Posted 12:24 am Tuesday, February 21, 2012
Patient Care Continuity Cited As Concern In Clinic's Funding Cut
By COSHANDRA DILLARD
Staff Writer
Since its inception, Total HealthCare Center in Tyler has struggled to keep its federally-qualified health center afloat.
Financial woes — including the loss of funding from Smith County and now the city of Tyler — and high staff turnover have plagued the facility.
Staff Writer
Since its inception, Total HealthCare Center in Tyler has struggled to keep its federally-qualified health center afloat.
Financial woes — including the loss of funding from Smith County and now the city of Tyler — and high staff turnover have plagued the facility.
Several community members, including leaders at PATH, the Smith County Medical Society and The University of Texas Health Science Center at Tyler, have expressed concern about the risk to the continuity of patient care.
City of Tyler officials were added Monday to the list of entities that are raising eyebrows. Clinic officials learned that $265,000 in annual financial support from the city will be suspended.
City of Tyler officials were added Monday to the list of entities that are raising eyebrows. Clinic officials learned that $265,000 in annual financial support from the city will be suspended.
In a letter from the city’s attorney, Gary C. Landers, he informed board chairwoman Pamela Phoenix about the decision, citing concerns over an ongoing state investigation, instances of noncompliance and recurring turnovers in leadership.
In 2009, Smith County commissioners voted to strike the inmate medical services option from a contract with the clinic, meaning a loss of $236,000 to the clinic. County officials cited limited funding and lack of communication from center board members as they prepared the FY 2010 budget.
The clinic had received $486,000 from the county as part of the Northeast Texas Public Health District since 2002, but when the clinic split from the district, both entities requested separate public health funding from the county.
In 2009, Smith County commissioners voted to strike the inmate medical services option from a contract with the clinic, meaning a loss of $236,000 to the clinic. County officials cited limited funding and lack of communication from center board members as they prepared the FY 2010 budget.
The clinic had received $486,000 from the county as part of the Northeast Texas Public Health District since 2002, but when the clinic split from the district, both entities requested separate public health funding from the county.
The history of this federally qualified health center began in 2002, when the Smith County Public Health District sought to increase health care services for low income patients. In October 2003, its board of directors was faced with decreasing federal, state and local funding.
This meant drastic cuts to its primary care for the poor, who would have reduced its services by at least half, but district officials learned that they would receive a $323,475 incubator grant from the Texas Department of Health and Human Services to gain federally qualified health center status.
In January 2004, Community Health Clinics of Northeast Texas, formerly the health district’s clinical departments, was spun off as a separate entity with its own board because of federal regulations. The clinic received its federal status in 2007 and officially split from the health district in 2008. Its five clinics were later consolidated into one location in 2009.
In a May 2010 visit from the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services, Total HealthCare Clinic was not in compliance in 10 out of 20 areas, according to a report. The report also detailed violations of Texas labor laws, poor financial management, improper board record keeping and unstable administrative leadership. A follow up showed that they were still out of compliance with six issues.
This meant drastic cuts to its primary care for the poor, who would have reduced its services by at least half, but district officials learned that they would receive a $323,475 incubator grant from the Texas Department of Health and Human Services to gain federally qualified health center status.
In January 2004, Community Health Clinics of Northeast Texas, formerly the health district’s clinical departments, was spun off as a separate entity with its own board because of federal regulations. The clinic received its federal status in 2007 and officially split from the health district in 2008. Its five clinics were later consolidated into one location in 2009.
In a May 2010 visit from the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services, Total HealthCare Clinic was not in compliance in 10 out of 20 areas, according to a report. The report also detailed violations of Texas labor laws, poor financial management, improper board record keeping and unstable administrative leadership. A follow up showed that they were still out of compliance with six issues.
The clinic has had eight professionals serve as either an executive director or interim executive director since 2006.
Stephanie Jones-Theaker, the center’s former executive director who recently resigned, said during a September 2011 meeting with board members that findings found in the federal report were not alarming, and many federally qualified health centers suffer the same problems.
“Just about every finding we’ve had has been corrected since I’ve been here in the last 90 days,” she said.
In two grant authorizations, the federal agency warned Total HealthCare Center that it is at risk of losing federal funding if compliance issues are not corrected. The clinic received more than $920,000 for FY 2011. The agency implemented a “draw down restrictions” on their payment management system.
According to Health Resources and Services Administration, this restriction means that on a monthly basis, the clinic must submit a request for funding and written authorization must be provided by agency in order for awarded grant funds to be placed in the grantee’s bank account.
A decision to place a grantee on draw down restriction is made based on the agency’s review of an annual audit submission and other financial information.
In a statement released last fall, a representative from Health Resources and Services Administration said, “HRSA is committed to addressing areas of noncompliance and assisting grantees, including Total Healthcare Center, in meeting Health Center Program requirements through the provision of appropriate guidance and facilitation of technical assistance.
“Less than 5 percent of health center grantees are placed on drawdown restriction. When a health center is not in compliance with one or more program requirements, a condition is placed on the grantee’s award providing a specific time period within which to respond.
