(From left) Monroe County Commissioners Lee Jones, Penny Githens and Julie Thomas (FILE: Community Access Television Services)
Monroe County government employees will have a new health clinic vendor by Aug. 1 due to recent action by the county Board of Commissioners.
The commissioners unanimously voted last week to transition from Everside Health to Proactive MD by approving a $59,750 agreement with the latter, despite several county employees voicing their opposition.
The change brings an end to the county’s nearly 14-year relationship with Everside, which offers free health services to employees and their families. Everside is now merging with Marathon Health, and the county says staying with Everside would incur an additional $1.5 million in contractual fees over the next five years compared to current costs.
In addition, the county said it has experienced issues with Everside regarding appointments, changes in administration, technology, reporting and programming.
Dr. Clifford Mitcheff is the physician family practitioner at Everside. He has been there since the clinic opened, and county employees said losing him as a primary care provider would be devastating.
Dr. Clifford Mitcheff (FILE: WTIU News)
Everside is staffed by Mitcheff, a physician’s assistant and nurse practitioner; they work a combined 40 hours a week, as none are full-time. Proactive, by comparison, will have a full-time nurse practitioner but no physician.
Monroe County Treasurer Catherine Smith told the commissioners at a May 29 meeting she disagrees with the change because of how deeply she and others appreciate Mitcheff and the fact Proactive will not offer a physician.
“Losing such an amazing doctor on the grounds of a lower contract bid when the bid winner will not directly provide a doctor's services means the cost reduction is only made by removing the primary physician that employees want and that they need,” Smith said. “
Catherine Smith (Courtesy, Community Access Television Services)
Smith was one of many in the county, including department heads and members of the county council, who signed a letter expressing concerns about the change.
The letter says many employees who utilize the clinic plan to seek alternative primary care providers without access to Mitcheff. It argues this is likely to increase the county’s insurance costs, counteracting the intended cost-saving measures.
It also warns many employees have stayed with the county because of the quality of care offered by Everside.
It also goes into detail about why employees object to opting for a nurse practitioner instead of a physician, which was a common theme at last week’s meeting.
Jody Madeira is the Democratic nominee for the District 3 seat on the Board of Commissioners, which is currently occupied by Penny Githens. She also is a professor at Indiana University, with expertise in law and medicine.
Madeira spoke about the change in her capacities as both a candidate and an expert on medicine.
“This is an unhealthy direction,” Madeira said. “Nurse practitioners are particularly useful when there just aren't enough doctors to serve a population, particularly in rural areas — and that's just not the situation here.”
Jody Madeira (Courtesy, Community Access Television Services)
Madeira said nurse practitioners in Indiana have limited practice authority and can optimally perform only some of the scope of their practice without physician supervision. She added nurse practitioner organizations across the country have lobbied for full practice authority but have not been successful in Indiana despite recent efforts.
Madeira said research shows the quality of referrals, pre-visit care and other factors are higher for physicians than for nurse practitioners while reimbursement rates for nurse practitioners are usually significantly lower than those for physicians.
“In getting rid of Monroe County’s (current) clinic, patients or employees — us — we're going to lose what individuals in the past have gained,” she said. “There will be month-long waits to see your real physician, more rushed appointments, more impersonal care, likely increased out-of-pocket costs, overall rising copays and inferior health care.”
Many said they felt blindsided by the change. Information presented by a county Employee Services representative last week indicates the county sent an email to employees notifying them of the situation, along with a survey, on Feb. 22.
Presentations from five vendors who responded to a request for proposals were noticed on March 14, and the vendors delivered those presentations on March 25, according to the county.
The five vendors included Ascension Health, Franciscan Health, Marathon Health (which is merging with Everside), Proactive MD and QuadMed. The finalists — Quad Med, Proactive and Marathon — all recommended a nurse practitioner model, according to the county.
Additionally, the commissioners received a briefing on May 15 with a recommendation to approve a contract with Proactive.
Commissioner Julie Thomas responded to comments that the change had come as a surprise, saying, “Things have been on the calendar. Things have been on the agenda. … We’ll have a conversation about what else we could have potentially done outside of hiring carrier pigeons to land on everyone’s desk.”
Julie Thomas (Courtesy, Community Access Television Services)
She continued, “We knew this was important. It has been something we have talked about a lot.”
