Medical Center cutting services to poor

hduncan@macon.comOctober 28, 2009 

The Medical Center of Central Georgia is cutting hours, clinics and pharmacy offerings at its W.T. Anderson Health Center, which provides primary and specialty care to the poor.

In addition, the Anderson Health Center will not be accepting new primary care patients into its CarePartners program, which provides primary and specialty care on a sliding-fee scale based on patients’ income, assets and insurance.

Most of the savings is expected to come from pharmacy cutbacks, said Sandra Higgison, business operations director for the Anderson Health Center. The center’s pharmacy will offer only about a quarter of the drugs it does now, she said.

Bibb County, which always has provided funding to the Medical Center to offset the cost of treating the county’s poor, cut the hospital’s allocation by almost $3 million for fiscal 2010. Hospital CEO Don Faulk had said the hospital would have to cut programs for the poor accordingly.

Rhonda Perry, chief financial officer for the Medical Center, said last month that the hospital spends about $25 million for charity care to Bibb County residents, although some of that is reimbursed through state and federal payments. The Medical Center will receive $1 million from Bibb County for charity care in fiscal 2010.

The Medical Center and other Georgia nonprofit hospitals are exempt from taxes in exchange for offering “community benefits,” particularly health care for the poor. According to the Medical Center’s Web site, the Anderson Health Center “was created in 1916 as an outpatient clinic of The Macon Hospital and has grown with and into an essential component of the Medical Center.”

Higgison said three of the Anderson Center’s 17 clinics have closed or will close: dermatology, behavior and pain. The number had already dropped from the 28 clinics once offered (and still indicated on the hospital’s Web site).

The pain clinic closed Oct. 1. The dermatology clinic closed shortly beforehand, and the behavior clinic, which mostly treats psychiatric patients suffering from depression and anxiety, is scheduled to close Nov. 25.

Higgison said most patients received about three weeks’ notice of the first two clinic closures, mostly through handouts at the time of their appointments. Notices have not been mailed to patients’ homes.

The Telegraph has been seeking information from the hospital about planned changes to the Anderson Health Center since late September, receiving only a vague response until last week.

The Anderson Health Center cuts come a year after the hospital closed the last of its neighborhood health-care centers, which provided primary care to the poor in their own neighborhoods. Many of those patients were encouraged to switch to the Anderson Health Center.

At the time, hospital officials noted that the Indigent Care Trust Fund, which reimburses hospitals for services to the uninsured, had stopped requiring that the hospital provide primary care.

Higgison said that since 2006, the Anderson Center went from serving 15,000 patients to 3,000. The drop was partly due to cuts in nursing positions and clinics such as a primary care clinic, she said. In addition, a more aggressive approach to validating patient financial information meant that fewer people qualified for the Anderson Health Center’s reduced-cost care.

In the last year, the Medical Center as a whole laid off more than 200 employees and cut $31 million in costs from its budget.

CLINICS CLOSING

All clinics at the Anderson Health Center, as well as the pharmacy, eliminated Friday afternoon hours starting Oct. 16.

The three clinics chosen for complete closure were picked because they don’t deal with life-threatening illnesses, they have smaller patient loads and affordable alternatives were available elsewhere in the area, said David Mathis, the Anderson Health Center medical director.

He said the pain clinic saw 56 patients for 110 visits during fiscal 2009, which ended Sept. 30. The dermatology clinic drew 36 people in 50 visits, and about 125 people were treated in 140 visits at the behavior clinic, he said.

Altogether, the Anderson Health Center clinics see patients for about 22,000 visits a year, he said.

Behavior clinic patients were referred to River Edge Behavioral Health Center, which also uses a sliding-fee scale. The doctor who had run the dermatology clinic has said he’ll continue to see those patients at his private practice using a sliding-fee scale, Mathis said.

However, “We haven’t been able to work anything out for the pain clinic patients,” Mathis said, adding that he’s still trying. He said those patients can receive medications through their primary care doctors but not the pain block injections they received at the clinic.

All of the doctors who work in the Anderson clinics donate their time, so the cost savings from closure don’t come from their salaries, Higgison said. But the process will reduce overhead and support staff costs, she said.

Besides the closures, some Anderson Health Center staff will drop from full time to part time, and the sole paid medical position at the internal medicine clinic was eliminated, Mathis said. (That person found a job elsewhere at the hospital.) Twenty-seven internal medicine residents provide the rest of the care at that clinic, he said.

