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Hospital District unraveling snags in seniors’ care

STORY BY LISA ZAHNER (Week of November 23, 2023)

With closure of the University of Florida Center for Psychiatry and Addiction in Vero Beach only four weeks away, several hundred senior citizens might find themselves without care and without their needed medications if the Indian River County Hospital District does not intervene.

As the details of referring and placing 2,600 UF Health patients with alternate providers was progressing, hospital district staff became aware most of the local providers of behavioral health services do not accept a Medicare Advantage plan that UF Health has honored for more than 400 seniors in its  care.

Hospital District Executive Director Frank Isele told the board of trustees that most of the UF Health patients have been established with a new provider, but “we have a lot of providers” who do not participate in some  Medicare Advantage plans.

“So these folks have nowhere to go in our county,” Isele said at last week’s district chairman’s meeting, which is more of an informal roundtable discussion than the monthly business meetings.

“The most immediate concern is this: The last day UF is operating is Dec. 29, which is not far away, and then anyone who has medications that are being managed, those all expire at the end of January. So that’s our concern,” Isele said.  “These folks need to make sure they can have their prescriptions renewed.”

Of the 450-plus patients at risk for losing covered care, about 200 are Indian River County residents, so those patients are the top priority for the Hospital District, which levies a separate tax that county property owners pay to provide various healthcare services to county residents, especially the indigent and under-insured.

The best-case-scenario would be to get more local doctors into the plans’  networks, or to get as many patients as possible to shift their coverage to a Medicare Advantage plan with a broader provider network and better mental health benefits.

A part of the problem, however, is providers’ lack of interest because the reimbursement rate for services is very low, or their practice is already full.

Self-pay cash clients are preferred, at the going rate of $320 to $350 per hour for talk therapy with a psychiatrist, or less for a psychiatric physician’s nurse practitioner.

“We do have new psychiatrists and nurse practitioners coming into the area, but they’re not going to be up to speed until the summer, so (we need) something to bridge the gap between January and June, July or August” Isele said.

Treasure Coast Community Health accepts several different Medicare Advantage plans, but the psychiatry staff they recently hired to help take the UF Health patients won’t be in place for several months. Worst case: Isele proposed that the Hospital District fund one visit per month with one of the cash-only providers in town for the intervening months until Treasure Coast Community Health’s expanded psychiatric services are able to absorb some, but not all of the extra patients.

Based upon one psychiatrist visit per month so patients don’t go without their medications, that could cost $70,000 per month just for the 200 senior citizens on this plan in Indian River County.

“Do you have a sense that the physicians are even willing to accept new patients? A new patient is a lot of work. You have to start with a diagnosis and medications,” district Trustee Dr. William Cooney said.

Treasure Coast Community Health Executive Director Vicki Soule said in her experience, UF Health provides very good, detailed notes on their patients, making it much easier for a new provider to pick up where the UF doctors left off. “So it’s really not like a brand-new patient. It’s similar to like what you’d have in a group practice.”

The Hospital District is under no obligation to step in to offer patients a temporary solution to the problem, as it is not responsible for UF’s departure from Vero Beach, but the district is in good financial shape, and has funds in reserve for this type of urgent, unbudgeted expenditure. The matter would need to be placed on a business meeting agenda, discussed in public and voted on by the trustees.

District Board Member Paul Westcott said he would push for patients to find a way to change their managed care plans, if possible, while the enrollment period is open, or for the district to research the different plans to find out which ones are accepted by local providers, “To do as much as we can do on the front side before the district starts writing checks, if we can mitigate it.”

Board Chair Marybeth Cunningham pointed out that some of the patients might not have the ability to shop around for new health plans.

Former, longtime board member Ann Marie McCrystal, who attended the public meeting, said the trustees should be very careful not to set a precedent of funding services for Medicare Advantage plan holders because many of those plans leave seniors with few or no provider options for various kinds of care, not just behavioral health.

District Board Member Karen Deigl said she supports the stopgap measure because of the potential risks of patients going off their needed psychiatric medications – which could be prescribed for anxiety and depression, to conditions such as post-traumatic stress disorder, schizophrenia or bipolar disorder.

“Here’s the concern for the community: We were part of bringing UF in,” Deigl said. ‘We knew it wasn’t going to be a forever situation when it happened. So I really feel like it is part of our responsibility because if there are any left over that are not being taken care of, that’s a loose cannon out in our community if they don’t get their medication. I mean, you all hear on a daily basis on the news what happens in communities.”

“If it means that we have to invest the dollars to make sure they get, above and beyond, I’m all for it,” Deigl said.

“This isn’t like there are five other options. I’m trying to avoid 200 people running into the emergency room and having potentially something catastrophic happen. That’s what we’re trying to avoid,” Isele said.