CINCINNATI – A Cincinnati health agency says it would not be cutting off services to thousands of people Monday if other city health providers and community leaders hadn’t opposed its plan to merge with a Northern Kentucky provider.
Neighborhood Health Care, Inc., said it ran into financial problems and made arrangements to merge with HealthPoint of Northern Kentucky.
But the Cincinnati Health Department and others objected to having an agency controlled by out-of-state interests providing services within the city and competing for federal funding, Neighborhood Health Care said.
After the Cincinnati Health Department and others complained in an Oct. 14 letter to the Health Resources and Services Administration, the HRSA denied Neighborhood Health Care a $1.4 million renewal grant for 2014, NHC said.
Neighborhood Health Care released a copy of the letter on Monday.
Read the entire statement from Neighborhood Health Care below.
The Health Resources and Services Administration wouldn't comment in detail about what happened to Neighborhood Health Care’s funding.
The good news for the community is that funding will stay in the city, HRSA spokesperson Martin Kramer told WCPO Monday.
The HRSA will offer the money Neighborhood Health Care didn’t get to another health services provider in the area, Kramer said.
“A service area competition will be announced around the beginning of January,” Kramer said. “By the end of April, the winner will be declared.”
The HRSA did send Neighborhood Health Care a four-month extension – “a little more than $400,000” – to maintain services through April, Kramer said.
“Whether they intend to use that or not is up to them,” Kramer said.
Neighborhood Health Care said it would use the $400,000 “to ensure appropriate patient notification and medical record management …The four month extension does not provide cash needed for vendors to continue service.”
The Neighborhood Health Care statement did not say how patients could obtain their medical records except to note: "Medical record placement and access will include paper and/or electronic TBD."
When WCPO asked for the information, Sher McClanahan, NHC Board Chair, responded by email:
"As soon as available will send. Thanks"
Neighborhood Health Care did not keep its HRSA funding for 2014 because it did not submit an “eligible application,” Kramer told WCPO. He declined to answer whether Northern Kentucky interest in the agency made it ineligible for the grant, or whether the letter influenced HRSA to deny the grant.
Kramer would not even confirm that HRSA received the letter from Cincinnati agencies. “I can’t comment about a letter,” he said.
The letter to the HRSA, signed by Joyce Tate of the Cincinnati Health Department and others, reads in part:
“We would like to bring to your attention our grave concerns over the potential merger of Neighborhood Health Care, Inc., with HealthPoint Family Care in Kentucky. We believe there is enough capacity and expertise in the City of Cincinnati and Hamilton County in general to provide services for Neighborhood Health Care’s patients.
“We find it extremely troublesome that an FQHC (federally qualified health center) from another state is being allowed to serve in an interim management structure (with competitive interests) when there are 5 FQHC based organizations already operating in the service area."
That refers to HealthPoint CEO Chris Goddard running Neighborhood Health Care. Goddard was listed as interim CEO on the NHC website.
The letter continues:
“The appearance or possibility of a Kentucky based FQHC coming into Ohio and competing for federal grants that have been historically earmarked for Ohio will have serious implications for not only us but also other states and cities.”
The letter is also signed by Delores Lindsay of the Health Care Connection, Miriam Crenshaw of Winton Hills Medical and Health Center and Sally Stewart of Christian Community Health Services.
Neighborhood Health Care responded in its statement Monday by saying: “What is more serious than 19,000 patients without a primary care site of service?
“Disruption of service was avoidable,” NHC said.
“In budget year 2013 we initiated a leadership change, received financial commitments from Interact for Health and HealthPoint Family Care to develop a financially viable budget for 2014, including a five year financial recovery plan to service all debt.
“The Board of Directors for Neighborhood Health Care and HealthPoint were committed to continuity of patient care in the existing service area, no money would leave Ohio. Is concern for the address of the administrative offices more important than continuity of patient care?"
Neighborhood Health Care also disputed the other city agencies’ claim that “there is enough capacity and expertise in the city of Cincinnati and Hamilton County in general to provide services for Neighborhood Health Care’s patients.”
“The resources needed and unresolved issues indicate there is very limited capacity. (A NHC survey in November identified a 2-4 month wait for adult patients depending on site) What is more serious than 1000 patient encounters a week unable to be met due to lack of capacity?”
Besides objections from health agencies, Neighborhood Health Care claimed local black leaders also opposed the NHC-HealthPoint merger. The NHC statement included a letter draft purportedly intended for local legislators from Bishop Bobbie Hinton, president of the Greater Cincinnati Chapter of the National Action Network; Jim Clingman, president of the Cincinnati NAACP, and Donna Jones Baker, president and CEO of the Urban League of Greater Cincinnati.
