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Community Clinic seeing more clients, looking for more providers

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The Community Clinic of Jefferson County is here to stay.

After a year of uncertainty with the recruitment and retention of mental health professionals and some insurance-reimbursement concerns, the clinic is thriving, according to Children’s Home of Jefferson County Executive Director Karen Y. Richmond. The Children’s Home oversees the 5,100-square-foot Community Clinic, 167 Polk St., Suite 300.

“We opened the doors with a full array of appointments, and when we opened, we had one locum tenens psychiatrist and six clinicians,” Mrs. Richmond said. “That was our biggest struggle until February of this year, both in counselors and psychiatric services. The beginning of this year brought us stability in staffing.”

The Community Clinic now has two half-time nurse practitioners, one full-time nurse practitioner and one part-time psychiatrist who also oversees the medical director obligations and direct-care services. There also are nine counselors/therapists.

More staff needed

A fully staffed Community Clinic would mean 12 counselors/therapists, one full-time psychiatrist and the equivalent of two full-time nurse practitioners. The clinic still may need some part-time psychiatrists because the caseloads keep increasing.

“We’re really looking to find that psychiatrist who wants to be community-based, not hospital-based,” Mrs. Richmond said. “We want to get the right fit. We wanted to get the first year behind us to be more marketable, and for 2012-13 one of our main goals is to recruit a full-time psychiatrist. Locum tenens and part-time psychiatrists are more costly, although they do a great job.”

When the Children’s Home took over the caseload from Mercy Behavioral Health and Wellness last June, agency staff was told there would be 700 to 800 active cases. The clinic has seen 1,100 clients since it opened; there’s an active caseload of 750 clients, of which about 75 percent are adults.

There is a waiting list of 350 adults and 50 children. While it may take up to four or five months for new patients to get an appointment, clinic Operations Director Jennifer L. Earl said that is down from the six months or more it took when the clinic first opened. People with the highest need are moved up more quickly on the list.

Those who go to the clinic have a range of mental health diagnoses, from attention deficit hyperactivity disorder to schizophrenia to bipolar disorder. Mrs. Earl said 30 percent of the clinic’s population also has suffered from some form of abuse, trauma or neglect.

Therapy is given on an individual or group basis. Group topics include cognitive behavior, adult depression, female teenage depression, adult female boundaries, adult anger management, teenage female stress management, safety/skills for trauma victims and teenage improving self-esteem and effective coping.

Insurance issue stabilizing

Mrs. Richmond said the clinic is doing much better than it was about eight months ago, when the Children’s Home was unsure if the clinic would thrive under the insurance-reimbursement structure.

Jefferson County Community Services Director Roger J. Ambrose said the Children’s Home had to wait last year for Medicaid’s new ambulatory payment groups model to be approved at the federal level. He could not be reached for comment Friday.

The APG model is stabilizing, and the Community Clinic is in year two of a three-year plan to get its full $138.97 base reimbursement rate per visit. When the clinic opened, it received a base reimbursement rate of $66 per visit; that has since increased to $110.

Since the clinic is a state Office of Mental Health Article 31 clinic, people can go to the clinic regardless of ability to pay. Mrs. Richmond said that makes reimbursement stabilization a priority, especially since 92 percent of clients have either Medicaid or Medicare.

Aside from some assistance from Jefferson County, the Children’s Home has invested about $1 million of its own money into the Community Clinic throughout the past year, which Children’s Home board President Robert R. Gefell said was a cautious yet necessary step in order to keep the clinic running.

“It’s a much-needed service in the community,” he said. “We serve a segment of the population that really can’t get services anywhere else. We’re definitely in it for the long haul.”

Mr. Gefell said the Children’s Home was able to make a significant contribution to the clinic because it is “financially healthy overall,” but said the agency can’t afford to support the clinic like that each year. While the clinic won’t make a lot of money for the Children’s Home, he said, the community would suffer without the service.

Meanwhile, the Children’s Home’s maintenance crew has been busy remodeling 3,500 square feet of first-floor space at the Marcy Building so clinic clients have a street-level entrance off State Street. The agency’s Human Resources and Finance departments and some administrative services will relocate from the Children’s Home’s 1704 State St. campus to the first-floor space downtown.

Children’s Home Administration Services Director Barbara J. Peck said the Finance Department move made sense because the majority of the agency’s billing focuses on the clinic, and this puts it in a central location.

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