Volunteers in Medicine transitions to VIMCare

Good-bye, Volunteers in Medicine. Hello, VIMCare.

A new name for the medical clinic, established 20 years ago for the uninsured, is just part of the transformation for the organization.

The most obvious change will be a new location. After being headquartered near 10th Street and Marr Road for the past two years, the VIMCare Clinic will open Sept. 7 in the former emergency room facilities at Columbus Regional Hospital.

The space became available after the county-owned hospital opened a new $16 million emergency department in May, but it may not be a permanent solution.

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“They really don’t know. But at least for the next two to five years, the clinic will be at the hospital,” said Carl Lienhoop, Bartholomew County commissioner.

The clinic has adopted a new business model that will enable VIMCare to treat people with or without health insurance, said Julie Abedian, vice president of community partnerships and corporate responsibility at Columbus Regional Health.

“From the patient standpoint, there will be very little, if any, cost,” Abedian said. “But it won’t be free care. It will be reimbursed care.”

An anticipated 70 percent of funding will come from state and federal health care reimbursement programs, said Larry Kleinhenz, another Bartholomew County commissioner.

That’s one reason the clinic will no longer be manned by volunteer clinicians and staff, Abedian said.

“Everyone who works at the (VIMCare) clinic will be paid,” Volunteers in Medicine clinical director Tina Latta said. “However, at some point in the future, we hope to work in volunteers in some capacity.”

The new business model will allow VIMCare to treat about 5,000 patients — about three times more than are currently seen at Volunteers in Medicine — as well as stay open late on Mondays, Abedian said.

“What’s most important to understand is that, even though we are going to look different, our vision remains the same,” Abedian said. “The whole point is to provide a place where people were being treated with dignity and respect, regardless of their ability to pay. That is still the top priority at VIMCare.”

State and federal requirements

The transition to a new business model was prompted by developments at both the Indiana Statehouse and in Washington, D.C.

For example, there’s the 2015 revision of the Healthy Indiana Plan, which is the state’s version of Medicaid expansion. Earlier this year, Indiana Gov. Mike Pence announced that about 500,000 uninsured Hoosiers had become eligible for the plan, also known as HIP 2.0.

However, when most Volunteers in Medicine patients become eligible for government health insurance, they were no longer eligible to receive free services, Abedian said.

By coincidence, the Volunteers in Medicine transition corresponds with the retirement of Dr. Charlie Rau, a Columbus physician and long-time Volunteers in Medicine medical director. His son, Dr. David Rau, said he will serve as a consulting medical director for VIMCare for at least six months after his father’s retirement.

Hospital officials estimate that when the state Medicaid expansion is combined with federal Medicare programs, only about 10 percent of Bartholomew County’s population will require free medical care, according to a recent newsletter.

For that reason, David Rau describes the creation of VIMCare as a necessary transition.

The greatest problem that all newly insured patients face is securing a primary care physician who is accepts new patients, due to a local shortage of medical doctors, Abedian said.

“Volunteers in Medicine was their medical home, and they have no home to go to,” Abedian said. “That’s been going on for almost a year-and-a-half.”

But by changing the business model, patients enrolled in the Healthy Indiana Plan or Medicare can receive services at the VIMCare Clinic at little to no out-of-pocket cost, she said.

Moving to hospital property

The necessity of moving the facility into the former emergency room was prompted by a provision contained in the federal Omnibus spending bill approved by Congress in late October.

The provision stops the Centers for Medicare and Medicaid Services from paying hospitals for outpatient services at newly acquired, off-site locations as though these clinics were part of the main hospital campus.

Currently, Medicare pays outpatient clinics at the main hospital more than it pays off–site clinics and physicians for the same services.

So in order for the hospital to receive full compensation, new federal statutes require VIMCare to be housed within 250 yards from the main hospital building, Lienhoop said.

This requirement grew out of concern that hospitals may be improperly incentivized to acquire and label physician practices and ambulatory surgery centers as hospital outpatient departments, according to industry publications.

While the Congressional Budget Office estimates the new provision will save $9 billion over 10 years, the Medicare Payment Advisory Commission stated the provision would decrease hospital revenue by $1.4 billion a year.