Most grantees are able to demonstrate compliance with requirements in a timely manner, and it is rare that HRSA needs to take further action on grant funding.”
The grant program was created in 1991 with an amendment to Section 1861(aa) of the Social Security Act, a result of the passage of the Omnibus Budget Reconciliation Act of 1990.
The program’s goal is to maintain, expand and improve the availability and accessibility of primary and preventive health care services to low-income, medically underserved and vulnerable populations who may otherwise not be able to afford it.
It means health care is available to anyone who is uninsured, has insurance or is covered by Medicare, Medicaid or state health programs such as the Children’s Health Insurance Program. A federal qualified health center must serve people with incomes of 200 percent of the poverty level or below.
Total HealthCare Center served 8,416 patients with 16,969 visits from 13 counties last year.
“The whole premise of an FQHC is to eliminate some of the strain of the emergency room by providing care for patients outside of the emergency room,” Ms. Theaker had said.
The clinic’s board must consist of 51 percent of its users. It also receives an enhanced reimbursement for Medicaid — twice as much as the reimbursements at hospitals and other health facilities. THC board members have said that since the changes in health care have occurred, more facilities now want to be affiliated with federally qualified health centers because of the enhanced Medicaid reimbursement.
The number of these types of clinics in an area depends on the need in a community and there is typically only one per area, with the exception of large metropolitan cities. There are three other federally qualified health centers in East Texas: Longview Wellness Pointe, Mount Enterprise Community Health Center and Marshall’s East Texas Border Health Clinic.
Ms. Theaker said medical actions fall under the federal medical tort act, meaning they don’t have to have liability insurance, which are the primary costs of medical facilities. She said billions of dollars have been “thrown at” these clinics for last couple of years and there is a lot of competition for the dollars.
Because of the reporting requirements, they are not easy to run, Ms. Theaker said.
“They are a different model from other nonprofits,” she said. “You’ve got to have somebody who’s a real expert in running an FQHC.”
Stephanie Jones-Theaker, the center’s former executive director who recently resigned, said during a September 2011 meeting with board members that findings found in the federal report were not alarming, and many federally qualified health centers suffer the same problems.
“Just about every finding we’ve had has been corrected since I’ve been here in the last 90 days,” she said.
In two grant authorizations, the federal agency warned Total HealthCare Center that it is at risk of losing federal funding if compliance issues are not corrected. The clinic received more than $920,000 for FY 2011. The agency implemented a “draw down restrictions” on their payment management system.
According to Health Resources and Services Administration, this restriction means that on a monthly basis, the clinic must submit a request for funding and written authorization must be provided by agency in order for awarded grant funds to be placed in the grantee’s bank account.
A decision to place a grantee on draw down restriction is made based on the agency’s review of an annual audit submission and other financial information.
In a statement released last fall, a representative from Health Resources and Services Administration said, “HRSA is committed to addressing areas of noncompliance and assisting grantees, including Total Healthcare Center, in meeting Health Center Program requirements through the provision of appropriate guidance and facilitation of technical assistance.
“Less than 5 percent of health center grantees are placed on drawdown restriction. When a health center is not in compliance with one or more program requirements, a condition is placed on the grantee’s award providing a specific time period within which to respond.
Most grantees are able to demonstrate compliance with requirements in a timely manner, and it is rare that HRSA needs to take further action on grant funding.”
The grant program was created in 1991 with an amendment to Section 1861(aa) of the Social Security Act, a result of the passage of the Omnibus Budget Reconciliation Act of 1990.
The program’s goal is to maintain, expand and improve the availability and accessibility of primary and preventive health care services to low-income, medically underserved and vulnerable populations who may otherwise not be able to afford it.
It means health care is available to anyone who is uninsured, has insurance or is covered by Medicare, Medicaid or state health programs such as the Children’s Health Insurance Program. A federal qualified health center must serve people with incomes of 200 percent of the poverty level or below.
Total HealthCare Center served 8,416 patients with 16,969 visits from 13 counties last year.
“The whole premise of an FQHC is to eliminate some of the strain of the emergency room by providing care for patients outside of the emergency room,” Ms. Theaker had said.
The clinic’s board must consist of 51 percent of its users. It also receives an enhanced reimbursement for Medicaid — twice as much as the reimbursements at hospitals and other health facilities. THC board members have said that since the changes in health care have occurred, more facilities now want to be affiliated with federally qualified health centers because of the enhanced Medicaid reimbursement.
The number of these types of clinics in an area depends on the need in a community and there is typically only one per area, with the exception of large metropolitan cities. There are three other federally qualified health centers in East Texas: Longview Wellness Pointe, Mount Enterprise Community Health Center and Marshall’s East Texas Border Health Clinic.
Ms. Theaker said medical actions fall under the federal medical tort act, meaning they don’t have to have liability insurance, which are the primary costs of medical facilities. She said billions of dollars have been “thrown at” these clinics for last couple of years and there is a lot of competition for the dollars.
Because of the reporting requirements, they are not easy to run, Ms. Theaker said.
“They are a different model from other nonprofits,” she said. “You’ve got to have somebody who’s a real expert in running an FQHC.”
