It seems to be a mantra across the nation and in Minnesota among healthcare providers – scaling back, closing facilities, repositioning – the terms used to describe the high cost of healthcare delivery, low reimbursement rates, and the eventual impact on consumers.  Courage Center, often thought of as the “rich kid on the block,” is finding that it’s no exception.

Faced with a looming annual two million-dollar deficit, the Courage Center has determined that it can no longer operate its nonprofit business as usual. Inadequate reimbursement for delivering higher-cost rehabilitation services, 70 programs, and the costs of serving an increasingly medically-complex clientele have created a financial burden – one that can’t be sustained by the annual support of our community’s generous donor base nor the organization’s current endowment fund.

So, what does all this mean for the Courage Center?  For our disability community?  For our community at large?  It means persistent challenges, lack of adequate funding to meet critical disability healthcare needs like mental health and outpatient services, and rising fees for people with limited incomes. It means getting these issues on the state’s public policy agenda, uniting together to call for stronger reimbursements for critical services.  It means sharing the responsibility for meeting the needs of the disability community.

In today’s health care system, reimbursements favor quick fixes.  For example, if you break your leg, you go to an orthopedic specialist, receive surgery and some physical therapy and you’re back on your feet.  The goal is restorative; this is sufficient for able-bodied individuals.  This reimbursement, while perhaps adequate for hospitals and clinics, does not work well for rehab organizations like the Courage Center that provide longer-term services addressing more complex needs.

The Courage Center’s work is not a quick fix.  It is about helping people move towards independence and towards appreciating interdependence.  Many Courage Center clients require individualized specialized treatment offered with patience and support – the very things that give the Courage Center its reputation for quality.  Often, Courage Center clients need individual or family counseling, vocational, or health and wellness services. These services require more time, care, and cost – none of which are adequately reimbursed by a health care system focused on quick fixes, episodic treatments, or increased efficiencies and productivity.

During the past year the Courage Center launched a thoughtful process to address many of the issues presently facing both the organization and the disability community.  Courage Center leaders, after extensive dialogue and research, gained insight on how to best meet the needs of our community and resolve the very real financial challenges we are facing.
 
As a result of this process, we determined that the Courage Center needed to narrow the focus of its services to those of a transitional nature. This includes such long-term services as rehabilitation, the Courage Residence, recreation, aquatics, vocational services and independent living skills programs.

We then made the difficult decision to cut some of our workforce and to transition some of our services to other community providers. Specifically, the Courage Center will no longer operate its two housing programs, Argyle and Welcome Place, nor its two sustained employment programs, Data Ability and Changing Futures.  While we believe that this plan focuses our resources, it also brings organizational loss.  An estimated 70-80 positions (10-12% of the Courage Center’s workforce) will be eliminated during 2001.

During the next six to eighteen months the Courage Center will continue to seek creative solutions to our financial challenges by working to strengthen reimbursement strategies, increasing efficiency in our health care services delivered by therapists, and overhauling our internal operating systems.

Despite a year of exceptionally challenging work and painful decision-making, we’re highly optimistic. We have a new strategic vision and plan that repositions the Courage Center for the future.  This plan calls for launching innovative programs in assistive technology, health, wellness and fitness, expanded independent living services, and consumer advocacy (further integrating the social model into the Courage Center’s disability services).

The Courage Center remains steadfast in our commitment to meeting the needs of the disability community. We will continue to partner with other disability providers, with those we serve and with healthcare and community leaders to educate decision-makers on the adverse effects of substandard reimbursements and service systems (e.g. Metro Mobility). We will also advocate strongly at the legislature to seek improved Medical Assistance reimbursements for greatly needed mental health services and for other needs of the disability community (e.g. housing and transportation).

We live in rapidly changing times.  More than ever, the Courage Center seeks full engagement with all constituencies to build a stronger, more inclusive and progressive community and Courage Center.