Although advocates say the provision prevented a 52 percent increase in Medicare Part B premiums, opponents note the spending bill also included a 2 percent cut in Medicare payments, according to news accounts.

In regard to previously announced intentions to house the clinic on the three-acre site of the now-demolished Bartholomew County Annex building, the new federal provision “really threw a wrench into the plan,” Kleinhenz said.

While the original concept of housing both the clinic and the nursing division of the Bartholomew County Health Department on the same property fell apart, Lienhoop strongly maintains it was a good plan.

“In terms of financing, the timing was terrible,” Lienhoop said. “But I don’t anticipate the county ever being super-flush with money.”

Kleinhenz and Lienhoop confirmed they are negotiating with Columbus Regional Health to exchange the land where the annex once stood for the current location of the nursing division of the Bartholomew County Health Department.

The hospital, which recently obtained the property at 2675 Foxpointe Drive, Suite B, is renting the facility to the county. If the deal goes through, the county health department would have a permanent home, Kleinhenz said.

While emphasizing negotiations are still ongoing, Abedian confirms the hospital intends to have a presence on State Street.

Decisions have also not been finalized regarding the future use of a former bank branch at 2033 State St., located next to the former annex site, as well as the current Republic building at 333 Second St., Abedian said.

The hospital announced the acquisition of the newspaper building in spring, while the former bank branch was purchased last fall.

Fundraising will continue

Emphasizing that no donations to the hospital foundation are being used to purchase buildings, Abedian said not all services available through Volunteers in Medicine will be covered by Medicare and Medicaid.

That means that, besides providing charity care, the foundation will still have to subsidize mental and behavioral health services and medication assistance as well as case management and social work at VIMCare, she said.

In addition, the foundation, which provided $561,966 to Volunteers in Medicine last year, will also need to pay a few percentage points of operational costs, she said.

“The foundation has typically provided $475,000 to $575,000 annually to the clinic,” Abedian said. “Going forward, we anticipate we will need to provide $330,000 to $340,000.”

As a result, the foundation will continue to hold fundraisers for the clinic, such as the popular reverse raffle each November, she said.

Although some challenges may be ahead, David Rau expressed confidence that those patients without means will continue to be served as long as the Columbus Regional Hospital Foundation remains committed to serving high-risk patients.

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The organization to be known as VIMCare can trace its roots to 1994, when 220 people met to identify community health priorities and developed a community health vision. From that meeting, the Healthy Communities Initiative (HCI) was born.

With the Columbus Regional Hospital Foundation as its major financial supporter, HCI established the free medical clinic known as Volunteers in Medicine in 1996. The mission of the clinic at 836 Jackson St. was to serve low-income, uninsured residents of Bartholomew County by providing care by community and medical professional volunteers.

In March 2014, Volunteers in Medicine moved to a new, temporary location at 940 N. Marr Road.

Plans were announced in the fall of 2014 that Volunteers in Medicine would build a permanent location adjacent to a new facility for the nursing division of the Bartholomew County Health Department. But those plans for a low-income health complex near State and Mapleton streets fell through when a financial crisis prompted the county to abandon its part of the project.

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The transition of Volunteers in Medicine into VIMCare corresponds with the retirement of Dr. Charlie Rau, a Columbus physician and long-time Volunteers in Medicine medical director.

The public is invited to a celebration honoring Rau’s career and community contributions next month.

When: 2 to 4 p.m. Aug. 28

Where:  Mill Race Center, 900 Lindsey St., Columbus.

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VIM of Bartholomew County (Volunteers in Medicine)

Address: 940 N. Marr Road, Suite B, Columbus

Telephone: 812-376-9750

Clinic hours: Mondays, Wednesdays and Fridays, from 9 a.m. to noon. Tuesdays and Thursdays, from 1 to 7 p.m.

Services provided: Acute primary care, annual physicals and sports physicals, chronic care management, self-care resources, lifestyle and education programs, and specialty clinics.

Eligibility: Patients must be Bartholomew County residents with no health insurance. Services, including medications, cannot currently be provided for Medicaid and Medicare recipients. Patients must have a household income at or below 50 percent of the Bartholomew County median income, adjusted to family size. Proof of income is required, and eligibility is determined by clinic staff.