San Joaquin County clinics report lower billable visits, favorable payroll variance in year-to-date finances

At a meeting of the San Joaquin County Health Care Services Review Project Committee, clinic finance staff said billable visits for the county-run clinics were below budget for February and year to date, while overall net income was better than budget because of lower payroll costs.

Roshna Sharma, controller for SJ Health Centers, told the committee that February billable visits totaled 9,813 compared with a budgeted 13,049, an unfavorable monthly variance of 3,236 visits. Year to date through February, actual visits were 79,871 versus a budgeted 103,773, an unfavorable variance of 23,902 visits. Sharma said the budget includes about 24,215 visits attributable to positions that are budgeted but remain vacant; excluding those embedded visits would bring year-to-date visits roughly in line with budgeted productivity.

The net-income picture was more favorable. For the month of February, clinics reported net income of $242,000 versus a budgeted $210,000. Year to date, the clinics showed $2,700,000 in net income versus a budgeted net loss of $754,000, a favorable variance of roughly $3.5 million. Sharma and presenters said most of the favorable year-to-date variance stems from payroll costs running below budget, which she quantified as nearly $10 million across salaries and benefits, partly offset by an unfavorable net patient service revenue variance of about $5.5 million and higher professional fees of about $1.2 million tied to contracted medical staff (locums).

County Administrator Regalo and others answered committee questions about vacancies. Regalo said the clinics had 67 vacant positions out of 215 budgeted positions (about 31%) when the budget was reviewed. Sharma said nine providers were slated to start between May and July and that additional locum providers were filling some roles in the interim; clinic leaders said filling provider positions is central to increasing billable visits and related patient-service revenue.

Sharma also discussed other contributors to the favorable position, including about $335,000 of interest income from a higher cash balance and a $495,000 favorable variance in the 340B pharmacy program tied to a referral-opportunity implementation. She said cash on hand remained strong at about $23.6 million and accounts receivable was about $2.0 million; deferred revenue included a $332,000 payment from the Health Plan of San Joaquin that staff later identified as related to HEDIS incentive payments and expected to reclassify to revenue in March.

Sharma noted the clinics implemented an “intermittent clinic strategy” on Sept. 9, 2024, which increased collections at higher PPS (Prospective Payment System) rates for some sites; the strategy contributed to a rise in collections beginning in September but staff said they need more months of post-implementation data to fully assess its impact on accounts receivable and revenue recognition.

Committee members asked about recruitment and retention. Sharma and other presenters said recruitment in the region is challenging, that some departures predated current leadership, and that many providers leave to return to their home areas or to join larger systems that can sometimes offer higher pay. Clinic leaders said stabilizing provider staffing and filling exam rooms are priorities and that they expect to make progress as new hires and locum arrangements begin.