Health clinics gird for patient boom

QUALITY CARE: Lawrence T. Geary, a patient at Thundermist Community Health Center, speaks to medical assistant Jill Antunes in the lobby of the newly renovated Quick Care Center in West Warwick. / PBN PHOTO/NATALJA KENT
QUALITY CARE: Lawrence T. Geary, a patient at Thundermist Community Health Center, speaks to medical assistant Jill Antunes in the lobby of the newly renovated Quick Care Center in West Warwick. / PBN PHOTO/NATALJA KENT

East Bay Community Action Program CEO Dennis Roy expects the number of patients his nonprofit health care organization treats to double shortly after Medicaid expands under the national health care law in 2014.
With more Rhode Island residents eligible for subsidized health insurance, the number seeking care at clinics like the ones East Bay runs in Newport and East Providence should rise.
“The act dramatically expands coverage and when more people have insurance we expect there will be pent-up demand for health services,” Roy said. “We see 2,500 people and expect that patient base in Newport to double within a few years.”
So East Bay, like the other nine community health centers in Rhode Island, is working to build its capacity and make care more efficient in preparation for the coming demand.
Fortunately for community health centers, the Patient Protection and Affordable Care Act includes federal money to grow their operations at the same time it grows their role in providing care.
East Bay received a $3 million federal grant that is paying for 90 percent of the cost of constructing a new 11,000-square-feet health center in Newport. The new building is 75 percent complete and slated to open in December.
In Cranston, Comprehensive Community Action Program received a $1.1 million capital grant for work on its medical building.
While measures such as the individual insurance mandate and Medicaid expansion have generated the bulk of the controversy attached to the Affordable Care Act, the law also includes approximately $97 million in total federal grants and other direct spending in Rhode Island alone.
In many states, officials opposed to the law have fought the new spending, but Rhode Island leaders have eagerly pursued it.
The majority of Rhode Island’s direct Affordable Care Act spending, $64.7 million, is going to set up the health-insurance exchanges intended to provide a transparent and efficient marketplace for insurance policies. Of the remaining $32 million, $21 million has gone to community health centers for capital projects, efficiency innovations and other programs.
For Jane Hayward, president and CEO of the Rhode Island Health Center Association, the funding is good, but not as significant as the health-reform law initially promised.
The opposition has brought cuts to existing federal spending for community health centers, Hayward said, as a way of canceling out the appropriations in the law.
“The ACA established a community health center trust fund, but for those in Congress who didn’t want it to go forward, one of the areas they cut was community health centers,” Hayward said. “Overall it has come out a wash for most, but a few health centers have benefited.”
One of the community health centers that has expanded without a capital grant from the Affordable Care Act is Providence Community Health Center, which recently completed a new clinic on Prairie Avenue in South Providence.
Another is Blackstone Valley Community Health Care, which is building a new 32,000-square-foot medical facility in Pawtucket slated to be completed in October.
“The one thing we know is that ACA looked toward community health centers as a foundation of primary-care delivery in communities and recognized there would need to be some expansion insured under the law,” Hayward said.
Some of the smaller Affordable Care Act grants include:
• $100,000 to eight of the nine Rhode Island health centers in “Beacon” grants for improvements in health-information-technology systems.
• $500,000 to Comprehensive Community Action and East Bay Community Action for capital improvements, plus $228,000 to Thundermist Health Center for expansion of its dental center in West Warwick.
• $363,799 to Thundermist for its clinic in Woonsocket High School and $33,177 for East Bay Community Action for school-based programs in Newport. • $35,000 to eight of the Rhode Island health centers to promote primary care.
The Rhode Island health center that has received the most Affordable Care Act grant funding is the Woonsocket-based Thundermist Health Center, which saw 30,500 patients in 2011.
Thundermist received a $5 million capital grant to replace its old health clinic in the South Kingstown village of Wakefield, in addition to the Wooonsocket High School grant and West Warwick dental grant.
“Our patients certainly have benefitted from [the Affordable Care Act], the Wakefield grant is the largest we have ever received,” said Thundermist President and CEO Chuck Jones.
Asked whether the added resources look like they will balance out the new demands being placed on community health centers, Jones said it would likely take a major effort.
“I think we will still be challenged to meet the demand of 2014,” Jones said. “There are two focuses: one is an increase in raw capacity of the infrastructure and the other is on transforming the way we deliver our care to be more efficient and treat more patients better with every dollar.”
Across the country, a major concern about the move toward universal coverage in the Affordable Care Act is that there will not be enough primary-care physicians to handle all the new patients.
Jones said in Woonsocket, his organization already sees a harbinger of the shortage in the competition for doctors a few miles across the border in Massachusetts, the only state to have near-universal coverage.
“Being so close to Massachusetts, we are already seeing the recruitment process as tougher for nurse practitioners and physicians,” Jones said.
To deal with the clinician shortage, James said Thundermist has hired seven nurse practitioners for a limited service walk-in clinic open until 9:30 p.m. that will hopefully take some of the pressure off the center’s doctors. •

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