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Cleveland Clinic’s expanded services fill void for older, underinsured psychiatric patients

STORY BY LISA ZAHNER (Week of December 28, 2023)

Hundreds of local Medicare Advantage policyholders who were at risk of being without their psychiatric medications in 2024 got an early Christmas present this month when Cleveland Clinic Indian River Hospital worked out a solution through its Behavioral Health Center.

In the process of referring 2,600 patients to other providers in preparation for Friday’s closing of the University of Florida Center for Psychiatry and Addiction, the Indian River County Hospital District was alerted that many of UF’s older patients had insurance that the area’s private psychiatrists do not accept.

In November, it appeared that the Hospital District might need to provide emergency funding of $350 per visit for several months so at least the 200 underinsured residents who live in Indian River County could be seen by doctors to get monthly prescriptions renewed for needed antidepressant, anti-anxiety, antipsychotic and other medications.

But even with the funding problem theoretically solved, it wasn’t certain that the private physicians could or would absorb hundreds of new patients into their schedules. If patients fell through the cracks, they could end up in Cleveland Clinic Indian River Hospital’s Emergency Department – or worse, there was the danger that they could harm themselves or others.

“Cleveland Clinic Indian River jumped in at the last minute and expanded their services with a contractor called Amwell for the next six months to make sure that all these scripts are able to be written. The way everyone came together was fantastic,” Isele said.

With regard to the other nearly 2,200 patients – including 250 children – not dealing with the Medicare Advantage challenge, Isele said local nonprofit agencies and providers have accepted referrals and are scheduled to pick up where UF Health left off, starting in January.

“There was a huge focus to make sure we got everyone settled, which to this point, it looks like we have,” Isele said. “And also the staff. One of our focuses, too, was to make sure that these caring staff, who did a lot of work for Indian River County in service to the patients for the past several years, were able to contributing the way they have been and stay in our community and they have been able to do that.

“The great news is we’re pretty sure we have our patients situated and we have our folks who were providing those services still doing that in the same capacity, but with a different company,” Isele said.

Isele credited the McCabe Connections Center in Downtown Vero Beach with matching patients in need with appropriate providers.

Mental Health Association, Tykes and Teens, Treasure Coast Community Health, Whole Family Health, the Visiting Nurse Association of the Treasure Coast, New Horizons, School District of Indian River County, Suncoast Mental Health Center, Legacy Behavioral Health Center, PUR Behavioral Health and Wellness, and New Seasons Treatment Center all agreed to take a portion of the clients needing care due to UF Health closing.

“Through that eclectic group, we were able to establish a solution,” Isele said. “One of the really neat things is, because we had so many organizations involved, we were able to make sure that folks were transitioned and that continuity of care was there.”

Isele said inevitably there will be the rare case of a patient who was unable to be contacted or maybe didn’t respond get the message straight about UF Health closing and their case referral to another provider.

“In the 30 years I’ve been doing this, I’ve been involved with at least a half a dozen or a dozen closures. Regardless of how well we communicated to the public, how well we communicated to doctors, how well we communicated to everyone, we will have a percentage of patients – hopefully it’s really small – who are going to say we didn’t know you were closing,” Isele said.

“They will show up at the ER and say we didn’t know what to do, how could they not tell us,” Isele said.  “I’ve never been through a closure where that hasn’t happened, so we should expect a little bit of that. But I think UF definitely did a sufficient job of making sure everyone had a safe transition.”

Hospital District Trustees praised the whole team for its efforts. Dr. William Cooney called the achievement “amazing.”

Hospital District Trustee Paul Westcott asked Isele how large of a void UF Health is leaving in the community moving forward from the short-term crisis.

“Where are we in terms of ongoing capacity? In other words, having UF here absorbed need. They’re not here, we’ve plugged the hole, but where are we in your assessment in terms of being able to meet the community’s needs at this stage?” Westcott asked.

Isele said that in 2024, the Hospital District staff will begin to quantify the met and unmet need for behavioral health services countywide.

Isele said several organizations, including Treasure Coast Community Health, New Horizons and Cleveland Clinic Behavioral Health Center are in the process of bringing new psychiatrists on staff. Those doctors will begin seeing former UF patients over the next few months on a permanent basis.

UF Health was initially recruited to open a psychiatric practice in Vero Beach by The Robert F. and Eleonora W. McCabe Foundation, which generously funded the initial five years of the clinic’s operations. UF Health served Indian River County for a total of 15 years, training psychiatric residents and bolstering the mental health services locally available.

Dr. Wayne Creelman, who headed up the practice and supervised the medical residents, has said he will remain in Vero Beach as a mental health advocate and consultant working to further the McCabe family’s mission in Vero, but he will not be in private practice.