The Hall County Board of Commissioners is scheduled to vote Thursday on whether to lease part of the Hall County Health Department to Northeast Georgia Health System.

Hall’s health department is among the few in Georgia that has a primary care clinic. It charges patients on a sliding scale based on their income, and it serves as a doctor’s office for people who do not have a private physician.

The health system, including Northeast Georgia Medical Center, contributes about $1 million a year to the operation of the clinic, which sees about 8,800 patients a year.

"Without the hospital’s funding, the clinic would not exist," said Dr. David Westfall, medical director of District 2 Public Health in Gainesville. "They essentially fund all of it."

County health departments, under the Georgia Department of Human Resources, don’t receive state money for general primary care. The departments target specific groups of patients, such as babies and pregnant women, and specific programs, such as immunizations and testing for infectious diseases.

Nor does Hall government contribute to primary care.

"The county does not fund operation of the clinic," said assistant county administrator Phil Sutton. "We provide funding to other areas of the health department, for state-mandated services, but not for this service."

But the Hall County Health Department has been working with Northeast Georgia Health System to provide primary care for almost a decade, with some assistance from the state’s Indigent Care Trust Fund.

About four years ago, Georgia changed the rules for how the trust fund could be used. Northeast Georgia Health System then stepped up its support, paying the salaries for one full-time and one part-time physician.

Westfall said in August, the health system went a step further, putting the clinic’s 12 employees on its payroll. This was a prelude to the health system actually taking over operation of the clinic.

"It’s part of an ongoing strategy to provide less expensive, non-emergent care," said Westfall.

Northeast Georgia Medical Center has been trying for years to redirect patients away from the emergency room. On June 1, the hospital started a new policy, requiring patients to pay $150 up front if they chose to be treated in the ER and did not have a true emergency. Patients are given a list of options for primary care, including the health department.

Westfall said discussions about the hospital taking over the health department’s primary care clinic started long before the new ER payment policy began.

"It was a mutual decision," he said. "As a health department, we didn’t have funding to improve facilities or extend hours."

But in order for the hospital to carry out its plan, it needed more control over the infrastructure at the clinic.

"The (proposed) lease is actually a sublease for a small portion of the (health department) building," said Sutton. "They’ll be able to do renovations and to control access. They’ll be more like a tenant rather than a service provider."

Sutton said the lease is just a formal agreement between the hospital and the county, but no money changes hands. There’s no expense to the county, and the hospital will not pay rent.

If approved, the lease would go into effect Oct. 1. Wanda Katich, consultant to physicians’ services for the health system, said it will cost about $180,000 to renovate the 6,000-square-foot space.

"We’ll reconfigure the front office, and we’ll have more exam rooms," she said. "There will also be a new lab for primary care, separate from the lab for the rest of the health department."

Westfall said they would also change some entrances and hallways so that the primary care clinic can continue to operate when the health department is closed.

Currently, the clinic doesn’t see patients on Friday afternoons. Katich said once the hospital takes over, the clinic will be open full time on weekdays, and eventually from 1 to 6 p.m. Saturdays. They’re also looking at some late evening hours and even opening on Sundays, she said.

In addition, by the end of March, the clinic’s computers will be converted to the same electronic medical records system that is used by the hospital’s network of Neighborhood Healthcare Centers.

"We need a patient record-keeping system," said Westfall. "The information system at the health department is not designed for a primary care clinic. It’s designed to collect information for the state."

Katich said the hospital won’t make any money off the clinic, which treats patients who have little or no insurance.

"The goal is not for it to be a profit center," she said. "But it can help to mitigate costs from the ER."