Health

Local service agencies still feel sting of weather-related school closures

Despite lower reimbursements, Tanager Place in-school services will see no impact, say officials

Tonya Hotchkin

Tanager Place
Tonya Hotchkin Tanager Place

CEDAR RAPIDS — With Corridor schools delaying or canceling classes all together due to weather in recent weeks, school-based service agencies and other child health care providers say their patient volumes and hours with students this winter have taken a dive.

And for one provider, its affecting the bottom line.

“Any time there’s no school, then therapists aren’t able to see kids, which means we aren’t able to bill, which means we’re not able to get reimbursed for the services we provide,” explained Tonya Hotchkin, Tanager Place director of clinical care.

However, Tanager Place officials have made it clear that a rough budget year won’t have a long-term effect on the services they provide in area schools.

“For us, we are just so dedicated to the mission of having kids getting easy access to services and meeting their health needs, I don’t think we’d ever reduce or shut down,” Hotchkin said.

Tanager Place, the Cedar Rapids children’s mental health provider, has a school-based program to offer behavioral and mental health services to students in Corridor schools.

Twenty-one therapists work with more than 300 students each year and are based in the schools full time, performing preventive measures, training, consultations and leading parent education, among other services.

Therapists are based in 33 schools across five districts — Cedar Rapids Community School District, College Community School District, Mount Vernon School District and Marion Independent School District as well as one school in Johnson County, Faith Academy.

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“Primarily, we go into schools because there’s free and reduced lunch and because kids can’t access services outside of that school environment for a multitude of reasons,” Hotchkin said.

The Cedar Rapids district delayed or canceled classes more than a dozen times between Jan. 13 and March 14, which meant Tanager’s in-school therapists were not providing services for those days.

Hotchkin said they haven’t seen this level of missed days since the 2016-17 school year, when the 2016 flood caused a week’s worth of missed school days on top of snow days the following winter.

Behavioral health services are paid on a cost-per-service model for insurance companies, including Medicaid, which covers the majority of students in the program. That means, if there’s no service, there’s no reimbursement.

“When you’re in a school setting, you can really only operate and provide those services during the school days and school hours,” Hotchkin said. “So there’s not much you do besides adjust your budgets accordingly.”

Low patient volumes due to weather have also been felt by Cedar Rapids outpatient providers.

“MercyCare family practice and Urgent Care clinics did experience a higher number of patient appointment cancellations and disruptions on days when the extreme weather conditions forced the closure of Cedar Rapids schools,” said Dr. Tim Quinn, Mercy Medical Center executive vice president and chief of clinical operations.

Quinn said in an email that January and February cancellation rates were up about 11 percent compared to the three previous years. However, he added most of those appointments were rescheduled and the clinics saw an increased patient volume toward the end of February.

Witwer Children’s Therapy Center, a part of UnityPoint Health-Cedar Rapids, experiences low patient volume “any time there’s a school closure,” said Jessica Mackey, business manager for the center.

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Witwer offers developmental, occupational and physical therapy, among other services, for children up to the age of 21. Many of its patients are pulled from classes for their appointments, so there tends to be a lot of correlation between low patient visits and bad weather.

“If the schools are out, parents or caregivers aren’t likely to travel,” Mackey said. “It happens a lot with any service.”

Therefore, Witwer typically closes when the schools close. But school has been closed so often this winter, the clinic has opted instead to stay open during the later part of the winter, Mackey said.

“We stayed open here the last few school closures,” she said. “We did have kids come, but not as many as we had scheduled for.”

Witwer’s reimbursement hasn’t been a major concern, as the center has the support of the UnityPoint hospital behind them.

In addition, Mackey said the staff likely will see those patients make up missed appointments into the spring and summer.

“When the weather gets better, we will certainly ramp up,” Mackey said. “Volumes will go through the roof in the summer.”

But Tanager Place does not have the same opportunity to make up sessions with Cedar Rapids students.

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State law requires a minimum of 1,080 hours, or 180 school days, per school years. As Iowa Code mandates class times by law, not by day, school administrators can make up those hours by adding extra minutes in the afternoons.

However, this model can present a challenge to Tanager’s model, which measures student access per day.

Hotchkin, the clinical care director there, said if a school cancels as many as 11 days but can fit those hours within three days, that’s less guarantee students have access to a therapist in school.

But Hotchkin said Tanager Place therapists intend to take this year in stride, hoping “it’s an anomaly and that it doesn’t happen again.

“It does inflect on the question of, if this does happen in the future, what are areas we have wiggle room? Does that mean that therapist for the rest of the year have to bill a little extra to make up for those missed days? You kind of weigh all of those,” she said.

• Comments: (319) 368-8536; michaela.ramm@thegazette.com

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