The Laurie clinic appears to be caught up in the trend away from small, independent clinics and the greater healthcare issues facing our nation.
Despite a full patient load and a doctor with a desire to continue practicing, Westlake Medical Center is closing its doors after 24 years of service in Laurie, and its doctor retiring.
A Facebook post to the WMC page on May 17 announced the last day would be July 31, 2017. Contacted subsequently by the Lake Sun, Office Manager Becky LaRock confirmed plans to shutter the independent primary care clinic located in the Laurie Terrace Mall on Highway 5.
She indicated a required change to a new electronic medical record system, effective Aug. 1, 2017, was the proverbial straw that broke the back of the struggling clinic.
A letter to patients from the sole doctor at the clinic - Kenneth L. Derrington, M.D. - confirmed that Boone Hospital through which the clinic leases its electronic medical records was changing its records system and that the switch was “prohibitively expensive for the clinic to pursue.”
In addition to new software, new computers would have been required, according to LaRock.
The announcement is the culmination of years in a financial downward slide for the not-for-profit facility which operates under a local board of directors.
“As many of you know the Clinic has been facing an escalating crisis for the last 3 years,” Derrington wrote in his notification letter to patients.
The clinic appears to be caught up in the trend away from small, independent clinics and the greater healthcare issues facing our nation.
According to Derrington, the “small business practitioner model is no longer viable.”
LaRock said the doctor and board of directors have had various negotiations over the last few years with regional healthcare systems from Jefferson City and Columbia to the Lake area to take over the clinic with Derrington continuing on - none of which have worked out.
“We have tried every avenue I know to bring new doctors to Westlake without success. Several times I thought we had a way to keep the clinic going but all have fallen through,” Derrington stated.
The Lake Sun began chronicling the clinic’s financial struggles in December 2012 after being approached by Derrington regarding its tenuous position in regards to a then-possible cut to the physician reimbursement sustainable growth rate during the midst of the so-called fiscal cliff crisis of 2012 in Congress.
Doctors faced a 26.5 percent cut in payments for Medicare patients, according to the American Medical Association, and another 2 percent cut without a budget deal in Congress due to sequestration cuts required by the 2011 Budget Control Act.
At that time, Derrington estimated 85 to 90 percent of the clinic’s patients were on Medicare on the federal medical program for Americans ages 65 and up - an unsurprising statistic in a city where the median age in the 2010 U.S. Census was 69.
Unattached to a hospital which can underwrite overhead costs, the cuts would have devastated the clinic requiring its closing then. A deal was worked out at the last minute through the American Taxpayer Relief Act, however, and that 30 percent cut avoided.
But the struggles for WMC continued when the second of two doctors left to go to work for a regional healthcare system, and Derrington was left as the sole provider. The move was perhaps unsurprising given that in December 2011, Derrington said the physicians had made no money after making payroll and other bills.
There was plenty of work though, both in reality and in theory.
The AMA had documented a growing gap in access to healthcare, especially among Medicare patients due to the low physician reimbursement rate.
While the AMA continued to lobby Congress to eliminate barriers and provide opportunities for doctors to transition to innovative payment and delivery models to improve care and lower costs, nothing has been done in this respect.
LaRock has been a nurse since 1981 and has always worked in a private doctor’s offices.
With the recent announcement, she commented, “A clinic not affiliated with a hospital just can’t make it anymore. It’s very difficult with government regulations put in place over the years. It’s not any one president - it’s all the regulations, the cutbacks in Medicare reimbursement. We’ve fought it for years. When I left my job in Omaha, it was getting ready to be taken over at that time. That was in 1987.”
Hospital-affiliated clinics typically offer incentives, such as helping pay for education and higher salaries, that the independent or owner-operator clinics simply cannot afford.
The clinic was originally designed to have four practitioners, but has been down to one or two at a time for years.
With the second physician leaving WMC in the spring of 2013, the Laurie facility approached the community for support. Various fundraising efforts produced money to recruit a new provider. The clinic saw a revolving door of physicians, attracting a couple of physicians who didn’t last long due to various reasons.
One of the doctors left to practice elsewhere, and another doctor hired subsequently only last a few months. Another physician also stayed for more than a year before leaving.
According to information provided by the clinic in May 2014, the two physicians were serving more than 4,000 patients.
A fundraiser in Sunrise Beach was held at that time in an effort to stabilize the practice in the face of flat physician reimbursements from the government for Medicare patients while personnel and other overhead costs continue to go up. The clinic was also the recipient of donations through the Community Foundation of Lake of the Ozarks.
Then, once again, only Derrington remained in practice at the clinic and has been working 10 hours days trying to keep up. The cost to recruit and pay a new physician the initial salary to get started became too much, even for a nurse practitioner, according to LaRock. And eventually, it became too much for Derrington to continue to bear the patient load himself.
While he attempted to work out a deal with one of the hospital, it wasn’t to be, and at age 73, he has instead decided to retire.
“I have been extremely privileged to have been able to have a career in medicine as a family practitioner both in my early years in the Navy and then in Kansas City for 20 years before moving to the Lake of the Ozarks for the last 21 years. It is hard to know where all the years have gone,” Derrington wrote. “Medicine is always a challenge and new knowledge and treatments are coming at an exponential rate. The face of medicine is changing.”
According to LaRock, Derrington had wanted to continue practicing, just not at the pace he has been maintaining.
This, while demand for health care is growing as our population ages and the American Association of Medical Colleges anticipates a growing doctor shortage nationwide, most notably in rural areas.
A report released in April 2016 from the AAMA projected a shortfall of physicians that would reach between 61,700 and 94,700 by 2025 with the shortage in primary care accounting for 14,900 to 35,600, excluding primary care-trained hospitalists.
With the notification, patients must begin looking for a new primary care provider. While there is another clinic in Laurie and others in the region, it may be difficult for them to absorb the number of patients, especially so many Medicare patients.
“They’re asking me, ‘where do we go?’ I wish I knew. I don’t have an answer. Health care is so needed on this side of the lake. A lot can’t even drive to Camdenton, let alone Osage Beach. They’re only choice is Laurie Clinic, and they’re short doctors too. It’s heartbreaking and it makes me want to throw up to tell you the truth,” said LaRock. “We’re encouraging them to look. Some have gone to Laurie Clinic, and that’s fine. I don’t care where, just that they get good care. D. Derrington is a fine physician and believed in offering the best care.”
With a scheduling backlog at other clinics in the area, LaRock said she is encouraging WMC patients to begin trying to get in as a new patients somewhere else, though WMC will continue to offer care until the last day. Their schedule is still full into July, she said.
And from Derrington: “I hope that some organization will see the need and viability for medical care in Laurie.”