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The Community Clinic is about to fall through a crack in the state reimbursement system.
It's slated to close Oct. 20 unless funding is found to help it stay afloat. The clinic relies heavily on government reimbursements – 92 percent of its patients receive Medicaid benefits.
The clinic sees between 700 and 800 patients now, and has had as many as 1,000 in its caseload in the past.
Roger Ambrose, director of community services for Jefferson County, says the consequences of a clinic closure could be “catastrophic”:
"I mean, we have patients who will end up in emergency rooms. Um, many patients may end up in jail, because when mentally ill, seriously mentally ill people don't get the medications or the counseling services that they need, they can decompensate and consequently a lot of them will behave symptomatically for the mentally ill, and that can scare other people, it can result in conflicts and so on. Um, yeah – it's overwhelming. It will overwhelm our hospital system, too."
The Children's Home of Jefferson County took over operations of the clinic from Mercy Care Center in late June. Children's Home Executive Director Karen Richmond says the timing of the takeover is a big part of the funding problem:
"Someone made the comment to me that we're just doing this at the worst possible time. Um, the method of running a clinic changed dramatically a year ago when New York state introduced the 599 regs. And the 599 regulations require a clinic to be reimbursed under a different model. So clinics that were currently in operation had four years of transition funding to get to the new model of funding."
The Community Clinic, in the midst of an ownership change, missed out on the interim money.
The clinic could still get transition funding through the state, Richmond says, but it would have to operate at a loss for two years to figure out what that funding level should be.
She said that's something the Children's Home just can't afford. When the Children's Home took over the clinic operations from Mercy, officials believed the clinic would receive reimbursement under the new state system. Instead, it's being reimbursed under a basic Medicaid model, at $68 per appointment. That's about to change to $80 per appointment.
"But the model that we based it on was $140 – $138.57" says Richmond.
Now, as elected officials struggle to find money to save the clinic and the possible closure date looms, Richmond says the Children's Home is also looking at a third alternative: scaling down the clinic. That would minimize operating losses during the transition to the new reimbursement model.
The new system will benefit clinics and patients in the end, Richmond says – the new reimbursement regulations are geared toward keeping patients out of emergency rooms and hospitals by providing more consistent outpatient care. So no one wants to scale back the clinic, even temporarily.
Richmond says elected officials and the Children's Home leadership are hoping to find a way to keep the clinic open at full capacity before the Oct. 20 closure date.