Outer Cape Health Services Struggles To Keep Clinics Open

By: William F. Galvin

Topics: COVID-19

Outer Cape Health Services, Inc. Chief Executive Officer Patricia Nadle. FILE PHOTO

Staff Reduced, Emergency Equipment In Short Supply

HARWICH — Outer Cape Health Services is hoping to keep its three health clinics in operation, but this week it took the drastic step of reducing its staff by 50 percent. The COVID-19 outbreak has reduced patient visits and driven additional expenses to the point that projected revenue losses are as much as $1 million a month, according to the agency.

“Between missed patient visits due to the coronavirus outbreak, new expenses, reduced services, and supply shortages, we are facing an immediate threat to our ability to provide health center care to residents of the Outer and Lower Cape who depend upon us as their healthcare resource,” read a fundraising plea issued a week ago.

“Unfortunately, as the federal government has not adequately responded to protect these critical healthcare services, we may have no choice but to begin to reduce our hours and, possibly, shutter one of our clinics,” the statement read.

Patricia Nadle, OCHS CEO, said Friday she hoped the agency will not have to go to the level of closing a clinic. Other federally qualified community health centers have done some consolidating, but OCHS does not want to make any rash decisions “and hopefully we can stabilize with this approach,” she said.

Nadle on Monday reported a good news from the federal Health Resources and Services Administration, which is distributing $100 million to 1,300 federally qualified health centers across the nation. OCHS will receive $61,000, she said.

OCHS has clinics in Harwich Port, Wellfleet and Provincetown. Last Wednesday the agency announced that due to the severe reduction in patient visit volumes, the 200-member staff will be reduced by 50 percent, which includes 70 temporary furloughs, a reduction in work hours for select employees and layoffs for a smaller number of individuals.

Most of the reductions were in support staff. No clinicians were impacted. “The clinicians are doing a lot of work with limited support staff,” Dr Andrew Jorgensen, chief medical officer, said on Monday. “There were also no reductions in primary care providers.”

The health centers reduced service to seven hours a day. The dental services are closed down, as are optometry services. Maternity and prenatal services are being provided one day a week.

“We’re focusing on restricting our mode of care on the side of safety of patients and staff,” Jorgensen said.

“In order to survive the economic challenges presented by the COVID-19 situation, and to make sure we had the resources necessary to meet our patients’ expected needs for critical services, we had to make some painful decisions,” Nadle said in a statement.

“Today has truly been one of the hardest days in my entire healthcare career. Making decisions that impact even one staff member’s life is very difficult. We deeply value the contributions made by every team member, and balancing how to care for people we serve while also protecting those that sacrifice for us each day has been a deeply painful process. Decisions impacting our staff are agonizing, but we are ensuring that they are supported as much as possible through our human resources department,” Nadle said.

She could not predict how long the reduced staff operations would last but said she hoped it would be no more than four to six weeks before operations begin ramping up and the full staff returns.

Nadle’s frustration over the lack of a response by the federal government to the COVID-19 outbreak was evident on Friday. She said at the time that the agency had received no help. Last week, Jorgensen highlighted the need for more personal protective equipment for the staff and for more COVID-19 test kits. The Wellfleet clinic where COVID 19 tests are done was using test kits created for earlier virus strains.

A couple of test kit supply deliveries have been received from Quest Diagnostics, which operates from the clinics, enough to last a week or two, Nadle said. But there has been nothing from the federal government in the way of personal protective equipment. People from within the community have been coming forward and providing masks and gloves, she said. However, when reaching out to suppliers for gown and gloves, the response is they are out of stock and can’t deliver.

“Personal protective equipment is the biggest challenge right now,” Nadle said.

Jorgensen reported that OCHS has tested 130 patients for COVID-19; 18 tested positive. The hometowns of those with positive tests are no longer being made available at the local level at the request of the state Department of Public Health.

The $2 trillion COVID-19 federal aid and stimulus package includes $1.3 billion to be directed to federally qualified health centers throughout the nation, Nadle said, but she could not estimate how long it will take for those resources to be distributed.

One of the main issues facing OCHS is the need to provide telemedicine services to patients. However, neither the volume of such visits, nor the revenues they generate, are comparable to in-person visits, she said.

Governor Charlie Baker has approved parity payments under Mass Health for telemedicine services during the crisis, but the numbers are not there, said Nadle. Thirty percent of OCHS patients are on Medicare and the federal program pays only 10 percent of the in-person visit fee, or $14, she said. from Medicare. On Monday she added that the federal government opened up and provided some room for discussion on those fees.

“OCHS continues to work hard to ensure our patient care teams are available and prepared to screen and potentially test symptomatic patients for COVID-19. Our urgent care service in Provincetown also remains open to the Outer Cape community,” Nadle said. “While the situation is challenging, we have been heartened and overwhelmed by the outpouring of private support from the community and we hope that they continue to stand with us.”

Trish Kennedy, the landlord of the OCHS clinic in Harwich Port, was just one of the supporters stepping up to ease the financial burden by providing rental concessions for the health care center, Nadle said.