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Clinical Recession

Dr. Eric Meininger says that despite financial woes, the U's decision to cut funding surprised many
Richard Fleischman

Amy McNeil, former director of the Health and Wellness Clinic at YouthLink, remembers a transgendered teenager relaying the saga of waiting four hours to see a doctor at a local hospital a few years ago. The patient reported that the staff spent half the time staring at her and the other two hours trying to figure out how to treat her medically.

Eventually, the teen made it to YouthLink, a homeless center for youth in Minneapolis, where she dropped in without an appointment, saw a doctor known on the streets for his GLBT expertise, and could have been tested for a sexually transmitted disease (STD) or received medication onsite. But teens like her may not have that opportunity in coming weeks, after Community-University Health Care Center (CUHCC) eliminates the clinic's funding.

YouthLink has had a clinic in its center on 12th Street off Hennepin Avenue for years, contracting the service from Health Care for the Homeless. Then YouthLink ran the clinic itself, but in 2004, a budget crisis required outside funding partners. That's when CUHCC came into the picture.

"It seemed like a nice fit," McNeil says of the relationship with CUHCC, which is overseen by the University of Minnesota. Last year the YouthLink clinic had more than 700 visits, many times seeing the same patient more than once, many of them receiving treatment for STDs. Further, all seemed well with CUHCC's 12 other satellites and a main clinic around town, which, combined, saw almost 9,000 patients last year.

But suddenly, on October 2, CUHCC's board announced it would be pulling its funding from the satellite sites. Citing operating losses of some $2.5 million at the end of its fiscal year in June, the board decided to sever financial ties with the clinics, which, it speculates, will save $500,000. On top of that, CUHCC eliminated another 17.5 positions from its main clinic, at the south Minneapolis intersection of Franklin and Bloomington avenues in the Phillips neighborhood. What's left now is a number of clinics and health care workers scrambling for funding and new partnerships to keep doors open.

State Rep. Karen Clark, a DFLer representing the Phillips neighborhood, says that at the state level, she's seen reduced funding to MinnesotaCare and grants for community clinics in recent years, while simultaneously there's been a tightening of restrictions on Medicaid, known as Medical Assistance in Minnesota. She says that, in part, led to the shortfall for CUHCC.

"If they can find money for a stadium, we should be able to find money for the community clinic," argues Clark, referring to state lawmakers, the governor's office, and the University of Minnesota, which oversees the clinic funding. She says she's willing to offer assistance to CUHCC, perhaps by introducing legislation for forgiveness of the $2.5 million debt. "We need to get them out of debt," says Clark. "Beyond that, we need to fix the system."

Of course, there may have been other factors in the rising debt at CUHCC, such as lower reimbursement rates from insurance companies and the failure of CUHCC to be in compliance with federal regulations in order to bill for services provided at satellite clinics. At a time when the most vulnerable are being squeezed out of the health care system because of budget cuts, and with other community clinics closing, the loss of these clinics will undoubtedly leave the already underserved with less.

"It's a hole in the context of health care," says Dr. Eric Meininger, CUHCC's director of outreach. "It's a hard time for health care. There isn't enough to go around."

 

The University of Minnesota created CUHCC in 1966 as a pilot program in Phillips, providing comprehensive pediatric health care to low-income families. The services expanded over the years, and CUHCC began funding satellite clinics in 2000, eventually expanding some services outside of the south Minneapolis neighborhood. When the university merged its hospitals with Fairview in 1996, the university retained CUHCC, and folded it into the Academic Health Center, which is the medical arm of the university. CUHCC now functions as a department of the university, with the CUHCC board's actions reviewed by the Academic Health Center.

Today, with a $12 million budget, CUHCC aims to provide underserved populations in the Phillips neighborhood with medical, dental, and mental health services. Of last year's 9,000 visitors, no one was turned away for an inability to pay. Eighty percent of its patients live below federal poverty guidelines, while more than 70 percent are people of color, immigrants, or refugees. The satellite clinics, housed in existing nonprofits, centers, and schools, serve communities that face even greater health disparities, with the clinics ranging in specialties from hepatitis screenings for drug users to Latinos in need of restorative dental care.

"You have to bring the medical services to them," says Meininger, explaining the practice of taking medical services into nontraditional clinical settings in established community spots.

Many clinics were faced with looking for new funding partners. CUHCC's board, which is composed of 51 percent community members and patients and 49 percent university associates, decided that CUHCC had to keep within its core mission—providing the underserved with health care out of its main clinic. That left the other clinics in a lurch.

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."


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