Dislocated health care

Hennepin County’s Lake Street clinic handles 75,000 visits – with work stations in hallways. That’s before upcoming budget cuts.

The Hennepin County Family Medical Center has set up work stations and patient waiting areas in hallways, moved staff lockers into bathrooms, converted a closet into a baby weigh-in station and put up to five doctors to an office.

The Southwest medical center, 5 W. Lake St., is part of the Hennepin County Medical Center (HCMC). It handles more than 55,000 medical visits a year – for primary, urgent and specialty care – plus 20,000 visits for Women, Infants and Children, a nutrition program, said Marie Maes-Voreis, clinic administrator.

“I have been here six years. We have used every space,” Maes-Voreis said.

The center has run out of space to grow at a time when its service demands are increasing 5 to 15 percent a year, and when the state is poised to cut health care programs, perhaps decreasing revenue by double-digits.

At one point, the medical center eyed space in the old Sears building at Lake and Chicago avenues. More recently it had talked to Sherman Associates about space in the Nicollet and Lake redevelopment, as part of the reopening of Nicollet Avenue.

The current medical center has 23,000 square feet, Maes-Voreis said.

The new site would have had 50,000 square feet, at a minimum. Sherman’s drawings inked in the clinic at Nicollet and Lake’s northeast corner.

Some city leaders opposed putting a clinic on a prime retail corner. The city did not renew Sherman’s exclusive development rights and plans are, at best, in limbo.

The medical center’s space problems remain. Parking is one small example. The center has 200 employees and serves roughly 200 patients a day. It has 40 parking spots.

“We are going to continue planning related to what our needs are going to be, regardless of the budget cuts and regardless of what is happening with a particular development,” Maes-Voreis said. “We are fighting to stay in this neighborhood.”

Demand swells

The medical center’s mission is twofold: it is a teaching facility and a safety net for a vulnerable population, said Chris Wolohan, HCMC administrator.

The Lake Street center has 80 health care providers, including 39 residents, most in family practice. Government health care programs, such as Medical Assistance, cover 60 percent of its clients; only 20 percent have private insurance, Maes-Voreis said. The remaining patients either pay out of pocket or simply can’t pay, leaving the county with the bill.

HCMC staff said proposed state health care cuts would increase the number of uninsured and increase the demand for safety-net services like the Lake Street clinic provides.

It opened in 1986 and has grown over the years. It added an urgent care service three to four years ago, converting an old lobby space, Maes-Voreis said. It added an on-site pharmacy last year. It has added evening hours – then added more staff to help on evening hours.

The medical center generally serves people living in south Minneapolis between Lyndale and Chicago avenues, Maes-Voreis said. It serves a large Hispanic and immigrant community. The center has seven to eight interpreters on duty at any given time, and 25 to 35 staff members are bilingual.

The center serves a large number of women and children. It has roughly 600 prenatal patients a year, she said.

It can no longer serve demand from new patients looking for a primary care provider, Wolohan said.

“People call and want an appointment and we can’t accommodate them,” she said. “We aren’t envisioning we can do a whole lot more on the current site.”

The county has another clinic at the Hub Shopping Center at Nicollet Avenue and 66th Street that is under capacity, Maes-Voreis said. It is merging the two operations and encouraging patients to go there.

State health care funding presents a big unknown in the medical center’s plans. They would affect HCMC’s hospital and clinics.

HCMC has already cut $10 million, or roughly 2 percent, of its $418 million budget due to state unallotments – cuts made in the current budget to balance the books, said Tom Hayes, HCMC spokesman.

HCMC anticipates cutting an additional $25 million in 2004 and $35 million in 2005 if the legislature passes Pawlenty’s proposals – reducing its funding 14 percent below 2002 levels.

The Lake Street family medical center will soon feel the unallotments. The county will close its WIC program June 27, Maes-Voreis said. WIC provides nutrition education and food vouchers.

Eliminating WIC won’t free up much space at the Lake Street clinic. WIC has used two modest offices – two cubicles each – to handle its 20,000 annual visits.

A tight fit

Maes-Voreis gave a tour of the medical center, showing space-saving initiatives, such as having three to four doctors share an office.

The information technology analyst, physician scheduler, patient education coordinator and quality improvement nurse all share an office. It was formerly the locker room. Staff moved the lockers into three of the bathrooms and the copy machine room.

The patient files are mounted on sliding rails, using space more efficiently. “We got a variance from the Fire Marshall to have the charts as close to the ceiling as possible,” Maes-Voreis said.

The medical center has no storage dock. When supplies arrive, the boxes get stacked in the hallway, and staff moves them to the storage room when they have time, she said. The storage room, roughly 100 to 150 square feet, is small for the facility. Staff orders supplies once or twice a week to reduce shelf-space demand.

Five sports medicine doctors share an office next to the storage room – their cabinet space has been commandeered to store supplies.

The 220-square-foot pharmacy fills 250 prescriptions a day, said pharmacist Kim Barth. There are five people working at any one time. “There is not much room to do any teaching,” she said.

The center has three treatment rooms, for “lump-and-bump” removals, gynecological exams and putting on and removing casts, Maes-Voreis said. The rooms double as equipment storage areas. In one room, a treadmill used for a stress test and computer equipment used for the colon camera crowded the exam table; a cast saw lay on the floor.

The center’s halls are more than passageways. Wall-mounted flip-down charts provide mini-workstations. Patient education materials are stored in hall files.

Some patients sit in the hall waiting for lab results or x-rays – another arrangement that required the Fire Marshall’s variance. The waiting room those patients used to use now provides space for physical therapy, family therapy, alternative medicine and other patient services.

Staff set up a check-in station in the hallway, to check vital signs and vision. Staff converted a hall closet to a baby weigh-in station.

“We wanted to keep it warm and out of the main hallway,” Maes-Voreis said.