The Minimally Invasive Care Center (MICC) Wound Clinic at the Abbott Northwestern Hospital in Minneapolis closed its doors on December 31st. Ultimately, the reasons for the clinic’s closure were a very high cost of care and insufficient funds to meet those costs.
Pat Hartwig, Vice President of Operations for the clinic-which has provided complete services to patients with complex, chronic and non-healing wounds such as diabetes and arterial injuries–cited several factors that led to the clinic’s financial challenges. First, the clinic never developed a consistent model of clinical care. She states, “we had eight physicians…practicing in eight different ways.” Also, clinicians had no database that could track, over a broad population of 450 people per month, a patient’s level of improvement. As a result of these inconsistencies, the clinic could not determine the best methodologies for a wound. Hartwig contends, ” we didn’t have any means of saying to a payer ‘Here’s why you should pay for the wound care because here’s what we’re seeing in the ways of improvement.'”
Another aspect of the clinic’s financial troubles involves extremely poor reimbursement rates from medical payers. As Ms. Hartwig indicates, “We have discounts with some of our payers such as Medicare in excess of 70 percent” meaning “we get less than 30 cents on the dollar for any charges we bill. So that leaves very little opportunity to even be able to cover costs.” She continues, adding “Within the years that the wound clinic has been in operation, the government compliance issues have changed around billing where Medicare patients are concerned, making it difficult for us to process claims on these patients. So even if we provided the care as cost-effectively as possible, we still have huge challenges as a hospital in being able to submit claims to Medicare.”
A final issue that Hartwig brings up is the space used by the Wound Clinic. The Abbott Northwestern “hospital setting…is an extremely expensive piece of real estate,” she insists. All of these factors combined–space, reimbursement from payers, and expenses due to inconsistencies in care and tracking models-have resulted in such a financial strain for the clinic that remaining open in its current form was no longer feasible.
Hartwig maintains that the choice went against her heart. “It’s not our intent to make money on these patients. Our intent is to provide clinically high-quality care in a cost-effective model that is reimbursable by payers. It’s unfortunate. We don’t like closing programs here and we don’t do it frequently and we don’t do it easily. So we feel we’ve exhausted every opportunity we have with the clinic open to make change occur.”
Both clinicians and patients of the wound Clinic are equally upset by its closing. Jan Chevrette, a nurse with the wound clinic since it began seven years ago, predicts that patients will have difficulty finding adequate care elsewhere. Patients have the following four options for continuing care:
1. Patients can meet with the doctors who worked at the wound clinic at their own practices.
2. Patients have the option of meeting with private health care clinics.
3. Patients may seek out other wound clinics in the area.
4. Patients may order supplies through the pharmacy at MICC and seek care independently or at home.
A number of problems stem from these options. The first, Chevrette says, is that many doctors “won’t have time in their schedules to meet with new patients at their practices.” The physicians at the wound clinic already meet with 12-15 patients in half a day at their private offices.
Accessibilty is another very important issue in receiving new services. Even if a patient is able to find time with a doctor, the office most likely will not be equipped with Hoyer lifts or have enough space for people who use wheelchairs-some of the amenities at MICC. Similarly, accessibility to transportation to a clinic not in the metro area like Abbott Northwestern may be difficult for people who have chronic wounds.
Plus, patients will be challenged to find doctors who are knowledgeable and trained to care for their wounds.
In addition, people will have to schedule multiple appointments for complete treatment. In contrast, the MICC Wound Clinic included the capability to run x-rays and provide pharmaceuticals, casting, bone scans and other tests. A person could receive full care in just one visit.
Directors at MICC, though, are currently assisting patients in the process of finding new facilities. As Hartwig says, “we’ll work with the wound clinic physicians to develop the materials that that a physician needs in order to continue the care plan for that patient.”
Chevrette raises concerns “that case histories and records won’t transfer and patients will have to start from scratch”-redoing the tests necessary to formulate these files, instead of receiving treatment for their wounds. She also predicts an increase in the number of patients admitted to the emergency room and a rise in the number of cases requiring amputation as a result of the Wound Clinic’s closing.
A local activist for disability rights, Dorothy Balen, routinely went to the wound clinic for care. She shares Chevrette’s frustration with the clinic’s close. Balen says, “The clinic was full of the elderly, elderly with chronic wounds. For these people in the inner city to go to a suburb for alternative care or to even search for alternative care is just asking too much.” She also praised the staff for consistently being “very professional, very concerned and very acknowledgeable,” and doubted whether or not patients, who were referred to MICC initially because others had already failed in providing care, could find such expert care at other clinics.
Both Chevrette and Hartwig hope that the wound clinic will reopen its doors soon. The next three months involve a restructuring project, led by Chevrette and Nurse Jennifer Todd, to develop a more cost-efficient clinic with a standard model for care. Hartwig elaborates, “I’m very optimistic that over the next three months this group is going to put together a plan…We’ll support them administratively.”
If Chevrette and Todd complete this project, they will reopen a new clinic soon. If not, they will lose their jobs and hundreds of people will have to seek out less convenient and less extensive sources of care.
