This article fist appeared in the St. Louis Beacon. - Only months after closing its specialty clinics, ConnectCare informed workers on Friday that it was eliminating the rest of its services on Nov. 15. The results will be a huge hole in the region’s medical safety net, officials say, noting that the urgent care center was on track to handle medical visits to about 17,000 patients.
"The failure to expand Medicaid by Jan. 1 was a key factor," says Melody Eskridge, ConnectCare's CEO. "The driving force is that we will be out or reserves by Dec. 15. Despite our restructuring there was still no funding sources to fill the revenue gap caused by serving uninsured and underinsured people."
ConnectCare has 53 full-time workers, and about 60 percent of its patients didn't have a primary care provider through a medical home. She says this means "the emergency rooms will see more non-emergency visits (from these patients) at a higher cost."
"Many patients will just choose to forgo care. Illnesses and injuries that could have been treated early may develop into more serious conditions with the ultimate impact of costing more to treat or, in the extreme case, result in death," Eskridge says.
The shut down of the Smiley Urgent Care Center comes only weeks after the St. Louis Regional Health Commission persuaded a team of providers to step in after specialty care services were discontinued at ConnectCare, 5545 Delmar Boulevard.
The team set up to accommodate the patients consisted of providers from BJC Healthcare, Barnes-Jewish Hospital, Mercy Health, SSM, SLUCare, and Washington University School of Medicine.
Just as health officials were taking a breather after an intense effort to find places for these patients, the other shoe dropped with news Friday that ConnectCare will now close its urgent care center.
Robert Fruend, CEO of the St. Louis Regional Health Commission. called ConnectCare an important piece of the region's safety net.
He echoed Eskridge's comment that shutdowns are likely to be an ongoing pattern until Missouri faces up to the impact of refusing to expand Medicaid. Under the Affordable Care Act, states were given the option of expanding this federal/state health insurance program for the needy with the federal government picking up all of the cost for three years, starting in 2014. After that, states would have to cover up to 10 percent of the cost.
Pressure on states to expand their programs began to build because the health reform law cut back on other payments, including millions of dollars to Missouri hospitals serving a disproportionate share of poor patients lacking health insurance. According to the Missouri Hospital Association, hospitals in the state are expected to lose $4 billion in federal payments over the next six years. The assumption had been Medicaid expansion would offset some of this cost.
The initial ACA law required states to expand Medicaid, but the Supreme Court later ruled that states should have the option of deciding whether to expand. Missouri is among about two dozen states that chose not to expand their programs.
Specialty care facilities that ConnectCare discontinued in September and October are pulmonology, neurology, dermatology, endocrinology, hepatology, cardiology, gastroenterology and orthopedic surgery.
Fruend noted that, in addition to finding other providers to treat the displaced patients, the commission helped to protect the region’s waiver to continue getting $30 million in health center funding. That money goes to a program called Gateway to Better Health. It accommodates about 23,000 uninsured residents. Although funding has been extended for another year, the program will now be limited to those earning 100 percent of poverty. The initial program covered primary care for patients earning up to 133 percent of poverty and specialty care for those with incomes up to 200 percent of poverty.
“Can we absorb this one?” Fruend asked, referring to ConnectCare’s new wave of reductions. “In the urban core and rural areas, the poorest populations, it’s predictable that services will be cut until we expand Medicaid. Medicaid expansion was supposed to give those providers the resources they needed to stay open.”
Fruend says this is only the beginning. “You can’t keep these cuts coming. The providers are going to lose their capacity. CEOs are saying that unless Medicaid expands, they will run out of money, run out of resources. They are trying to hold the fort until we get Medicaid expanded, hopefully, in the next (legislative) session.”
