Vancouver Clinic to reduce Medicaid services

It will no longer accept new clients covered by the program

By Marissa Harshman, Columbian Health Reporter

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The Vancouver Clinic will no longer accept new Medicaid clients and, over the next three years, will reduce the amount of Medicaid services it provides to Clark County residents.

The Vancouver Clinic currently provides primary and speciality care for more than 36,000 Medicaid clients — more than any other community Medicaid provider — as well as specialty care for those other providers. Medicaid services account for 25 percent of the clinic’s total business. Over the next three years, the clinic will reduce that amount to 10 percent.

“We’ve had an open door to Medicaid,” said Duane Lucas-Roberts, chief executive officer of The Vancouver Clinic. “That’s one reason our volume is so high. The problem is, that’s not sustainable. There won’t be a Vancouver Clinic.”

To get to more stable ground, the clinic will not accept any new Medicaid clients and will not replace existing Medicaid clients as they leave the clinic or are removed from the Medicaid program, which serves low-income children and adults, said Ann Wheelock, the clinic’s chief financial officer.

The clinic will continue to provide care to Medicaid clients who are already established patients. And in areas where the clinic has the only specialty provider in the community — infectious disease, for example — the specialists will continue to treat new clients, Wheelock said.

If those strategies don’t reduce the clinic’s Medicaid business to 10 percent, clinic officials will consider taking additional action, Lucas-Roberts said.

“We’re trying to do it very gradually, so it’s not such a severe impact,” he said. “We know it’s challenging, but we have to do it.”

The changes are necessary to avoid negative economic consequences while continuing to provide quality care for existing patients, said Dr. Sharon Crowell, chair of the clinic’s board of directors.

In the first four months of this year, the clinic added about 5,000 adult Medicaid clients — the result of the state’s Medicaid expansion implemented under the Affordable Care Act. The expansion added about 19,000 new Clark County adults to the Medicaid program, bringing the county’s total number of Medicaid clients up to an estimated 100,000 people.

Meanwhile, Medicaid reimbursement rates have been cut to historically low levels.

The clinic’s reimbursement rate for Medicaid clients has been cut in half over the last three years, with the current reimbursement for an office visit covering about 40 percent of the cost of providing the services, Crowell said.

With Medicaid reimbursements accounting for 25 percent of the clinic’s business — a percentage that’s more than double the national average — the clinic can’t sustain the losses at such a large scale, Lucas-Roberts said. The clinic has so far avoided layoffs and cutbacks and is trying to prevent future financial problems, he said.

“By starting now, we’re out ahead of it so it’s not a crisis,” Wheelock said.

Vancouver Clinic officials hope to take the lead in a community collaboration to find a more sustainable way to care for Medicaid clients, Crowell said. They’ve begun working with PeaceHealth Southwest Medical Center, Legacy Salmon Creek Medical Center and others to search for that solution, she said.

In the meantime, clinic officials hope other community providers will help share the Medicaid patient load.

“(The Vancouver Clinic has) kind of made it easy for others to not do much,” Wheelock said. “We would like some help.”