HHS Grants $727 Million To Community Health Centers

Photo by ell brown via flickr

The Patient Protection and Affordable Care Act (PPACA) continues to make headlines.  Recently the Department of Health and Human Services (HHS) awarded $727 million for construction and renovation projects at 143 community health centers across the country.  HHS Secretary Kathleen Sebelius noted that

[t]here is no question that the economic downturn has made it harder for some Americans to get health care and important preventive services.  Community Health Centers provide quality healthcare services to Americans across the country but are a life line for those who have lost coverage or are between jobs.  These funds from the Affordable Care Act will help get more people care in some communities where there have not been many options in the past.  The newly constructed or expanded community health centers will provide care to an additional 745,000 patients and much needed employment opportunities in both rural and urban underserved communities.

According to the National Association of Community Health Centers, there are approximately 1,200 centers across the country.  They provide care for 20 million patients.  Seventy-one per cent of these patients have family incomes at or below the poverty line while 38% are uninsured and 36% are on Medicaid.

Over the next five years, PPACA will provide $11 billion in grants to fund the construction, operation, and expansion of community health centers.  These grants come at the right time as Mary K. Wakefield, Administrator of HHS’ Health Resources and Services Administration, observes how

[m]any of these community health centers need more modern space to meet the increasing patient demand for services. These funds will help community health centers build new facilities and modernize their current sites in their continuing effort to provide the best care possible to more and more people in need.

The PPACA funding is in addition to the $2 billion allotted for health centers under the American Recovery and Reinvestment Act of 2009 (ARRA).  ARRA provided health centers with $500 million to expand services to new patients and $1.5 billion to support facility construction and renovation as well as equipment acquisition.  (Click here to see a list of grantees receiving ARRA funding.)

Clinics and the Weight of the Wait

The Hourglass, Evelyn de Morgan (1850-1919)

In a post yesterday from Professor John V. Jacobi, he pointed out that “Uninsurance kills people, and extending coverage to all is critical.” A recent AP article, “Free Clinics Hit with More Patients, Less Funding ” is worth a quick read:

Like countless others stripped of health insurance because of the recession, Anderson and his family were forced to turn to a free health clinic. In all, about 4 million Americans are expected to visit the nation’s 1,200 free health clinics this year - a surge that comes as clinics face a drop-off in financial support.

“Over the last year, free clinics have seen patient load increase by 40 to 50 percent,” said Nicole D. Lamoureux, executive director of the National Association of Free Clinics. “People who just last year had health coverage are now out of work and need to have their health care needs met.”

And there is perhaps one aspect of the situation which the article does not address that is worth noting. With increase in volume and decrease in resources, wait times must mount. Wait time for the working poor can be onerous. Obviously, a long wait is a long wait for anyone, but if one is out of work the time element is not as pressing as it would be for one who is employed.

I had occasion recently to accompany someone to what will remain an unnamed sliding scale clinic in Elizabeth, N.J. She lacked transportation. The place was mobbed and although we had a 12 noon appointment, it took a full 3 and a half hours and then some to make it out of the waiting room,  and then another 45 minutes to an hour to be seen, examined and treated by a doctor. After paying the bill, I was lucky to get my companion to her  poorly paid no benefits job on time at 5pm. That job, difficult as it was to find in this economy, is pretty much all that stands between her and destitution. It is not a good job, but it is better than nothing. In speaking with the office manager/nurse, I was told that the wait time was, unfortunately, give or take “normal.” That funding was scarce and volume as high as it has ever been.

When it’s truly difficult to make ends meet, to find 4 or 5 hours to commit to a doctor  visit, as opposed to hustling the dollars one needs to squeak by, can be  hard. Arduous as the wait can be, it makes it that much easier to postpone the visit. And lest we forget for whom the bell tolls, if she postponed that visit to her ultimate detriment and wound up uninsured in an emergency room–the cost of care (falling, ultimately as it would, upon the public) would have been extreme by comparison: in health care, the old adage “a stitch in time saves nine” can sometimes seem modest. In addition, there is a national cost in lost productivity to consider. Earlier this year I wrote the following in regard to lost productivity through illness:

Having just returned from my family physician (who stayed open past hours to see me), perhaps you will forgive me if, not feeling well myself, I dwell for a moment upon the cost of illness and inefficiency. Not as a matter of out of pocket cost, per se, but as a matter of macroeconomic cost–a roughshod (I am sick) calculus based upon diminished productivity and national opportunity cost: simply put, if I am busy being sick, I may well have to forego the productivity of work–or I may perform that work at a lesser level ( I suppose this post will tell).

For the working poor, with very little buffer to sustain them, sickness can easily amount to a calculus of ruin.

