Funding crisis threatens clinic serving ‘the little people’
A much-used community health institution, Open Cities Health Center, finds itself needing nearly two million dollars to keep its doors open in 2020 after 52 years of serving the community. The center’s closing “would be a major loss for the community, especially for our minority and immigrant population,” according to clinic physician Dr. Cynthia Woods. “They just don’t need one more setback.”
“[Open Cities] was originally known as Model Cities clinic and was located in Hallie Q Brown Community Center,” said Yusef Mgeni, longtime St. Paul community activist. It is the last vestige of the anti-poverty Great Society programs of the LBJ administration. In its early years the clinic operated from the basement of St. James AME Church in St. Paul’s Rondo neighborhood.
Open Cities serves primarily St. Paul residents. A large percentage of its patients are Somali and Southeast Asian along with members of the historic African American population. Nearly 35% of patients have no income or low incomes. People pay based on a sliding fee scale; if a patient has no income, they are not turned away.
“We take care of patients who can’t pay. If someone can’t pay, we are not going to send them to collections, so we write it off,” said Open Cites CEO Dr. Ritesh Patel. He lamented news reports of a young man dying because he had to ration his insulin when he couldn’t afford the cost.
“If he came to Open Cities he would not have had to ration it out,” Patel said of this tragedy. “He could have gotten a three-month supply for less than $15.
“It doesn’t help if you get all this care but you can’t afford your prescription. Under the 340B program, as long as one of our doctors writes a prescription you can get your medicine for cheap or low cost.”
Phyllis Henry has been going to Open Cities for over 40 years. “My kids and their kids went there,” she said. “My son had great insurance, top-notch insurance, but he went to Open Cities because they have good doctors. What I like about Open Cities is that the doctors care. I love all the doctors, especially Dr. Woods, who just came.”
Henry told a story about Dr. Lewis, a former practitioner at the clinic, who upon hearing about a patient suffering in her home, rushed from the clinic to her house to provide assistance. Henry jokingly repeated the doctor’s insistence that “if she didn’t go to the hospital he was going to have her arrested.”
Henry said the doctor’s insistence that the patient go to the hospital immediately saved her life. “Many people are not worried about the little people, but the clinic, it cares about them,” she said.
Patel said the Center needs $2.1 million, a little more than $600,000 per month, to remain open until April 2020 when—if still in operation—they expect to receive a federal grant of $2.7 million. The federal government awards such grants to clinics like Open Cities to help subsidize the care of no-income and low-income people.
The grant is given in three-year increments, so the clinic will likely receive total of $8.1 million if they can keep their doors open until April.
Dr. Woods came to Open Cities from a similar local clinic in Dubuque. “When I read about the history of the clinic and the role played by African American women, being an African American woman, it made it more attractive to me. To serve patients that look like me is a plus.
“Patients mention that they are not treated the same when they visit other places,” Woods said. “Hopefully, this being a valuable need will resonate with the governor.”
“If Open Cities fails, a lot of people will be forced to use Regions [Hospital], and that won’t be good,” said Dr. Patel. “At Open Cities, we don’t just do medical care. I have dentistry, counseling, chiropractic medicine, eye doctors, the whole integrated health care within our doors.
“It is top-notch care,” he emphasized. “Even I get my care at Open Cities, and my wife gets her care here.”
After realizing that the clinic was in trouble, Dr. Patel decided to conduct his own audit and discovered that accounting mistakes had been carried over for a number of years. Accounts receivable had recorded that they were owed $1.7 million when the actual amount turned out to be $600,000.
According to Patel, those accounting errors are a major reason why they are experiencing a shortfall. He said that not only were they victimized by bad accounting, but they were also using vendors that were too expensive and did not meet the clinic’s needs.The clinic has terminated its contract with billing company CHMB, which was charging the clinic whether they collected the money or not at rates in excess of the industry standard.
Patel explained that he is doing what he can “to stretch our dollars and be efficient. We laid off 10 employees that were not contributing to the benefit of our community and our patients. The plan is for us to be able to make more money and at least break even every year.”
Patel has already initiated changes to make the clinic more user-friendly and created a vision for the clinic and the community. “We changed our scheduling template so that our patients can see more of our doctors and sooner. We have added more Saturday hours and are open to 8 pm.
“One of the things me and my doctors are passionate about is caring for everyone,” Patel said. “We have a lot of patients who can’t come to us, so we go to them.”
Open Cities is currently working with Union Gospel Mission, Catholic Charities and Rivers Edge Academy, a St. Paul Charter school, delivering services to their respective populations. Patel has been corresponding with the superintendent of St. Paul Public Schools and hopes to see his doctors implanted in public schools.
The Department of Human Services has agreed to go back as far as January 2015 to look at instances in which the clinic was denied payment and perhaps reverse those decisions. Patel has met with Ramsey County officials, the Minnesota Department of Human Services, St. Paul Mayor Melvin Carter, St. Paul city council members, state legislators, the governor, and Minnesota Senator Betty McCollum in an effort to obtain the stopgap funding the clinic needs to stay open.
Incidentally, Patel pointed out, Carter and his family members have been patients at the clinic. “We are asking everyone to pitch in a little bit,” he said. “We are asking the community to help us, and our [request to them] is not financial but to reach out to their elected officials and let them know how important Open Cities is to them.”
Open Cities has two locations in St. Paul: 409 North Dunlap Street and 916 Rice Street. Anyone interested in helping or contributing is invited to call 651-290-9200.
Correction: A previous version of this story incorrectly cited the Department of Health instead of the Department of Human Services.
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