Total Health Care, a 45-year-old network of medical clinics that treats tens of thousands of poor people in Baltimore, is in financial trouble, according to an employee.
"Numerous employ[ees] are reporting missing contributions to their retirement accounts, employees not getting reimbursed for expenses incurred at the job and the pharmacies at Total Health not being able to stock common medications for patients," a person who works there, who asked to remain anonymous, told City Paper. "HR says nothing and questions regarding staff's money goes [sic] unanswered."
(In a late-Friday email to City Paper, Total Health CEO Faye Royale-Larkins acknowledges most of the employee’s concerns, but says the issue with the retirement payments has been corrected.)
One of several nonprofit companies providing basic health care to the city's underserved and uninsured, Total Health expanded recently to cover the gap left when People's Community Health Center closed its doors suddenly in the summer of 2014, becoming the fifth-largest Baltimore-area bankruptcy in 2015, by the BBJ's reckoning. Total Health has 10 locations. It merged with Tuerk House, the west-side addiction treatment center, last July.
Total Health Care is a Federally Qualified Health Center, a medical provider that receives federal grants to care for the uninsured. In 2013, those grants totaled $5.8 million of its $43 million in revenue, according to the company's publicly available IRS filing.
"A lot of expansion was occurring in the past two years and now basic supplies like paper can't be ordered," the anonymous employee says. "The medical director just announced she is leaving, along with numerous other staff." The employee says services are being cut back, hours of the sites have reduced, and two dental departments closed down in the last few months.
City Paper asked Total Health CEO Faye Royale-Larkins to comment for two days. She returned the call at noon today but declined to answer City Paper's questions. "I want to tell you . . . in terms of people leaving, like Dr. Kirk [the medical director] I want to be specific," she said, promising to email a statement later that would answer them all.
Two hours later she emailed this statement:
"Due to changes in the health care marketplace, like many health care companies, Total Health Care Inc. is making changes to its operations and services offerings.
"That said, Total Health Care Inc. is committed to taking the necessary action needed to meet the current realities.
"Moving forward, we are confident that we will be able to address these challenges and continue our mission of providing quality medical care to the patients we serve throughout Baltimore City and Anne Arundel County."
City Paper reiterated its specific questions, and Larkins promised to respond. We will update this story when she does.
(Update: True to her word, Larkins sent more detailed answers to City Paper's questions just before 6 p.m. on February 12. "As I mentioned in order to meet our current realities, Total Health Care is making changes to its operations and service offerings," she wrote. Here are the questions and answers, verbatim:
1. Is THC up to date on paying its pension obligations for all employees. Yes or no? If not, please explain why and what your next steps are.
A: Yes, we are up to date.
2. Did you or your staff send an email several days ago regarding these missing deductions, and promising to repay or make these good?
A: Yes and the issue has been corrected.
3. What specific cuts—in hours, services and/or personnel—has THC undertaken over the past six months? Were the dental clinics at Kirk avenue and the open gates shut down as of the new year? Were several staff let go then?
A: Total Health Care reduced hours at Union Memorial, Odenton, Mondawmin, Men’s Health, and Division. We eliminated 2 out of 9 clinic managers. Total Health Care closed two out of the three of our dental clinics: one at Open Gates and one at Kirk Ave. We expanded our OB/GYN services at Division and Mondawmin. We also expanded our Infectious Disease service.
4. Have clerical staff been cut since last summer? When, and how many?
A: Four clerical positions have been eliminated since July 2015.
5. Were site hours cut in November?
A: Hours were reduced in November at some of our sites.
6. Was there as Saturday "Sick Clinic" on Division Street that was cut?
7. What are specific "changes in the healthcare marketplace" that has affected THC since 2015?
A: As part of health care reform, THC is increasingly focused on providing quality care in a cost effective setting. We cannot afford to continue to operate as a “free clinic.” In addition, there have been changes in reimbursement.
8. What is THC's current status regarding the HRSA? Is there an audit pending? If so, what are the results so far, and when is the audit due for completion?
A: Our status with HRSA has not changed over the years. HRSA has scheduled a routine site visit for the end of February.
9. Is your medical director, Dr. Arethusa Kirk, leaving? Will you share her contact so I can talk to her?
A: Dr. Kirk who is Vice President of Medical Affairs has accepted a new position with a managed care organization.
10. Have any other staff made it known to you that they are also leaving? If yes, how many, and how many of those do you foresee replacing?
A: We have not been notified by any other staff that they intend to leave.)
Martin Kramer, spokesman for the Health Resources and Service Administration, which oversees the federal grant money given to Total Health and similar companies, says his agency offers technical assistance to its grantees and monitors them to make sure they are meeting program requirements. He says he can't speak specifically to the situation at Total Health, but "I can tell you as of now there are no conditions on their grant."
Kramer says that, in general, the health insurance reform known as ObamaCare has improved the prospects for companies like Total Health Care. “Generally Obamacare brings more insured patients to the health centers, which should help them stretch their resources,” he says.