Seton Hall Regent Donna M. O’Brien Honored with NIH Director’s Award

Seton Hall Board of Regent Member Donna M. O'Brien, President of Community Healthcare Strategies, LLC.

[Ed. note: Today's post was culled from Seton Hall University News and was written by Jill Mathews]

Seton Hall University Board of Regent member Donna M. O’Brien, President of Community Healthcare Strategies, LLC, has been selected to receive the National Institutes of Health (NIH) Director’s Award. This award is being presented in recognition of Ms. O’Brien’s work in developing The National Cancer Institute’s (NCI) Community Cancer Centers Program (NCCCP). She will receive her award during a presentation on July 29th in Bethesda, Maryland.

The National Cancer Institute (NCI), the largest institute of the National Institutes of Health, leads the nation’s research efforts to discover better ways to prevent, diagnose and treat cancer. In 2007, NCI launched NCCCP as a three-year pilot program to extend the reach of NCI’s cancer research into more U.S. states, cities and towns, including rural areas and inner cities. The NCCCP program has 16 community hospital cancer centers in 14 states representing a cross-section of this country’s population and its health care organizations — with a special focus on reaching minority and underserved patients. The NCCCP program sites serve 27,000 cancer patients each year. Plans are underway to expand the program.

The NCCCP program is creating a platform in the healthcare delivery system for personalized medicine and developing a national electronically-linked network which will collect high quality biospecimens and patient data to support molecular medicine and the work of the Cancer Genome Atlas. The overarching goal is to bring science, early-phase clinical research, and evidence-based therapies to people in their home communities.

Ms. O’Brien currently coordinates healthcare projects in several locations across the U.S. Her prior experience includes serving as Executive Vice President of Catholic Health Services of Long Island, Associate Director of the Alliance for Catholic Health and Human Services in New York City, and as Assistant Administrator for Hospital Administration at the University of Texas M.D. Anderson Cancer Center. She was a Member of the New York State Governor’s Commission to Restructure Healthcare Facilities for the Twenty-first Century and currently serves on the Board of Regents for Seton Hall University and on the Board of Directors of the Flushing Savings Bank.

Ms. O’Brien is a graduate of the College of the Holy Cross and she has her Masters of Health Administration from St Louis University. She is a Fellow in the American College of Healthcare Executives.

Model Wanted

The NY Times reports that according to Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and an associate professor at the Harvard School of Public Health, “there’s a drastic decline in the number of geriatricians - and just 300 new ones are being trained each year - yet the number of people over 65 will double in the next 20 years. Those who work in geriatric care are among the worst paid in the health care system.”

That last statement, as shown in a recent post regarding physician compensation, is backed up by numbers. According to the American Group Medical Association (AMGA) the median compensation for a geriatrician is $179,344. The median compensation for a podiatrist is $180,080. These AMGA numbers have been approved by the Center for Medicare and Medicaid Services (CMS) for use in CMS related calculations.

Dr. Gawande “and others see a pressing need for new approaches to keep aging patients as healthy as possible and living independently as long as possible.” The Times reports that “Dr. Chad Boult, a geriatrician at Johns Hopkins School of Public Health in Baltimore, says the goal should be care that is well coordinated, and patients and families who are involved in and educated about the care plan.”

To that end, Dr. Boult is participating in the testing of a “team approach” which is somewhat reminiscent of the subject of a recent post, Alaska’s Southcentral Foundation’s “medical home” approach. Southcentral’s “comprehensive” health care strategy has shown some promising results. The Times reports that

Dr. Boult is involved in testing a team approach, in which nurses trained in geriatrics are helping physicians in the Baltimore-Washington area provide coordinated care for 50 or 60 of their highest-risk older patients. The nurses go to patients’ homes, develop comprehensive care plans, help the patients in self-monitoring, help them overcome obstacles to self-care and connect patients and their families to community agencies.

According to geriatrics experts, social workers trained in the problems of the elderly can also participate by performing home assessments, for example, to prevent falls and costly, disabling fractures. They can help overcome barriers to good nutrition, and they can help make the community connections for assistance with the activities of daily living, like shopping.
Dr. Boult said that “The Baltimore team project has already demonstrated an improvement in the quality of care that ailing elderly patients receive, and by keeping patients out of the hospital, he expects it will save money for insurers like Medicare.

The NYTimes also reports, however, that the current fee for services compensation scheme has not yet been structured so as to provide monetary incentives for such prophylactic care. The Times states: “While current insurance systems pay many thousands of dollars for hospital-based care, they cover only a fraction of the far less expensive care delivered by doctors and nurses that can keep patients out of the hospital,” and that experts say “a new model of care is needed.”
Read full article here.

