The Emily Program, one of the nation’s largest eating-disorder practices, is dropping as many as 250 patients as it shifts toward a more intensive treatment model for people with severe or life-threatening conditions.

The for-profit program, based in St. Paul with clinics in Minnesota, Ohio, Pennsylvania and Washington, will stop providing outpatient therapy for many patients who have eating disorders but whose primary diagnosis is a mental illness, such as anxiety or depression.

The move means that about 250 patients, including 100 to 150 in Minnesota, will be dropped from treatment starting in January 2018, officials with the Emily Program said.

The program currently provides inpatient and outpatient therapy to about 3,000 people in Minnesota.

Chief Strategy Officer Jillian Lampert said the shift will enable the firm to focus on patients with acute eating disorders who are engaging in extreme, self-harming behaviors. That includes people who may be dieting or “purging” themselves to the point where they are severely malnourished, as well as those who are endangering themselves through excessive eating or repetitive bingeing.

The shift could be a financial boost for the private owners of the Emily Program. That’s because acute-level care, including residential treatment, generally requires more billable hours, and the reimbursement rates for intensive treatment are more lucrative, say providers. But Lampert said the Emily Program’s decision was motivated by patient needs, not business concerns.

“We’re finding that people coming into our programs have higher acuity levels and more intensive symptoms than in the past,” she said. “They are extraordinarily ill and we want to better meet their needs.”

Still, the decision stunned and angered some long-standing clients, who just received word that their care will be discontinued next year. Some patients expressed concern about going without mental health care, and said they doubted whether they could find specialized therapists outside the Emily Program who understand the complex nature of eating disorders.

Nancy Grace Norman of St. Paul said she broke down in tears when her longtime therapist at the Emily Program told her that she was being discharged in January.

“I was devastated,” said Norman, who had been seeing the same therapist for six years. “I’m being terminated from a program that has been vitally important to maintaining my mental health. It’s like I’m starting all over again.”

ER visits

Other patients raised concerns that, without regular access to outpatient therapy, they would end up at hospital emergency rooms. Only a handful of Twin Cities-area clinics provide specialty treatment for eating disorders, but waits for admission into these programs can be months, patients said.

Vinita Dalgleish, 29, a former Emily Program client and a law student at the University of Minnesota, said the consequences of being dropped from treatment can be “life-threatening.”

Last spring, Dalgleish said, she nearly starved herself to death after a clinic suddenly terminated her regular outpatient therapy for a severe eating disorder, which she’s had since childhood.

Dalgleish said she spent months searching for a new therapist, while struggling to control her anxiety and depression. She checked herself into a hospital emergency room at least a dozen times because of severe dehydration and lack of nutrition; and passed out several times on the floor of her apartment in Minneapolis’ Uptown neighborhood.

“It’s hard when you invest all this time and effort into therapy and then you’re just dropped all of a sudden, like you don’t matter,” Dalgleish said. “It feels like you’re just thrown out with the trash.”

Lampert said clinicians at the Emily Program will “do all they can” to help affected patients transfer to other providers over the next month. Many of the patients being discontinued from care have complex mental health problems and histories of trauma, which can be treated by psychotherapists instead of eating disorder specialists, she said.

Patients can still return to the Emily Program if dangerous eating patterns resurface or if they need high-level, clinical care, Lampert added.

The Emily Program was founded in 1993 by a psychologist, Dr. Dirk Miller, who named it after his sister, Emily, who recovered from an eating disorder.

The program mushroomed in size as public and private insurance programs expanded their coverage of eating disorder treatment.

In 2002, the program opened the Anna Westin House, the first residential facility for treating eating disorders in the nation. The Emily Program now operates four residential centers and 10 outpatient clinics that treat about 5,000 clients in four states.

The Emily Program is partly owned by TT Capital Partners, an Edina investment firm that seeks to buy health care companies with “the potential for rapid expansion,” according to its website.

In recent years, private equity firms and other for-profit companies acquired eating disorder clinics because of the growing visibility of eating disorders and expanded insurance coverage.

 

Twitter: @chrisseres