The letter expresses concern about Ohio’s federal dollars going to Kentucky and “potential negative health consequences of an out of state based entity with no significant experience delivering health services to an urban population.”
Neighborhood Health Care serviced uninsured families through centers in Walnut Hills/Evanston, Norwood, Harrison and Downtown, along with school-based programs at Rockdale Academy, South Avondale, and Hughes Center.
NHC said it serviced 4,000 patient visits per month.
The following is Monday’s statement from Neighborhood Health Care:
"December 17, 2013, HRSA notified the Board and leadership of NHC the 330 grant for calendar year 2014 was denied. HRSA indicated there was no appeal process.
"NHC Board members discussed appeal options with aides for Senator Sherrod Brown, Senator Rob Portman and Congressman Steve Chabot. Several indicated the “City of Cincinnati opposed the merger.” (see attached draft letter obtained to the congressional delegates).
"December 23, 2013, the City of Cincinnati Health Commission, Noble Maseru informed and engaged many of you to “address unanimous concerns” regarding the closing of Neighborhood Health Care, Inc (NHC).
"Assurance of patient care continuity in the service area is a core principle for all community providers. Continuity of care in the service area was attainable. Disruption of service was avoidable.
" It is fact, NHC experienced financial difficulty. In budget year 2013 we initiated a leadership change, received financial commitments from Interact for Health and HealthPoint Family Care to develop a financially viable budget for 2014, including a five year financial recovery plan to service all debt.
"The plan for merger and financial recovery was discussed with HRSA leadership prior to grant submission and during grant submission. The recovery plan required (1) the 2014 grant and (2) merger of Neighborhood and HealthPoint.
"In September HRSA leaders from both NHC and HealthPoint regions discussed HRSA requirements for successfully completing a merger. NHC and HealthPoint leadership received no indication a merger was going to prevent the granting of the 2014 330 grant.
"The Board of Directors for Neighborhood Health Care and HealthPoint were committed to continuity of patient care in the existing service area, no money would leave Ohio. Is concern for the address of the administrative offices more important than continuity of patient care?
"Please reference attached letter to Jim Macrae, MA MPP, Associate Administrator for primary health Care dated October 14, 2013. The following statement is in reference to a merger. “It is not warranted and it has serious and far reaching consequences for the community we serve.” What is more serious than 19,000 patients without a primary care site of service?
"The Macrae letter continues: “we believe there is enough capacity and expertise in the city of Cincinnati and Hamilton County in general to provide services for Neighborhood Health Care’s patients.” The resources needed and unresolved issues indicate there is very limited capacity. (A NHC survey in November identified a 2-4 month wait for adult patients depending on site) What is more serious than 1000 patient encounters a week unable to be met due to lack of capacity?
"The Board of Directors for Neighborhood Health Care and HealthPoint were committed to paying all outstanding debt. This commitment to vendors was clearly communicated and ensured continuation of services and supplies. With denial of the grant, HealthPoint Board and leadership could no longer make this commitment. Vendors immediately began withdrawing services and supplies.
"The Cincinnati Health Department called for a second meeting Monday December 30 to make certain “everyone hears the same information” from NHC.
"The following is Neighborhood Health Care, Inc.’s information:
> HRSA provided NHC with less than 10 full working days to develop a plan in response to the 330 grant denial
> NHC will apply for the HRSA 4 month extension to ensure appropriate patient notification and medical record management…award of funds TBD
> The four month extension does not provide cash needed for vendors to continue service
> NHC will stop seeing patients December 30, 2013
> Notification of patients has begun consistent with Ohio code
> Medical record placement and access will include paper and/or electronic TBD
> “Through a future Service Area Competition-Additional Area announcement, HRSA will make a 330 grant award to an organization that demonstrates its ability to carry out a service delivery program consistent with Federal Center Program requirements starting on May 1, 2014”. Source: HRSA December 17, 2014 letter of notification to NHC.
> The HRSA announcement of a SAC fulfills a request in the letter to Jim Macrae for the FQHCs in Hamilton County to participate. Please note only NHC submitted an application in the initial offering.
"The Neighborhood Health Care, Inc. Board of Directors is truly saddened by these avoidable consequences to the underserved citizens of Cincinnati."
Board Chair (non-patient healthcare representative)
Senior Vice President
Clinical & Operational Transformation
TriHealth Corporate Administration
Robert Collins, MD FACS
Vice Chair (patient)
Executive Medical Director
TriHealth Corporate Administration
Andrew Ruffner, MA, LSW
Secretary (non-patient healthcare representative)
University Of Cincinnati
Department of Emergency Medicine
Walnut Hills Area Council
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