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Funding Yanked; Total Healthcare Losing Money

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FROM THE TYLER MORNING TELEGRAPH:

Funding Yanked; Total Healthcare Losing Money
BY DAYNA WORCHEL
AND COSHANDRA DILLARD
Staff Writers

A Tyler health clinic that serves the poor and has a history of legal and financial woes will lose its federal funding as of Aug. 31, a federal agency has confirmed. 

Total Healthcare Center at 928 N. Glenwood has lost its status as a Federally Qualified Health Center, although the facility might reapply again in the future, an official with the Health Resources and Services Administration said. 

Two more entities, one in Tyler and one in Longview, have applied for that grant funding from the Health Resources and Services Administration, or HRSA, so they may address the growing demands of a medically underserved population. 

Lindsey Birdsong, the Tyler attorney who represents the clinic, said in a statement Thursday that the clinic is appealing the decision. And Harry Stewart, board chairman, insists the clinic will not close. 

HRSA confirmed it has pulled all of the Total Healthcare Center's funding because of "its failure to maintain compliance with Federally Qualified Health Center requirements," according to a statement from a HRSA press representative. 

On Sept. 1, HRSA will open a competitive bid to service the area currently served by Total Healthcare Center and "will make a grant award to an organization that can carry out a service delivery program consistent with federal Health Center program requirements starting on Sept. 1." 

According to Birdsong, HRSA said it pulled its funding "because Total Healthcare Center did not timely comply on a condition for the grant for billing and collections policies." 

Clinic staff had asked for more clarification from HRSA about how to comply, Birdsong said in his statement. 

"In any event, this has nothing to do with providing good patient care and services to the community; it would be unfortunate to pull the grant over such an issue," Birdsong said. 

Birdsong said, in a statement, that "the billing and collections policies of HRSA required that the clinic demonstrate compliance by submitting … procedures for documenting billing, col­lecting and crediting of payments, including the procedures and policies for billing Medicaid and Medicare to maximize collection of payments and reimbursement of services rendered." 

The clinic was awarded $734,144 in health center grant funding for the period of Jan. 1 through Dec. 31, a representative from HRSA said. It is this amount that the clinic lost, Martin Kramer, of HRSA, said. The HRSA grants are awarded to cover a five-year period, and the amount can vary from year to year. The clinic received notification in April that the funding from HRSA would be suspended, Total Healthcare CEO Rodney Ivy said.

According to its 2010 tax statement, the clinic had $3.4 million in total revenues, and $1.3 million of that came from government grants. A copy of a notice of grant award from HRSA to Total Healthcare for the time period of Sept. 1, 2010, to Dec. 31, 2011, showed the agency awarded the clinic almost $846,000 that year, Ivy said. HRSA also conducts regular assessments and site visits to the recipients of the grants. 

Ivy said the current clinic board members will continue to serve as required by HRSA and that until otherwise notified, the clinic will continue to serve the people of northeast Texas. 

Stewart said HRSA funds are not the clinic's only financial source. 

"We are appealing the decision of HRSA, which will take approximately three months to process," Stewart said in his statement. 

Stewart acknowledged that Total Healthcare has had multiple staff turnovers, but now said that there is a new executive team, board and staff in place, the clinic is ready to "move the organization in the right direction." He said the clinic has asked for the city of Tyler and Smith County to restore funding that each of the entities had pulled, and that the clinic also asked for help from the city and county in appointing board members. 

"This facility has brought over $2.5 million in federal funding into the Tyler community, which is pretty magnificent when you are operating only one facility with approximately 28 employees," Stewart said in his statement. He added that the clinic is investigating the possibilities of partnering with local hospitals in the area "to expand our reach to the community in need." 

According to an October 2012 site visit report obtained by the Tyler Morning Telegraph, HRSA officials recorded numerous financial, administrative and staff issues that had not been resolved since a previous visit in April 2012.

Officials found they did not have the necessary core staff to carry out the clinical and nonclinical services appropriate for serving the patient population, according to the site visit report. 

Items noted in the report included lack of stable leadership, a reported loss of more than $400,000 and bad debt of about $368,000.

The Federally Qualified Health Center at the time had been without a chief financial officer for 18 months. The financial department operated with two degreed accounting staff members, although they had limited or no supervision, according to the October site report.

According to the site review report, it did show there were some improvements in the governance of the Federally Qualified Health Center by its board of directors. However, while the board holds monthly meetings, documentation for appropriate tracking of key decisions had not improved. The report notes that documentation did not disclose when or why board members resigned in July 2012.

Total Healthcare Center is a nonprofit organization that serves the medical needs of the poor, for adults and children, and provides dental services. In 2011, the center served more than 9,700 patients in more than 25,000 visits, according to its website. It serves as a home for Medicare, Medicaid and CHIP patients, as well as those with private insurance. 

A Longview nonprofit clinic has applied for the HRSA grant in the Tyler service area, its CEO confirmed on Wednesday. Wellness Pointe is the largest Federally Qualified Health Center in East Texas, Carl Walters II said. He said the Longview clinic sees more than 200 families each year from Tyler and would like to help those patients access that care here. He said he hopes to gain the support of the Tyler City Council and other city leaders. 

Walters said he wants to make sure residents understand that Wellness Pointe is not coming to compete for patients in Tyler. 

"We are coming in peace to be a part of the solution — we don't want to take over the Tyler market," Walters said. 

He said the Wellness Pointe budget is more than $14 million a year and the clinic employs about 160 people. If it is awarded the grant, the clinic will employ people who live in Tyler, he said. Walters said he has more than 25 years of experience in hospital administration and in running Federally Qualified Health Centers. Wellness Pointe is the fourth such clinic that he has run. 

He said he doesn't know whether a new facility, if it should open in Tyler, would be at the current Total Healthcare Center location or would open at a different site. 

"We're working hard to earn the trust of families in Tyler," Walters said.

A group of former Trinity Mother Frances clinics, now known as the Tyler Family Circle of Care on North Broadway, also has applied for the HRSA grant in the Tyler service area.

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