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How clinics are paid

Although Dr. Dan Bibelheimer’s opinion piece regarding the flight of primary care physicians is in many ways accurate, it contains a couple of factual errors.

Sierra Family Medical Clinic is close to Camptonville and proud to serve its citizens, but it is located on the San Juan Ridge with a Nevada City address on Tyler Foote Road. That’s quibbling, I know.

The real point is how clinics are paid. Clincs do not receive the full amount for a visit from Medicare or MediCal. The reimbursement rate is set on a “cost” basis (you get paid what it costs to provide the service).



Unfortunately, these supposed costs for a lot of very complicated reasons are always less (often considerably less) than the actual cost of providing the service. For example, each time a MediCal patient visits our dental clinic, it costs, on average, $38 more to provide the service than we receive from MediCal. Medicare, on the other hand, while “cost” based, is capped at less than what MediCal pays.

Sierra Family, Miners, Western Sierra, and Chapa-de are nonprofits that provide services to the community at what in any other business would be called a loss. They rely heavily on foundation and consortium grants, and on support from the community itself to keep their doors open.




Richard Mantle

Chief Administrative Officer

Sierra Family Medical Clinic


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