NEWS

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May 22, 2009

Women’s clinic closes as hospital refocuses efforts on research and special cases

The Women’s Health Center, a University-run clinic on East 47th Street that serves Medicaid and Medicare patients, will close at the end of June. Administrators say the decision was made for financial reasons, and as part of the University of Chicago Medical Center’s (UCMC) effort to focus on research and treatment of complicated cases, but critics say the clinic’s closing will severely limit access to University health services for low income patients.

UCMC spokesman John Easton said discussions about closing the gynecological and obstetric care clinic have been underway for about a year, but were spurred along by the Medical Center’s $100 million budget cut earlier this year.

“It has been difficult to run these clinics in a way that didn’t lose money,” he said. “Because we are research- and teaching-oriented, we have much higher costs. The clinics are seen as a place where we can get outpatient experience for residents. That brings more eyes and attention to each case, but it’s not always more efficient.”

In searching for ways to provide more efficient care, the UCMC, like many other academic medical centers, has started to back away from the regional health clinics it set up throughout the 1980s and ’90s, Easton said. Two other primary care clinics were closed and the physicians’ practices relocated to the Duchossis Center for Advanced Medicine (DCAM) in April.

The UCMC has turned its focus to building “non-acquisitional” partnerships with local clinics and community hospitals, hoping to enable these partners to provide the bulk of routine community health care. In the last three years, the Urban Health Initiative has worked for this reorganization of local health care.

But some say that the new policies will create a two-tiered healthcare system in Hyde Park, in which the University will see patients with private insurance and delegate the uninsured and those with public insurance to local clinics.

“When you get down to it, a Medicaid patient who has a gynecological complaint is going to be seen in a community clinic. A patient with private insurance with a gynecological complaint is going to be seen by OB/GYN department faculty. That’s a disparity of where care is delivered. I’m not sure if it translates into disparity of health outcomes,” said Dr. Mishka Terplan (A.B. ’91), head of the clinic.

Some of the clinic’s patients will continue to be seen by the University. The center’s high-risk pregnancy clinic will still operate through the University, though in a new location. Patients with complex medical issues will be seen at a once-a-week clinic at the DCAM. Terplan said that this accounts for less than 10 percent of the nearly 4,000 patients the clinic saw last year.

But the rest of the clinic’s patients must find a new provider of gynecological care from clinics in the South Side Healthcare Collaborative (SSHC), a group of federally-qualified health clinics throughout the area that have established relationships with the UCMC. Laura Derks, the director of the SSHC, said that after a meeting between representatives of the 25 SSHC clinics and the Women’s Health Center earlier this year, nine clinics can provide comparable care for current University patients.

“The difficulty is in deciding who should be seen in [the new DCAM clinic] and who should be seen in the community,” Terplan said in an e-mail.

Patients with public insurance seeking care at the U of C have generally been referred straight to the Women’s Health Center instead of to the general OB/GYN practice at the Medical Center for financial reasons, according to Terplan. The clinic’s patients came from well beyond Hyde Park: Terplan said 6 percent of the clinic’s patients in the last six months have traveled over 20 miles to see the University faculty and residents who staff it.

“Regardless of income, [patients] want to go where they perceive the care is best. U of C is at the forefront of medicine; they’re willing to travel,” Derks said.

The clinic’s staff has worked with the Urban Health Initiative in order to ensure a smooth transition for patients.

“Before the UHI, the Medical Center would have made the decision to close 47th Street, and that would have been the end of it,” Derks said, noting that the same would be true of any academic medical center. “What the Urban Health Initiative says is that we know there are other community resources that can help fill the gaps, and do just as good of a job in caring for patients. Let’s make sure patients know about these resources, so they’re not wandering around blind.”

On-site patient advocates have reached out to most of the clinic’s patients with information about the alternative clinics. They have scheduled appointments at new facilities for many patients, and have also made efforts to ensure a smooth transfer of records between the University and local clinics.

Speaking about the transition process, Terplan said, “I had incredibly low expectations for the process,” but he recognized that the Medical Center was doing the best it could in a difficult situation.

Medical residents, who staff the clinic under faculty supervision five days a week, will complete the clinical aspect of their residency at NorthShore Medical Center in Evanston, through a new partnership established last year. The clinic’s other staff, including nurses and technicians, have not been promised employment at the UCMC, and most plan to seek employment elsewhere once the clinic closes.