementation.
  • Partner with Health Department staff to analyze the impact of turnover, including costs.
  • Address the differences in provider workload across the system.
  • Change Call Center greeting so that announcements about what to press for different languages occurs in the most commonly used languages of their patient population.
  • Hire a financial director with industry expertise to be part of the ICS leadership team.
  • Work with Central Finance to create a special revenue fund.
  • Evaluate provider productivity goals to ensure they are aligned with financial goals.
  • Develop procedures to ensure that all patients are notified timely of any abnormal lab results.