Crafting a Model on Mississippi Medical News

Crafting a Model

By: LYNNE JETER

UMMC and Jackson Medical Mall Collaborate on Landmark Program to Benefit Underserved Mississippians

A landmark event involving an academic medical center's educational and training efforts at a federally qualified health center (FQHC) occurred quietly last month in Central Mississippi, marking one of few collaborations of its kind nationwide and possibly creating a model for other states.

Effective July 1, pending federal approval, the University of Mississippi Medical Center (UMMC) and Jackson-Hinds Comprehensive Health Center (JHCHC) embarked on an innovative collaboration to provide better access to primary care medical services to medically underserved Mississippians.

JHCHC, a FQHC that employs nearly 200 health professionals throughout the Metro Jackson service area, will take over UMMC's primary care outpatient clinics at the Jackson Medical Mall Thad Cochran Center (JMM) to serve obstetrics and gynecology, pediatrics and internal medicine patients. Last year, more than 18,000 patients were treated at the mall's 14 clinics in the tri-county metropolitan area.

Making the System More Efficient

Two years ago, the University of Mississippi Medical Center (UMMC) collaborated with the Mississippi Primary Health Care Association and the Mississippi State Department of Health to form the Mississippi Healthy Linkages Project, a process that connects patients to one of the state's 21 federally qualified health centers (FQHC). UMMC provided emergency room patients with contact information for FQHCs in their counties that could serve as their primary care providers.

"That project started us trying to figure out how to best serve people in this area," said Jasmin Chapman, DDS, CEO of Central Mississippi Civic Improvement Association Inc., also known as the Jackson-Hinds Comprehensive Health Center (JHCHC). "We want to be able to say that Jackson, Mississippi, isn't at the bottom for health disparity. Improvement in healthcare status of clients is what made us want to do this."

Studies conducted by the Center for Medicare and Medicaid Services (CMS) have indicated that for every dollar spent at a community health center, $3 is saved. The Bureau of Primary Health Care published data showing that community health centers have a tendency to improve the health disparity in medically underserved areas, said Chapman.

"Community health centers have been found to be very efficient," she added, noting that FQHCs have bipartisan support. "UMC studied that data, and was interested in pursuing this arrangement to better serve patients."

When Congress passed healthcare reform earlier this year, both parties were at the end of the negotiation process.

"Both of us had decided it was a good but difficult thing for us to do for our patients," she said. "It's ironic that in the healthcare reform legislation, community health centers have a center position. If universities join with community health centers to provide opportunities for residency training in a community setting, more medical students will go toward the area of a primary care practice, which is most needed across the country, and then into pediatrics, internal medicine, and OB-GYN. It's also believed that it could help lower costs of treating patients. Community health centers are normally more cost-effective treating primary care issues anyway."

As part of the community benefit agreement approved June 16 by the Mississippi Institutions of Higher Learning Board of Trustees, UMMC will pay JHCHC $9.25 million for five years—$1.85 million annually—to support the educational mission of the clinics. The contract will be automatically renewable for another five years. Also, UMMC will sublease nearly 20,000 square feet of space (room numbers 1370 to 1520) for $367,096 for a year, and use existing equipment. At this time, there is no plan to relocate the clinics, said Jasmin Chapman, DDS, CEO of Central Mississippi Civic Improvement Association Inc., also known as JHCHC.

UMMC physicians in residency training will continue to see patients at the clinics; operational responsibility for those clinics will shift to JHCHC. During the transition, 41 UMMC employees will have the opportunity to remain with University of Mississippi Health Care at the medical center's main campus or satellite clinics; no UMMC employees will lose their jobs through layoffs, said James Keeton, MD, vice chancellor for health affairs at UMMC.

As an FQHC, JHCHC, the largest community health center in Mississippi, receives federal operating grants and higher reimbursement rates because of its locale in a designated underserved area and by treating patients regardless of ability to pay.

"That policy won't change," said Chapman. "We do get federal funds to bridge the gap on a needs-based sliding scale. The FQHC was created mainly for the working poor who cannot afford healthcare and don't have access to healthcare through their employer. It's not a free clinic."

The operational change should improve access to care while also reducing demand on emergency rooms in the tri-county area. Approximately 17,000 adults visit UMMC's emergency room annually for treatment that could be provided by a primary care physician. Even though UMMC's primary care operations at the mall do not have the capacity to manage all patients who need comprehensive primary care, the new structure of combining residency training with an FQHC will provide a unique way to address the shortage of primary care physicians while also allowing JHCHC to continue building capacity at the 14 clinic sites in the growing tri-county area, said Chapman.

"We started talking about this collaboration three or four years ago, before healthcare reform came to the forefront," she pointed out. "We were both looking for ways to better provide a better continuum of care to our patients and it took us a long time to look at how we could do this, and to establish a model."

UMMC and JHCHC worked with consulting firm RSM McGladrey to study the financial feasibility of the project, which is pending approval from the Health Resources and Services Administration, the primary federal agency responsible for improving access to healthcare services for people who are uninsured, isolated or medically vulnerable.

UMMC will maintain operation of its ancillary services and specialty care clinics at the JMM, including the Cancer Institute, dialysis clinic and several administrative and educational support offices. Also, within the next fiscal year, UMMC plans to occupy an additional 60,000 square feet of support space.

"Initially, there will be very little noticeable change," said Chapman. "What will change with patients coming to a community health center instead of an ER is that they'll receive primary care and also get instructions on preventive care. That's the biggest difference."

Expanding Women's Specialty Care

To continue building collaboration and communication among healthcare providers in Metro Jackson, the University of Mississippi Medical Center (UMMC) recently opened University Physicians-Women's Specialty Care in Flowood.

Located in the Mirror Lake building off Lakeland Drive in Flowood, the new center unites women's specialty care under one roof in a venue closer to referring physicians in the community. Clinical services were previously based at UMMC.

The move, said Michelle Owens, MD, assistant professor of obstetrics-gynecology, "offers us an opportunity to truly get out in the community that we serve and provide the full range of services traditionally found in the hospital setting."

Rodney Meeks, MD, interim chair of obstetrics and gynecology, said specialized care for women includes maternal-fetal medicine, pediatric gynecology, urogynecology and gynecologic oncology

"We're also trying to emphasize treatment for vulvar disease, reproductive tract abnormalities and menopause complaints that don't respond to usual therapies," he said, "all of which are a little bit more specialized than general obstetrics and gynecology."

Patients accustomed to visiting the UMMC campus for appointments are being rerouted to the new location. Clinic physicians have adapted their schedules to coordinate outpatient care with inpatient services.

Dana Habers, COO of University Physicians, said the Mirror Lake location enables physicians to reach more patients and to improve the level of service University of Mississippi Health Care provides.

"Having this dedicated space for the women in our community encourages their continuity of care and their sense of security and stability in a healthcare system that can go from basic annual exams to complicated pregnancy and postpartum services," she said.

University Physicians' Women's Health Clinic, which provides general obstetrics and gynecology care, moved to University Physicians-Grants Ferry and opened last month.

"We have fantastic subspecialists here who have essentially been sequestered in the hospital," Owens said. "I think as the medical center is changing and we're reaching out to partner more with the community, this falls right in line with that mission."