VERO BEACH — More than 1,000 Medicare patients were impacted by a decision by a health maintenance organization this month to end its affiliation with a local clinic, which has offices in Indian River and St. Lucie counties.

Quality Health Plans, of Tampa, which is contracted to offer a Medicare Advantage Plan through the Centers for Medicare and Medicaid Services has terminated its contract with University Medical Clinics as of June 30.

The company “felt that this was necessary due to multitude of reasons; abrupt closures of UMC clinics thus affecting patient care and accessibility, UMC threatening patient abandonment, inability of UMC to maintain financial solvency,” according to an e-mail sent Monday from Quality Health Care.

According to the company, both the Florida Department of Insurance and the Center for Medicare and Medicaid Services “were made aware of the events” that led to the termination of the contract.

“We won’t respond to such allegations,” said University Medical Centers spokesman Joe Salenetri upon hearing QHP’s stated reasons for terminating the contract.

He said UMC has and will continue to do all it can in terms of providing quality patient care. Salenetri said he believes many patients will return to the clinic after the open enrollment period in November when Medicare patients can decide upon other plans.

“It’s unfortunate for the patients because we gave them good quality care here,” Vero Beach clinic office manager Barbara Castagna said.

QHP said a little more than 1,000 patients were impacted by the decision, with the majority being clients of the Vero Beach clinic at 3745 11th Circle. Salenetri estimated QHP patients represented about 50 percent of the 1,800 to 2,000 clients at the Vero Beach clinic.

He said the company’s smaller clinic on Port St. Lucie Boulevard near U.S. 1 won’t be as impacted because more clients there were with other insurance plans.

Clinics in Barefoot Bay and in Lakewood Park along the Turnpike Feeder Road in St. Lucie County were closed earlier reportedly because of air quality problems with the facilities, according to clinic officials. Salenetri said UMC plans to eventually re-open a clinic in that area.

“QHP wants every patient to know that we are here for them and will assist any patient to ensure that their care is not disrupted,” the company said in an e-mail. “We will work with the patient, their new primary care physician and if applicable their specialists and pharmacies to make sure that their care is not compromised.

Castagna said some of the physicians the clients are being sent to are sole providers, while there were four physicians providing care at the Vero Beach clinic. That number has been reduced to two physicians now.

Salenetri and Castagna said the governor and other political leaders were contacted about the situation. Salenetri said a petition containing 400 to 600 signatures of patients who wanted to stay with the clinic was presented to the Centers for Medicare and Medicaid Services to no avail.

University Medical Clinics earlier this year sought to obtain a contract to provide health care services for Vero Beach city employees. They were not recommended by the city staff, which resulted in strong criticism by Samuel Sadow, the president of the company. The chief operating officer of UMC is Jason Mankiewicz, who a couple of years ago worked in marketing for America’s Health Choice Medical Plan, a Vero Beach-based health maintenance organization whose contract with Medicare was terminated after inspectors found alleged deficiencies at the company and several clinics of Medical Resources LLC “a related entity.”

More than 1,000 local Medicare patients are being referred to new physicians after Quality Health Plans, a Tampa-based health maintenance organization, dropped its affiliation with University Medical Clinics.

QHP said each patient impacted by the decision should have received a letter notifying them of the change in their primary care physician effective as of July 1. If someone has not received a letter, would like to choose a different physician or needs to change prior to July 1, they can call QHP customer service at (866) 747-2700, between 8:30 a.m. and 5 p.m. Monday through Friday. TTY users dial (866) 455-6010.

By Ed Bierschenk

Tags: abandonment, application, beach, chief, contract, critical, Florida, Health, insurance, medical, pharmacy, physician, roads, Turnpike

This entry was posted on Tuesday, June 30th, 2009 at 9:51 am and is filed under Health, Indian River County, St. Lucie County, Stuart. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.