Clinics ponder how to fill gap left by closure of hospital programs

WILLMAR -- Local medical providers are trying to figure out how to fill the gap that'll be left when two outpatient chronic-disease management programs close this month at Rice Memorial Hospital.

WILLMAR -- Local medical providers are trying to figure out how to fill the gap that'll be left when two outpatient chronic-disease management programs close this month at Rice Memorial Hospital.

Officials with Affiliated Community Medical Centers and Family Practice Medical Center said they'll have something in place -- but it'll take time for a full solution to be developed.

"We are in transition," said Dr. Ronald Holmgren, president and chief executive of Affiliated. "We're trying to come up with a model that will meet the needs."

Rice Memorial Hospital announced last month that it is closing its Diabetes and Nutrition Center and its Congestive Heart Failure Clinic, effective Sept. 18. Citing a need to hold down the hospital's operating costs, officials said they targeted the two programs because neither generates enough revenue to cover its expenses.

Nearly 500 patients -- 390 at the diabetes center and 90 in the congestive heart failure program -- are affected.


The loss of the two programs is part of nearly $3 million in budget cutbacks the city-owned hospital made last month to head off financial losses.

With just four weeks' notice, there's been little time to find alternatives for these patients, said Stacey Zondervan, patient services director at Family Practice Medical Center.

"That's a true challenge," she said.

"We are kind of scrambling to gather as much information as we can," Holmgren agreed.

Both medical clinics, however, plan to pick up as much of the two services as they can feasibly manage.

In most cases, local doctors already were overseeing the care of patients enrolled at the Diabetes Center or in the congestive heart failure program, Holmgren said.

What the two programs were able to offer was more intensive management and one-on-one coaching and education for patients who needed it.

The Diabetes and Nutrition Center excelled at working with people newly diagnosed with diabetes, Zondervan said. It also worked with women diagnosed with pregnancy-related diabetes, and provided insulin pump management, especially for children.


Both programs did particularly well at managing the care of patients whose diabetes or congestive heart failure were difficult to control.

"They did such a great job. They had the time. They had a great reputation. The patients love them," Zondervan said. "They were our resource."

She said Family Practice Medical Center has decided to wrap diabetes education into the clinic's overall services. In preparation, some of its mid-level practitioners are signing up for specialized training at Park Nicollet in the Twin Cities.

"Over the next several months we will be ramping up to a more formalized program," she said. "We need to figure out how to do that and do it well... We need to find another avenue for our patients."

At Affiliated, physicians likely will shoulder more of the day-to-day management of patients with congestive heart failure, Holmgren said. "Much of that can be done through the physicians' offices."

The regional multispecialty clinic is focusing most of its attention on how to fill the gap in diabetes care, he said.

Details are still being worked out, and there's a good chance that Affiliated will seek out partnerships with other agencies that can help, he said.

"We really are trying to rethink things... We don't have all the answers yet," he said. "We are responding to it and looking at a lot of different avenues to meet the need."


Funding could be especially challenging to address.

While intensive management can help improve the health of people with congestive heart failure or diabetes and reduce the likelihood of costly complications, it's often expensive to provide -- and many payers don't reimburse at a rate that allows such programs to cover their costs.

Funding is "the real crux of the matter," Holmgren said.

"It's everyone in the state," he said. "Everyone is really struggling to have diabetes care done in a way that's high-quality yet can sustain itself."

Zondervan said the family practice clinic has been receiving phone calls from patients wanting to know who will manage their care once Rice's two programs close.

"We're trying to reassure people," she said. "We're telling them, 'We'll still be here as your primary care provider. We'll work it out together.' Can we take care of them? Certainly. Will it be the same as it was before? Probably not."

Holmgren had a similar message.

Patients "won't go without the services," he said. "They're going to have to rely on their primary care doctor. The primary care doctors are a patient advocate and they are going to help steer the patient to necessary services."

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