Battle of the budget: How can your clinic win?

With forecasts of shortfalls in state revenues, stagnant federal Title X funding, and increased operating costs, what is your facility doing to combat the battle of the budget?

Achieving success with pared budget figures will be a true challenge for family planning providers, forecasts Judith DeSarno, president and chief executive officer of the Washington, DC-based National Family Planning and Reproductive Health Association (NFPRHA).

"There is not a lot of fat in clinic budgets, so there is no real room for saving without cutting staff, services, or patients — solutions which only undermine quality and access to care," states DeSarno. How can your facility wage the budget war? Consider these suggestions:

Karla Schmitt, PhD, MPH, ARNP, chief of the Florida Department of Health’s Bureau of Sexually Transmitted Diseases (STDs) in Tallahassee, says the primary cost containment approach has been the following:

• The department has revisited all business practices to assess how the department can operate "smarter."

• It has reduced wasted staff time.

• It has increased client case loads for staff.

While Schmitt’s department has not experienced a direct impact from falling budget revenues on STD services, indirectly reduced or level funding has meant that vacant positions have been more difficult to fill since there has been no additional salary to offer clinical staff, she says.

"Due to the severe nursing shortage in the state, salaries for nurses are highly competitive and driving the comparable salaries for other health professionals," reports Schmitt.

Finding ways to operate more efficiently has been a challenge for Tecumseh, NE-based Family Health Services, says its deputy director Jean Brinkman.

• The program stretches its dollars is by purchasing items through the Los Angeles-based Family Planning Purchasing Cooperative.

While Family Health Services has used the cooperative’s services for less than a year, Brinkman estimates the agency has saved $500 to $800 in expenses. (Contraceptive Technology Update reported on the cooperative in its August 2002 article, "Will rising prices limit the options for patients at family planning clinics," p. 85.)

• To maximize staff hours, when patients do not show up for scheduled appointments, the time is allocated as "down time."

Some staffers prepare new patient charts, ready handouts on HIPAA (Health Insurance Portability and Accountability Act), and perform other clerical tasks, while other staffers catch up on reading material and provider updates, Brinkman says.

"This has probably saved us approximately 10 hours a month of extra paid staff time that won’t be paid now due to doing this work during down time at clinics," she says "We are such a small agency here in rural southeast Nebraska that I only have two full time staff and one part time. We do not have many staff, and the staff I do have to wear hats of many colors as they do many, many jobs."

• Family Health Services has increased its number of family planning patients by garnering referrals from established patients.

If the referral becomes a patient, the agency may give the established patient two free packs of pills to say "thank you," says Brinkman.

However, due to the lack of extra funding, the ability to attract additional patients is a challenge in its own right, states Brinkman.

"We do not even have enough money to advertise our program on a continual basis, due to high costs of advertising," she observes. "How are you supposed to see more clients when you do not have the funding to help you do that?"

Forecast: no increases

Agencies may be tightening their fiscal belts even more in the coming months due to shortfalls in Medicaid funding. The program is the single largest source of funds for family planning services and supplies.1 Twenty-eight states anticipate Medicaid shortfalls in the current fiscal year due to growing patient rolls, according to a recent survey.2 A one-time $10 billion boost from the federal government to state Medicaid programs may aid in avoiding current cuts, but offer only short-term relief to the growing deficits caused by increased Medicaid costs, say state budget directors and policy analysts.3

On the federal Title X front, do not expect an increase in funding levels, forecasts DeSarno. Instead, look to the government to increase emphasis on abstinence education, she predicts.

"In FY 2003 alone, [the federal government] will spend more than $117 million on abstinence-only education programs through three separate programs funded through the U.S. Department of Health and Human Services, representing a $15 million increase over FY 2002," reports DeSarno. "As for FY 2004, abstinence-unless-married education programs are headed for double-digit increases, while funding for family planning appears likely to barely maintain level funding."

[Editor’s note: What are some of the cost-containment tactics your facility is implementing to win the budget battle? Share them with Contraceptive Technology Update readers. E-mail them to, fax to (229) 551-0539, or mail to Contraceptive Technology Update, PO Box 740056, Atlanta, GA 30374.)


1. Gold, RB. States eye Medicaid cuts as cure for fiscal woes. Guttmacher Report on Public Policy 2003; 6:6-9.

2. National Governors Association. Tough economic times remain for states. Press release. June 26, 2003. Accessed at:,1422,5631,00.html.

3. Madigan E. Tax-cut cash won’t fix Medicaid, states say. June 17, 2003. Accessed at: