Total Healthcare closing its doors today

On the front doors, signs give patients notice, and Rodney Ivy, the clinic's chief executive officer, said Tuesday that they have mailed letters to patients over the last few days.

The closing comes six years after the clinic, formerly known as Community Health Clinics of Northeast Texas, gained a Federally Qualified Health Center status, which comes with federal grant funding.

But years of financial, administrative and legal issues marked the clinic through much of its short history. The clinic filed a lawsuit against the Attorney General's office, saying it overstepped its boundaries when urging board members to relinquish their positions and have an outside party appoint new members. Ivy said that in lieu of the clinic's closing, they will be asking their attorneys to drop the lawsuit.

However, it still faces a lawsuit from the Texas Attorney General, whose office alleges violations of the business organization code, common law breach of fiduciary duty and grossly negligent mismanagement.

Tom Kelly, from the AG's office, said Wednesday that the lawsuit against the clinic still stands, but no court date has been announced in Travis County.

FUNDING LOSS

In May, clinic officials learned they would lose federal funding from Health Resources and Services Administration, a branch of the U.S. Department of Health and Human Services. That office confirmed it had pulled the clinic's federal grant because of "its failure to maintain compliance with Federally Qualified Health Center requirements," according to a statement from a HRSA press representative.

The representative said that the clinic was awarded $734,144 in health center grant funding for the period of Jan. 1 through Dec. 31.

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.

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 clinic 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.

Also 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 held 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.

THC received funding from various sources, but with the loss of the federal grant, as well as city and county funds in recent years, the clinic suffered a great financial loss.

WHAT'S NEXT?

Ivy said there were 27 people employed at the clinic including three medical providers, but patients could be greatly impacted by the clinic's closing as well. THC saw an estimated 5,500 patients, which yielded about 13,000 patient visits in 2012. FQHCs provide a medical home for those who are under-or uninsured. For those who self-pay, fees are determined by a sliding scale.

There is no word on where the three providers will relocate, but patients do have a choice to make Tyler Family Circle of Care, the newly granted FQHC in Smith County, a medical home. When asked what steps will be taken to ensure continuity of care for former patients, THC officials said in a statement, "We are working on various transition arrangements with other health care providers."

A HRSA communications representative also said in a statement, "HRSA will remain in frequent contact with Community Health Clinics of Northeast Texas and the new grantee for the service area to monitor this transition."

Ivy said the board filed a notice to appeal HRSA's decision but later decided that since the FQHC status was granted to Tyler Family Circle of Care, "any further efforts on the appeal would be fruitless." They said they would not consider applying for an FQHC status in the future.

Ivy has said they plan to sell the building, which was donated to the clinic by the county in 2008.

"Our hope is to sell it to someone that will continue to provide healthcare services in the building," Ivy said in emailed statement.

FILLING A GAP

Tyler Family Circle of Care has been about for 20 years as part of Trinity Mother Frances and Clinics, but separated in October 2012 to seek an FQHC status. The clinic at 2990 N. Broadway Ave. was a pediatric clinic but now serves adults as well as provides referrals for dental and behavioral health services.

The other clinic at 910 W. Houston St. is the former Family Care Center, and continues to serve women.

HRSA officials announced this week the clinic would receive the two- to three-year federal grant, worth more than $700,000 effective Sept. 1.

At least one other clinic, Longview Wellness Pointe, applied for the federal dollars. As Tyler Family Circle of Care awaited HRSA's final decision, Mary Elizabeth Jackson, the clinic's chief executive officer, said they were "cautiously optimistic" because of their years of providing service through the two clinics.

Tyler Family Circle of Care officials have said the grant represents between 8 percent and 9 percent of their revenue, bringing their total revenue to an estimated $7 million.

The clinic sees about 50,000 patient visits each year and expects they will need to expand services and facilities in the future as they take on new patients. However, Ms. Jackson said any expansion would be tied to additional funding sources.

"Right now we have what we think are an adequate number of providers to care for what we are expected to have," she said.

The clinic has 65 employees between the two sites. There are a total of 16 medical providers, which includes eight physicians and eight mid-level providers, such as physician's assistants and nurse practitioners.

There, 88 percent of patients are enrolled in Medicaid or Children's Health Insurance Program (CHIP). Six percent are self-pay while the remaining 6 percent have commercial insurance or TRICARE insurance, a program for veterans.

Ms. Jackson said they've gotten a few calls from former THC former patients, but most calls are coming from entities outside of Smith County, who were referring patients to THC.

"Until today we were unaware that they were taking patients from outside of Smith County," she said Tuesday.

While she said the clinic would not turn anyone away, a priority will be placed on patients who reside in Smith County.

The clinic's board, which must meet FQHC requirements, has been in place before they were awarded the grant. Ms. Jackson said the final plans in meeting FQHC requirements is to get new provider numbers and ensuring they have all documents and processes in place by Sept. 1.

Trinity Mother Frances Hospitals and Clinics continues to be the clinics' largest supporter, which includes financial contributions.