Clinical Recession

With tempered language, Meininger says the board's decision was hard to hear. "It's not easy. I'm very invested in the patients," he says. The clinic's programming, some of which he developed, was specifically designed to be sustainable. "The university has a history of moving in and providing services and pulling out of the community," says Meininger. He learned of the pending board's decision just days before the vote.

Colleen McDonald, CUHCC's development director, says that growing health care needs and increased regulatory requirements, both stresses on the health care system, hurt CUHCC's bottom line. "Community clinics are having a difficult time," says McDonald. "The number of uninsured are up and the reimbursements are down."

To add further duress, it was discovered a few years ago that CUHCC wasn't billing properly for any of the services being provided at satellite clinics. CUHCC had been getting federal grants because it was dealing with the uninsured. In federal government audits, it was determined that there were compliance issues, and some federal money was lost. While work was being completed to get the satellite clinics into compliance, billing hadn't occurred for some time, according to Meininger.

Losing money is nothing new for the clinics, but while the university's Academic Health Center was willing to absorb financial losses of years past, around $1 million annually, the center wasn't willing to forgive $2.5 million. So the Academic Health Center offered CUHCC a five-year, no-interest loan to cover the operating loss, which the CUHCC board accepted. Yet it also determined that continuing to fund the clinics would still cost too much (which is why Rep. Karen Clark is willing to try to get the loan waived.)

Each of the 13 sites being eliminated from CUHCC's budget either found partners or is encouraging patients to travel to CUHCC's main Phillips clinic, even if it is short-staffed. The lone exception is YouthLink, which continues to search for a partner. YouthLink's McNeil says the decision's timing makes finding new funding difficult, as money from other sources is granted for the year. "I'm not very optimistic the doors won't be closed for a short time," says McNeil. That doesn't bode well for youth health care. A survey conducted a few years ago found that if teens didn't use the clinic, they'd likely go to the emergency room or not seek health care at all.

"It's taken how many years to put these services in place," Meininger notes with a sigh, "and look at how quickly they go away."