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The state employee health clinic in Miles City closed Friday, after efforts to boost the number of patients failed, making its continued operation financially unfeasible.

Clinics in Helena, Billings, Missoula, Butte and Anaconda remain in operation. The Miles City clinic opened in 2013.

“The center was opened originally to try to serve people in the eastern side of the state a little bit better,” Marilyn Bartlett, director administrator of the state’s Health Care Benefits Division, said by telephone Thursday. “We could never reach utilization targets.”

For a clinic to remain financially healthy, at least 85 percent of available appointments must be used, “and we were never able to reach that point with Miles City,” she said.

Citing numbers, Bartlett said 48 20-minute appointment slots were open per week at the clinic. But, on average, the clinic averaged only 14 visits a week.

A number of different strategies were employed to boost user numbers, which is open two days a week, Bartlett said. The clinic changed providers, revised its operation hours, sought to get the word out to employees about the available services and opened it up to a couple of other employee groups, to no avail.

The clinic also had a difficult time recruiting part-time staff. It employed a nurse and two physicians, each doctor working one day a week, and one of the two physicians recently left to work at the community health center in town.

Among the state employee clinics, the Miles City one has also been the most expensive to run per appointment, even though the cost has come down since it opened. In 2013, the cost was $130.68 per appointment before it jumped to $188.89 in 2014, then dropped slightly to $180.27 in 2015.

It dropped again in 2016, to $134.86. But even that amount was more expensive than Butte, which in 2016, totaled $72.68 per appointment, and Helena, which came in at $90.85 per appointment. A major factor in bringing that figure down, Bartlett said, is usage.

The break-even point for onsite health clinics tends to be a user-base of around 500 people, she said. The number of employees in the geographic area linked to the Miles City clinic is 484.

Bartlett contrasted that with 1,744 patients in the Butte area and 5,839 in Helena. A majority of people who use the Miles City clinic live in Miles City and Glendive, with fewer coming from Forsyth and Baker and other surrounding towns.

Another factor that came into play, Bartlett said, is with three other health clinics in Miles City, the wait time to access primary care is not as difficult as it is in Helena and Butte. Since the Helena clinic opened in 2012 and Butte in 2014, both have seen usage levels remain above 90 percent.

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Bartlett acknowledged dismay among employees affected by the closure.

“We’re very sympathetic,” she said. “It’s never an easy decision when you give benefits some find valuable and you have to take them back.”

But the bottom line is making the best use of available resources. For the most part, Bartlett said, employees have understood that with the Legislature holding a special session to deal with a shortage of funds, the decision "boils down to cost."

It also meshed with a recommendation from the Legislature’s Audit Division in a report released in June for officials to consider whether the Miles City clinic should be closed.

Care Here, the contractor who runs all the state employee health clinics, notified patients of the impending closure on Nov. 10 and then told all employees on Nov. 16. It has been working with its Miles City patients to help them transition to other primary care providers.

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General Assignment and Health Care Reporter

General assignment and healthcare reporter at The Billings Gazette.