THE MISSISSIPPI LEGISLATURE

The Joint Committee on

Performance Evaluation and Expenditure Review

Report # 493

A Review of the Medical Clinics at Mississippi’s Universities and Community and Junior Colleges

Executive Summary

Introduction

In response to an anonymous complaint, the PEER Committee reviewed the operation of medical clinics at Mississippi’s public universities and community and junior colleges. PEER sought to determine:

• what services the clinics provide;
• the capacity of each clinic to provide services;
• who has access to each clinic;
• how each clinic is monitored;
• how each clinic is funded; and,
• how efficiently the clinics operate relative to each another.

Background

No state laws require or regulate medical clinics at Mississippi’s public universities or community and junior colleges.

The Board of Trustees of Institutions of Higher Learning (IHL) has only two policies relating to the medical clinics at the state’s public universities. The first of these policies notes that individual university administrations are responsible for their campus medical clinics. The second policy requires the universities to establish and charge a rate to the university’s medical clinic for facility costs (e.g., utilities and maintenance) and account for these costs separately as an auxiliary of the university.

The State Board for Community and Junior Colleges does not have any policies requiring or regulating medical clinics at community and junior colleges.

Conclusions Regarding University Medical Clinics

Because no central IHL policy addresses funding method or services to be provided by university medical clinics, PEER found a wide range of costs and levels of service at the university medical clinics. FY 2005 costs to university funds per clinic visit ranged from $25.75 at UMMC to $329.82 at MVSU. The level of service at university medical clinics varied from solely nurse-provided health care at MUW to clinics with physical therapy centers (MSU, UMMC, and UM).

Mississippi has eight public universities located throughout the state. Each of the main campuses of these universities, as well as the University of Mississippi Medical Center, operates a medical clinic.

Services, Capacity, and Usage of University Medical Clinics

PEER found that all of the Mississippi universities’ medical clinics offered at least the following services:

• consultation with a physician (except at the Mississippi University for Women, which provides a nurse practitioner) with no additional fee charged at the time of the service. USM charges $5 at the time of service to students for consultation with a physician;
• visit with a nurse with no additional fee at the time of service; and,
• access to laboratory services for a fee.

Some of the clinics provide services beyond this minimum level, such as access to a pharmacy, mental health counseling, an infirmary (i.e., facilities for overnight stay and monitoring), or physical therapy. Usually these services involve charging a fee to the patient, although UMMC, ASU, and MVSU do not charge fees for any of the services of their clinics1. Universities offering these additional services are:

• Pharmacy: USM and MSU clinics operate pharmacies on a for-profit basis. UM provides prescription medications to university clinic patients through the School of Pharmacy. The UMMC medical complex operates a pharmacy. DSU and JSU clinics fill prescriptions for acute illnesses.
• Counseling: USM, MSU, UM, DSU, and MUW. Although this is a free service to students, the counseling centers are operated independently of the medical clinics. JSU and UMMC offer free access to counseling through the St. Dominic Hospital.
• Infirmary: DSU, ASU, and JSU.
• Physical therapy: MSU and UM. The UMMC medical complex operates a physical therapy department.

None of the university medical clinics has trauma care.

Because such a diversity of services is offered, PEER could not compare directly the effectiveness and efficiency of each university medical clinic’s staff. In order to compare directly the clinics’ service effectiveness and efficiency, more detailed information about visits for each service offered and dedication of staff time to each function would be necessary. Currently, this information is not available for all universities.

Concerning staffing of university medical clinics, overall, Mississippi’s universities utilize approximately sixteen full-time-equivalent physicians and forty-nine full-time-equivalent nurses.

In terms of students’ use of the clinics, MSU had the highest usage in academic year 2005, with the average student visiting the clinic 2.5 times that year. MVSU had the lowest average student usage, with fewer than half of the students using the clinic that year. Overall, since academic year 2002, student usage of university medical clinics system-wide has decreased by 5%. MSU accounts for much of the usage, and when the system-wide use is considered without MSU, university medical clinics have experienced a 10% system-wide decrease in student usage.

University Subsidies for Faculty and Staff’s Use of Medical Clinics

In addition to providing services to students, all Mississippi universities also allow faculty and staff to receive care at the medical clinics. Most of the university medical clinics provide free physician visits for faculty and staff. USM and MSU clinics allow faculty and staff to receive clinic services on a fee-for-service basis. DSU and MUW allow faculty and staff to receive care from a nurse practitioner, rather than a physician.

As many as one in four visits to the university medical clinics in FY 2005 were from faculty and staff of the universities. At some universities, such as ASU and MUW, faculty and staff usage rates for the university medical clinics are higher than student usage rates. In FY 2005, universities spent $770,730 to subsidize faculty and staff visits to the medical clinics. This represents money that universities could have spent for additional clinic staff, expanded medical services for students, or for academic purposes.

Cost of Operations and Funding of University Medical Clinics

Mississippi’s universities spent approximately $10.1 million on university medical clinics in FY 2005. Of this amount, approximately $6.6 million was from university funds2. Seventy-seven percent of the expenditures for university medical clinics were for clinics at USM, MSU, and UM, which represented 67% of the state university system’s enrollment for that fiscal year.

