Amistad’s CEO retires, leaves legacy of keeping affordable clinic afloat

March 04--CORPUS CHRISTI -- On paper, Amistad Community Health Clinic appeared financially sound when Eddy Herrera took over as CEO in 2009.

But weeks into his new job, Herrera discovered the federally qualified health clinic -- which had taken years to develop and open -- was in serious trouble.

At Herrera's second board meeting, members contemplated bankruptcy.

Instead, Herrera piloted a transformation to haul the clinic from financial collapse with a series of unpopular but necessary decisions to keep the clinic's doors open.

When Herrera retired last week, he left behind a more stable, affordable clinic with nearly twice as many patients as when he took over, solidifying Amistad's reputation as a reliable source of primary care for some of the region's poorest patients at a time when such treatment for uninsured and Medicaid patients is becoming scarcer.

But new tests await Amistad with the rollout of the Affordable Care Act, which is covering fewer people than anticipated in a state that rejected Medicaid expansion. Newly hired CEO Joe Flores will be charged with navigating the clinic through this new era of health care reform.

When Amistad opened in April 2008, Corpus Christi was the last large Texas city to get a federally qualified health center, a clinic partially funded by the federal government to provide preventive care to the uninsured.

The clinic at 1533 Brownlee Blvd. opened with much fanfare, offering dental and behavioral health services as well as primary care. But as a steady stream of uninsured patients flowed through the doors, Amistad started to gain the reputation of a free clinic.

When Herrera took the reins about a year after Amistad opened, he discovered that while the clinic was seeing patients covered by Medicaid and Medicare, it didn't have the proper government contracts in place. As such, Amistad wasn't getting reimbursed for those patients. The clinic was close to not having enough money for payroll taxes.

Under Herrera's tenure, Amistad slashed its dental and behavioral health services and laid off staff. The clinic hiked its fee to $25 per visit for self-pay patients and started seeking Medicaid and Medicare patients to better balance its revenue stream. To reverse Amistad's reputation as a free clinic, Herrera set a goal: At least 30 percent of patients should have Medicaid, he decided.

Once Amistad stabilized, it began to grow.

A pediatrician was hired, further boosting the clinic's Medicaid population. A section of the clinic was remodeled using stimulus money and community development block grant funds to create pediatric exam rooms and a special waiting room for sick children. And the clinic has submitted paperwork to become a patient-centered medical home, a designation given to practices that provide intensive preventive care focused on patients.

In 2012 the clinic saw a record number of patient visits -- 14,577 -- but that number dropped to 11,822 last year because the clinic's doctors left for jobs elsewhere, forcing Amistad to use temporary doctors and cut back on patient visits until the clinic could hire new providers.

The clinic plans to expand its primary care capacity this year under a partnership with Corpus Christi Medical Center, which is working on a plan to use Medicaid transformation money to hire new family practice doctors for Amistad. The clinic has applied for federal grants to bring back behavioral health services.

Last year 58 percent of patients treated at the clinic were uninsured, and 28 percent had Medicaid, a healthy mix but not quite as diverse as Herrera would like.

But with the deadline approaching to sign up for health insurance or face a penalty, Flores said he expects to see the clinic's uninsured population increase.

That's because Amistad got grant money to hire two certified application counselors to help people sign up for insurance through the exchanges, one of two federally funded Affordable Care Act outreach efforts in Corpus Christi.

Those counselors are discovering that in Texas, many people are falling in a coverage gap where they are not eligible for Medicaid or Medicare, but they make too little to qualify for subsidies to buy health insurance. Flores' challenge will be maintaining a diverse mix of patients -- including the newly insured -- to keep the clinic in good financial shape.

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