Memorial Health System is working with Southern Illinois University School of Medicine to change where Memorial provides outpatient psychiatric care for hundreds of low-income patients from Springfield and elsewhere in central Illinois.
Plans by the two organizations call for Medicaid patients currently receiving care at Memorial Physician Services – Vine Street, 3225 Hedley Road, to receive visits in the future from psychiatrists at SIU’s Center for Family Medicine, 520 N. Fourth St., or Memorial Behavioral Health’s Integrated Wellness Clinic at 701 N. Eighth St.
The transfer to treatment sites six or seven miles to the northeast — expected to take place sometime in the next several months — is fueled by chronically low Medicaid rates and state funding cuts that make it hard to financially support psychiatric care, Memorial and SIU officials said last week.
“The reimbursement just isn’t there,” said Dr. Kari Wolf, chairwoman of the SIU department of psychiatry. “I think this work is going to lead to a better system in the long run.”
Despite rumors to the contrary, the Vine Street clinic on Springfield’s west side isn’t closing at the end of 2017, according to Edgar Curtis, chief executive officer of Memorial Health System.
Memorial Behavioral Health is an affiliate of the health system.
“I’m not getting out of behavioral health,” Curtis said. “Memorial is fully committed to taking care of all patients. We’re in this for the long haul.”
The reason for transferring almost all Medicaid patients from the Vine Street clinic, where they represent one out of every six patients, is because care provided at the Center for Family Medicine or the Memorial Behavioral Health clinic generates Medicaid rates four or five times higher than at Vine Street, Wolf said.
The higher rates — $120 or more per visit versus about $30 at Vine Street — are granted through the state-federal Medicaid program because the Center for Family Medicine and Memorial’s behavioral health clinic are considered part of SIU’s federally qualified health center.
Federally qualified health centers, or FQHCs, receive their designations from the federal government. They receive higher-than-normal Medicaid rates to support their mission of providing access to health care for traditionally underserved low-income populations of patients who are either uninsured or covered by Medicaid.
SIU’s FQHC is based at its Center for Family Medicine.
“We’re trying not to do anything disruptive,” Wolf said of the collaborative planning process between Memorial and SIU officials.
But for the more than 900 Medicaid-covered patients who visit the Vine Street clinic about 4,000 times each year, it’s unclear whether they will lose access to the particular psychiatrists and nurse practitioners they have seen until now.
At least in the short term, and perhaps for the long term, SIU may contract with Memorial for Vine Street psychiatrists and nurses to travel to the FQHC sites on certain days of the week so those health care providers can continue to see their longtime patients, Wolf said.
All the details still need to be worked out, she said, adding that some Vine Street clinic patients may end up transitioning their care to SIU psychiatrists.
And more new Medicaid patients may see SIU psychiatrists rather than Memorial psychiatrists, she said.
“We will evaluate existing patients’ current clinical conditions and needs before making any determination about where they should receive future care,” Wolf said. “But for new patients requesting care, we will divert them to the FQHC.”
SIU’s psychiatric patients already are served by SIU psychiatrists at the FQHC sites, rather than other SIU clinic locations, to qualify for the higher Medicaid rates, she said.
Across the country, difficulties in financially supporting psychiatric care, whether through Medicaid or private health insurance, are leading to more use of FQHCs as settings for psychiatric visits, as well as other creative solutions, Wolf said.
There will be side benefits of more psychiatric patients receiving care at the FQHC sites in Springfield, she said. Primary care doctors and other caregivers will be more readily available to tend to psychiatric patients’ other medical needs, she said.
It is well-documented that people with mental illnesses have a shorter lifespan than people without because mental-health-related conditions often get diagnosed later or are neglected, according to Jan Gambach, president of Memorial Behavioral Health.
Having patients with mental health needs served in settings with primary care services available makes sense, she said.
“It’s a better system of care,” Gambach said.
As part of the planning process between Memorial Health System and SIU, more SIU psychiatrists may be “embedded” in Memorial and SIU clinics — both primary care and specialty medical clinics — to make psychiatric consultations more convenient, Wolf said.
Spreading out the expertise of psychiatrists also could lead to efficiencies that reduce the time many new patients must wait for a psychiatrist visit in Springfield, she said. Waits that can last three to six months might be reduced to a week or two.
The work by Memorial and SIU to reconfigure the local system for psychiatric care comes at a time when Memorial faces increasing financial stresses and manpower issues.
Two psychiatrists from Vine Street are expected to leave that clinic for jobs outside the community by the end of the year, and a nurse practitioner is leaving as well. It’s hard to replace those positions, especially when there’s a nationwide shortage of psychiatrists, Wolf said.
With the expected departures, SIU psychiatrists are working with Memorial psychiatrists to make sure there will be enough doctors to care for patients in Memorial’s 36-bed inpatient adult psychiatric unit, Wolf said.
There’s already a shortage of psychiatric beds for adults in central Illinois. And in 2015, HSHS St. John’s Hospital changed its inpatient psychiatric unit. The 16-bed unit now only serves geriatric patients.
Memorial Health System also is dealing with the elimination of hundreds of thousands of dollars in annual state funding since 2010 that helped support its outpatient mental health services, Gambach said.
Dawn Kelly, 42, a longtime patient of Vine Street psychiatrist Dr. Fareed Tabatabai, said she at first feared the clinic would close.
Kelly, a resident of Creve Coeur near Peoria, said she was relieved the rumor turned out to be false. But as someone with both Medicare and Medicaid coverage, she might be affected by the plans to change where Vine Street clinic’s Medicaid patients receive care.
Kelly, a former insurance adjuster who is disabled because of bipolar disorder, said she hopes she can keep Tabatabai as her psychiatrist. Tabatabai declined comment for this story.
“Their operation there is fantastic,” Kelly said of the Vine Street clinic. “The care I get there is unbelievable.”
Kelly said she appreciates Memorial and SIU discussing alternatives for Medicaid patients to make sure patients continue to be served.
“It makes me feel hopeful … that they are trying to do something to recognize that population,” she said. “Mental health is overlooked by our country as a whole.”
– Contact Dean Olsen: firstname.lastname@example.org, 788-1543, twitter.com/DeanOlsenSJR.