In calculating the total costs at university medical clinics, PEER noted that IHL policy requires that each university establish and charge a rate to the clinic for facility costs (e.g., utilities and maintenance) and that these costs be accounted for separately as an auxiliary of the university. PEER found that three of the university medical clinics (MVSU, JSU, and UMMC) do not account separately for their clinics’ facility costs, as required by IHL policy, thus costs are not truly comparable between university medical clinics.

Funding of University Medical Clinics

For the university system as a whole, PEER found that reliance on universities’ use of university funds to operate university medical clinics decreased by 8% from FY 2002 to FY 2005. As reliance on university funds has decreased, reliance on fees charged to users of the clinics has increased. From FY 2002 to FY 2005, fees for service increased 19%.

Effect of University Medical Clinic Costs on Satellite Campus Students

Most of the state’s universities operate satellite campuses that do not have medical clinics. The students at satellite campuses pay the same tuition and general fees as do the students on the main campuses. Although a percentage of the tuition and general fees that they pay is used to help fund the university medical clinics, students who attend satellite campuses do not have reasonable access to use of the medical facilities as do students on the main campuses. Therefore, these students at satellite campuses are paying for a service that they cannot readily use and are in effect subsidizing the clinic for students at the main campus.

Operational Philosophies and Effects on Clinic Operation

Operational philosophies for university medical clinics range from heavy subsidizing by the university to entrepreneurial operations that rely extensively on fees for services. Because student usage of medical clinics has declined at most campuses other than MSU, universities may need to re-evaluate their operational philosophies and entertain questions about the clinics’ role in accomplishing the universities’ mission in view of societal changes.

Issues to Consider in Making Choices Regarding Future Operations of University Medical Clinics

Student enrollment has increased faster than student usage of university clinics. Since FY 2002, student enrollment has increased by 11%, while the student usage rate (student enrollment divided by the number of clinic visits) of university medical clinics has decreased by 5%. In view of this fact, universities may wish to re-evaluate their clinics and determine whether to continue their current operational philosophies or whether to move more toward one end of the continuum or the other (i.e., university subsidized versus enterprise).

Ultimately, the university administrations should consider the demographics of their student populations, societal changes, and how the clinics help to accomplish the mission of the universities in making decisions about their medical clinics. In the past, a university often served as a surrogate parent and provided necessary medical care. However, a dramatic shift in the delivery of medical services has occurred and raises the question of whether the need for university-sponsored medical care will continue to be necessary.

Conclusions Regarding Medical Clinics at Community and Junior Colleges

The State Board for Community and Junior Colleges does not have policies requiring or regulating medical clinics. Nurses provide all health care services and usage rates are lower than those of many of the university clinics. The community and junior colleges spent $252,294 on their medical clinics in FY 2005.

Mississippi’s public community and junior college system has fifteen colleges. Five of these operate medical clinics:

• Pearl River Community College;
• Jones County Junior College;
• East Central Community College;
• Coahoma Community College; and,
• Copiah-Lincoln Community College.

East Mississippi Community College does not operate a clinic, but has an agreement with a local health clinic for student medical care.

Unlike the universities, none of the community and junior college clinics provides a physician for students on campus. Registered nurses and licensed practical nurses, who cannot prescribe pharmaceuticals, carry out the majority of health care services in these community and junior college clinics.

For FY 2005, on average, 37% of students visited the medical clinic at each college. The system-wide cost to operate these clinics was $22.63 per visit.

Recommendations

1. The Board of Trustees of Institutions of Higher Learning should create a policy to require all faculty and staff at public universities to pay a market rate to receive services at university medical clinics unless a visit is required as a condition of employment.
2. Each community and junior college should create a policy to require all faculty and staff to pay a market rate for services received at a community or junior college medical clinic unless a visit is required as a condition of employment.
3. The Board of Trustees of Institutions of Higher Learning should amend its policy to show the costs of fees, such as health care fees, charged to students. Students at satellite campuses who do not have reasonable access to student health services should not be required to pay the effective fee to operate a university medical clinic.
4. IHL should alter its policy and bylaws 901.04 to require clinics to capture information relevant to managerial analysis of the medical clinics. This should include records of visits by type of service provided and to determine the reasonable allocation of costs and revenue associated with each activity operated by the clinic.

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1 Throughout this report, PEER uses the traditional acronyms to represent the names of the universities: ASU=Alcorn State University, DSU=Delta State University, JSU=Jackson State University, MSU=Mississippi State University, MUW=Mississippi University for Women, MVSU=Mississippi Valley State University, UM=University of Mississippi, UMMC=University of Mississippi Medical Center, and USM=University of Southern Mississippi.

2 University funds used to cover operational costs of a university’s medical clinic are composed mainly of revenue from tuition and general fees and could also possibly include general funds appropriated by the Legislature to the university, foundation funds, and other revenue sources.

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