Health care center faces widespread structural changes

V. Paul

A Minneapolis clinic run by the University has come under the scrutiny of Academic Health Center officials after a two-year struggle to redirect its role in the community it serves.
The Community-University Health Care Center in the Phillips neighborhood, an AHC community-outreach clinic, is undergoing widespread changes in leadership, administration and financial management.
A search for a new executive director and chief operations officer is now underway. Other recent fundamental changes include those to the clinic’s governing board, accounting system and interior spaces.
Annual losses of more than a half-million dollars have also prompted concern for the clinic’s management.
Academic Health Center officials have no intention of reducing the medical care provided to the community as a result of the clinic’s mismanagement, said Frank Cerra, health center senior vice president.
Cerra does, however, advocate a reevaluation of the clinic’s health-care services to determine if they meet the community’s needs.
“In the point of view of the University, the issue is one of how will (the clinic) best survive to meet its mission,” Cerra said. “The University has no intention to be involved other than in a supporting role.”
The AHC’s role has become much more directly linked to the clinic after the University’s 1996 merger with the Fairview hospitals system. The clinic previously relied on the University hospitals for its operational needs, but it now turns directly to the Academic Health Center.
“What we’re trying to do is evolve (the clinic) to the point that there is an equal 50-50 partnership and marriage between the community and the Academic Health Center,” said the Mark Niblick, president of the clinic’s board of directors.
Preaching to the faithful
University auditors made 33 recommendations to improve administrative, financial and operating conditions in the clinic in their August report. According to the report, 24 recommendations were rated as essential to “help avoid a potentially negative critical impact.”
The audit confirmed the AHC’s preliminary findings regarding changes in clinic management, said Cerra.
Among the recommendations, the audit reaffirmed the clinic’s need to hire a new chief operations officer with responsibilities complementing those of the director. It also called for a clear distinction of the two clinic roles.
Auditors advised the clinic to establish a clear procedure managing overall health-care services. The report also suggested an improved patient-billing system.
Furthermore, auditors encouraged the clinic to use the same accounting system as the University of Minnesota Physicians’ system, one used by the University’s entire medical community.
Also, the clinic’s ties with non-University groups will be monitored annually by the AHC to keep track of the amount of school resources it uses.

Changing of the guard
The re-evaluation has caused its fair share of controversy, especially concerning the resignation of senior staff member Dr. Amos Deinard.
Deinard, a 15-year veteran of the clinic, resigned abruptly as executive director in August. In a meeting with Cerra that month, Deinard was instructed to leave the directorship but to stay on as a pediatrician and researcher.
“It was either quit or be fired,” Deinard said. “I was there 15 years. It was my passion.”
The University audit of the clinic was also completed in August but did not call for Deinard’s replacement. The Academic Health Center did seek a leadership transition in its overall clinic analysis.
The staff had no idea that Deinard’s resignation was imminent and found out only after the announcement, said Bonnie Brysky, the clinic’s interim executive director and a 29-year clinic employee.
What has been characterized as a sudden change in leadership was done at Deinard’s request, Cerra said.
After Deinard was told to step down as director, he turned in his resignation and asked that it be immediately announced, Cerra said.
“We had not gotten any foreshadowing about that,” Brysky said. “Had Dr. Deinard been talking about leaving (his position) to the staff? No.”
But the bitterness caused by Deinard’s sudden resignation is mixed with a sense of rebuilding, Niblick said.
“When a man as great as Dr. Deinard leaves an institution he gave so much to, it’s hard not to feel a great sense of loss,” he said. “From that loss comes bitterness. But the reality is all of us are expendable. What really matters is (the clinic’s) mission of serving the people of the Phillips neighborhood.”
Because the clinic is run by the University, it is subject to periodic review by AHC officials regarding the clinic’s governance and financial performance. The clinic’s board voted over the summer against severing ties with the University.
“Let’s say I said to you, ‘I want to come into your house, and I want to write checks from your checkbook, and don’t you hold me responsible for the balance of your bank account.’ Are you going to tolerate that?” Cerra asked. “Probably not. I don’t think the University should either.”

Community care
Nestled on the corner of Franklin and Bloomington avenues, the clinic serves about 8,600 individuals annually. Most patients come from lower-income families in the Phillips neighborhood and have little or no insurance, making the subsidized clinic’s existence all the more vital to the community.
The clinic’s offices are made up of medical, dental and health-care units. Started in 1966 as a University outreach program, the clinic has provided 40 positions each year for University medical students.
The clinic operates on an annual budget deficit of about $600,000, according to its financial documents. Academic Health Center officials do not think the clinic will ever break even; however, clinic services will not be cut, Cerra said.
“I fully expect (the clinic) to have a $500,000 yearly deficit,” he said. “That’s the University’s responsibility.”
Niblick agreed that a $500,000 deficit was reasonable because of the clinic’s mission but estimated that the clinic’s actual annual deficit is much larger. He cited differences between accounting standards for academic and business purposes.
“In looking at (the deficit) on an ongoing basis as a business, I see it at $1.2 million,” he said.

Community changes
Changes in the Phillips neighborhood are part of the reason for the clinic’s renovations, University health officials said. For instance, the clinic staff has developed a growing need for translators when providing basic services to patients from the community, Niblick said.
According to the 1990 U.S. Census, 88 percent of Phillips neighborhood residents speak English at home. It also reported that 55 percent are from minority backgrounds.
In comparison, a 1999 study conducted by the Minneapolis-based Urban Coalition found that only 66 percent of Phillips neighborhood schoolchildren speak English at home. It also determined that 94 percent of the students are from a minority group.
Although a strict comparison of the two studies does not paint an entirely accurate picture of the changes, it does reflect a significant trend toward greater ethnic diversity in the neighborhood.
By restructuring the clinic’s role in the community, University health officials are trying to keep up with the pace of these changes.

V. Paul Virtucio welcomes comments at [email protected]