Clinic Expansion Under Bush Thought Likely to Continue Under Obama

The NY Times reports that “President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas.”
The article notes that:

“As a crucial component of the health safety net, they [community health centers] are lauded as a cost-effective alternative to hospital emergency rooms, where the uninsured and underinsured often seek care,”

and that

“Studies have generally shown that the health centers — which must be governed by patient-dominated boards — are effective at reducing racial and ethnic disparities in medical treatment and save substantial sums by keeping patients out of hospitals. Their trade association estimates that they save the health care system $17.6 billion a year, and that an equivalent amount could be saved if avoidable emergency room visits were diverted to clinics.”

As an example, the Times article cited Nashville’s United Neighborhood Health Services, a recipient of increased funding which has expanded more than two-fold in the last 8 years. The Times notes that “One of the group’s recent grants helped open the Southside Family Clinic, which moved last year from a pair of public housing apartments to a gleaming new building on a once derelict corner.” A 68 year old patient of that clinic who had just received breathing treatments, “said she would have sought care for her bronchitis in a hospital emergency room were it not for the new clinic. Instead, she took a short drive, waited 15 minutes without an appointment and left without paying a dime; the clinic would bill her later for her Medicare co-payment of $18.88.”

The article also states that “Despite the clinics’ unprecedented growth, wide swaths of the country remain without access to affordable primary care. The recession has only magnified the need as hundreds of thousands of Americans have lost their employer-sponsored health insurance along with their jobs.”

Widespread Support for Community Health Centers
The Times notes that “In response, Democrats on Capitol Hill are proposing even more significant increases, making the centers a likely feature of any health care deal struck by Congress and the Obama administration.”

In August, President-elect Obama sponsored a bill in the Senate “that would quadruple federal spending on the program - to $8 billion from $2.1 billion — and increase incentives for medical students to choose primary care. His wife, Michelle, worked closely with health centers in Chicago as vice president for community and external relations at the University of Chicago Medical Center.”

In his recent book on health care reform, HHS secretary Tom Daschle referred to the health centers as “godsends.” The Times article also notes that the federal program “was first championed by Senator Edward M. Kennedy” and “has earned considerable bipartisan support.”

Physician Compensation, Subsidies and Service Requirements
The article notes that with United Neighborhood Health Services starting pay for doctors is $120,000. “Because of a nationwide shortage of primary care physicians, the clinics rely on federal programs like the National Health Service Corps that entice medical students with grants and loan write-offs in exchange for agreements to practice as generalists in underserved areas. Of the 16 doctors working for United Neighborhood, seven are current or former participants.”

Follow-up Care Lacking
Although widely lauded as a viable solution to Primary Care medical delivery, the article notes that follow-up for more serious conditions can be problematic.

“A deeper frustration for health centers concerns their difficulty in securing follow-up appointments with specialists for patients who are uninsured or have Medicaid. All too often, said Ms. Bufwack [Chief Executive, United Neighborhood Health Services], medical care ends at the clinic door, reinforcing the need to expand both primary care and health insurance coverage. ‘That’s when our doctors feel they’re practicing third world medicine,’ she said. ‘You will die if you have cancer or a heart condition or bad asthma or horrible diabetes. If you need a specialist and specialty tests and specialty meds and specialty surgery, those things are totally out of your reach.’”
Read full NYT article here. Read WSJ Health Blog report here.

Alaskan “Medical Home” Approach

A recent piece in the Anchorage Daily News highlights some health care successes worth noting. Southcentral Foundation serves the medical and other needs of Alaska Natives. Its network includes a primary care clinic and some specialty services and it jointly runs the Alaska Native Medical Center with the Alaska Native Tribal Health Consortium.

Southcentral’s approach is one version of the “medical home” model that is said to have piqued the interest of members of the Obama administration. It is a “comprehensive” approach to health care which distinguishes acute and traumatic maladies from chronic conditions. The Southcentral system is premised on the belief that the “mechanical-repair model” (it’s broke, let’s fix it with a procedure and/or medication) “is great if you are in an accident and need trauma care….But the vast majority of health care deals with chronic conditions and the fallout from behavioral choices people make.”

For these chronic issues, Southcentral offers a team which “includes a doctor, nurse, and case manager, as well as access to a nutritionist, traditional healers and a behavioral counselor,” and “follow-up services - pharmacy for drugs, labs for testing - are right on the same campus, making access easy.” Southcentral’s Karen McIntire has stated that “70 percent of primary care does not require a doctor,” and that “In our system, who you see depends on what you need.” The Anchorage Daily News reports that “With this comprehensive approach, Southcentral reports major changes for the better. Writing in the January 2008 issue of Family Practice Management, CEO Gottlieb reported that emergency room and urgent care visits have dropped by more than 40 percent, while use of specialists fell 50 percent and the number of hospital days shrank by 30 percent.” Read full story here.