The elimination of the clinical job means the residents must see about 18 more patients a day, plus the clinic backlog of about 225 patients who have missed appointments or otherwise gotten temporarily out of the rotation, Mathis said.

This is the reason for the freeze in enrolling new patients in the center’s most comprehensive CarePartners program, the “Medical Home” plan. People seeking reduced-price coverage at the Anderson Health Center must enroll in CarePartners, which is for low-income adults with no access to insurance or Medicaid.

There are three other CarePartners plans that offer access to specialty care or help low-income Medicare patients. But the Medical Home plan offers a full range of primary care and specialty clinic access.

“Hopefully this will be a short-term freeze,” Mathis said. “We hope to be looking at reinstating the plan at the beginning of next year.”

Mathis said existing members whose annual enrollment ends during the next few months will be allowed to re-enroll.

An average of 40 new patients enroll in the Medical Home plan a month, Mathis said.

PHARMACY CUTBACKS

The Anderson Health Center pharmacy offers prescriptions for as little as $5 for a 60-day supply of medications, said Michael Strange, an outpatient pharmacy assistant manager. Mathis said the pharmacy now fills about 100 prescriptions a day.

Between now and February 2010, the pharmacy will begin phasing out all drugs except those that pharmaceutical companies agree to supply in bulk for free, Mathis said.

Jeff Price, a clinical pharmacy assistant manager, said he expects prescription volume to drop by half as three-quarters of the drugs now offered are eliminated. Eventually, the drop in volume will mean that the center downsizes a pharmacist and a tech position, Strange said.

Some of the most frequently filled prescriptions being eliminated include contraceptives, insulin and some other types of drugs that treat diabetes, hypertension and high cholesterol, he said.

Mathis said the pharmacy is telling patients who need drugs covered by the $4 program at commercial pharmacies to use that option. Others are encouraged to talk with their doctors to find out if a cheaper drug, or one that will still be offered at the pharmacy, could do the same job as their current prescriptions.

Strange said patients who need insulin have expressed the most concern, and most other patients haven’t complained about the upcoming changes.

Holly Lang, manager of the Hospital Accountability Project for the consumer group Georgia Watch, said the Medical Center’s status as a nonprofit hospital makes its cuts to charity care troubling.

“The cuts to pharmacy programs are very, very disturbing,” Lang said. “That’s going to create a massive issue for a lot of families, because a lot of these prescriptions aren’t available in generic form but are required.”

Valerie Biske, executive director of the Macon Volunteer Clinic on Rogers Avenue, said her clinic and two others in Middle Georgia are likely to see a large influx in patients as a result of the Anderson Center changes.

Biske said the pharmacy cutbacks will be especially tough for people with chronic illnesses such as diabetes.

She noted that although there are cheaper or generic equivalents to some medications, all drugs don’t work the same way and may not be equally effective for different patients.

“We do have some people who are allergic to some of the generic components,” Biske added.

MONITORING CHANGES

Biske and Lang both noted that people without access to primary care are more likely to end up in the emergency room, which is more expensive for both the patient and the hospital. Medical Center officials have said the same in the past.

Higgison said Anderson Health Center leaders will be monitoring inpatient and emergency room visits during the next few months to see if there is an increase in usage and severity of illnesses among former Anderson patients.

Higgison said more aggressive financial evaluations of Anderson Health Center patients assure that those still served are truly needy. In 2008, the center began running credit checks on all CarePartners members, turning up many hidden assets, she said. The hospital also began requiring applicants to obtain a statement from their employers about whether they have access to insurance.

Biske said some of the patients who come to the Macon Volunteer Clinic, which is free, say they have been turned away at the Anderson Center because they have access to insurance. The problem with that, Biske said, is that some of those insurers either won’t cover pre-existing conditions, such as diabetes, or they charge exorbitant rates to cover them.

Lang acknowledged the types of cuts being made at the Medical Center are common at Georgia hospitals.

Mathis said, “It’s always a battle to get the funding for those people who need it.”

The Medical Center continues to offer more care options to the poor than many hospitals in Georgia’s major cities, Higgison said.

“For some people, it’s been free for so long, it’s rough for people to realize: ‘It’s not free, but it’s my health, and I have to make a choice,’ ’’ she said. “And choices are difficult sometimes.”

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