Plainfield Health Center talk of the town
Patients say care, doctors 'go beyond the call of duty.'
By BOB CONSIDINE
The increased number of patients using the many services of the Plainfield Health Center mirrors a national trend, as the underinsured and uninsured seek federally funded health centers for quality health care.
Yet there was the fully insured Lisa Pellegrino, taking her daughter Chelsea to the Plainfield Health Center on Thursday for a doctor's visit, just as she has for the past 15 years.
"They have always taken care of our family, and the care is absolutely wonderful," said Pellegrino, a North Plainfield resident. "The doctors go beyond the call of duty every time. Everyone from the nurses to the people in the offices when you walk in make you feel so good. My kids love the place. I don't know what more you could ask for."
In recent years, more people are asking more of the center's increasing array of services. And unlike Pellegrino, the majority of them don't have insurance and would have otherwise fallen through the holes of the nation's health-care blanket.
"The trends for us show we have a continuing increase in immigrant population, as well as undocumented cases of pregnant women," said Rudine Smith, president and chief executive officer of the facility, which since 1969, has sought to provide accessible and quality health care to lower-income and uninsured portions of the community.
The facility's main building is on Rock and Myrtle avenues, and it has two satellite locations in city schools. It also has three affiliated locations around the region.
"We have also seen an increase of people displaced without insurance because of corporations downsizing or closing up," Smith added. "So for the homeowner who fell off the ladder at home and now has no insurance, he is coming to our center for services."
By the numbers
Of the 24,489 patients served in 2006, 47 percent were uninsured, while 42 percent received coverage through Medicaid. Of those served last year, 13,347 were Hispanic or Latino (54.5 percent) and 7,801 were black (31.8 percent).
On the socioeconomic scale, 74.6 percent of the center's patients have family incomes at or below the federal poverty level.
These numbers fall in line with, or exceed, the other 951 federally approved health centers nationwide. According to a 2005 study by the National Association of Community Health Centers, 71 percent of health-center patients have family incomes at or below the poverty level. Forty percent are uninsured, while 36 percent depend on Medicaid. And 36.1 percent of those served nationally were Hispanic or Latino, while 23 percent were black.
So as one of 19 community-health care providers in New Jersey -- with none in Somerset or Hunterdon counties -- the Plainfield Health Center is an increasingly busy place.
"It's packed all the time," Pellegrino said. "But it's a great atmosphere. I've never seen anyone complain."
Because of the skyrocketing costs of medical costs and the number of services that are performed at PHC -- including dental, vision, gynecological, podiatry and the usual urgent or walk-in sick care -- the facility does face increased financial burdens.
"One of the biggest challenges we face are funding sources," Smith added. "When funding comes from the federal government, most health centers don't get the amount they need to run the operation in the beginning. So we have to rely on other grants, whether they are state grants of private grants or donations, and the rest of it is generated from patient revenue."
The center also accepts patients with other types of insurance, as well as those who can pay for the services privately.
"It's probably our biggest misconception," said Smith, who also uses the client's services as a consumer. "We are not a clinic. Anyone can schedule an appointment, come in and see the same doctor every single time -- even those who are not centrally located.
"It's just the same as a private practice," Smith added. "Yes, of course, we do reimbursements of those who are uninsured or underinsured, but we can see anyone -- no matter what economic level they come in."
Funding sources, challenges
Out of its $14 million operating budget in 2006, 48 percent came from patient services. The remainder came from federal grants and contract services.
But there is also the ever-present threat of decreased reimbursement rates. For example, the pool of state funds designated for undocumented pregnancy dried up midway through the 2006 Fiscal Year. So with reimbursement now coming through charity care, the rate dropped from $130 to $95 -- for the same level of comprehensive care.
"That's why we are always looking for funding sources, in order to close those gaps," Smith said.
Staffing can also be an issue. A total number of 225 people make up the Plainfield Health Center. It handled more than 91,000 patient visits in 2006, in part due to an extension of hours. The facility is now open 8 a.m to 8 p.m. Monday through Thursday. It had previously closed at 6 p.m. on those days. It remains open 8 a.m. to 5 p.m. on Friday and 9 a.m. to1 p.m. on Saturday.
"We've found those night hours to be very important to patients, so they don't have to take time out of work to come see us," Smith said.
There is also the matter of retaining qualified physicians when private practices may be able to offer more competitive benefit packages, Smith added.
"But for the people who do work here, this job is a passion," she said. "It's a passion to help those that are less fortunate and to work within the community to provide quality and preventative health care."
Plainfield resident Mary Robinson, a mother of four, swears by the coverage at the Plainfield Health Center.
"All of my kids were either delivered here or treated here," said Robinson, who receives coverage through Medicaid. "I have a very touch-and-go pregnancy my last time around and they took such great care of me. Whatever problem I had, they took care of it. My baby survived with their help.
"So I love it here," she added. "They are like family to me."
ABOUT THE PLAINFIELD HEALTH CENTER
- Established: 1969
- Plainfield locations: Main Site, 1700-58 Myrtle Ave. (corner of Rock and Myrtle avenues); "The Healthy Place," Washington Community School; Cardinal Health Center (Plainfield High School).
- Other locations: Elizabeth Port Community Health Center, Elizabeth; Phillipsburg Community Health Center, Phillipsburg; Newton Community Health Center, Newton.
- Patient Origin (2006): The Plainfields (67.5 percent); Elizabeth (10.5 percent); Piscataway (4.7 percent); Other (14.2 percent).
- Services: Adult Medicine; Dental; Ob/Gyn; Pediatrics; Urgent/Walk In Sick Care; Podiatry; Vision; Adolescent Medicine; Senior Care Case Management Services; Smoking Cessation Program; Comprehensive HIV/AIDS Early Intervention Program; HIV/AIDS Treatment, Counseling and Testing; NJ Cancer Early Education And Detection Program; 340B Discount Prescription Drugs Program; Assisted Living Without Walls Program; Access to Healthcare Program for the Uninsured; Family Planning; Referral for Specialty and Diagnostic Services; Mental Health Counseling; 24-Hour On-Call Physician Coverage; Ancillary Support Services; Phlebotomy Services; NJ FamilyCare Presumptive Eligibility Enrollment; NJ FamilyCare Program Enrollment; Health Education; Medicaid Presumptive Eligibility Enrollment; Nutrition Services.
- Institutional affiliations: Solaris Health System; Muhlenberg Regional Medical Center; Robert Wood Johnson Health Network.
Link to online story.
Health Services Corporation
Community Health Center data for 2005
Users in 2005
No Private Insurance
Health centers grow, but gaps remain
By LARRY WHEELER
Gannett News Service
Americans are used to hearing bad news about their health care system --- that millions of people lack health insurance and medical costs are spinning out of control.
But amid those trends is evidence that a vital and often overlooked health care safety net is performing effectively and efficiently.
That national network of 952 federally approved community health centers serves more than 14 million poor and uninsured patients who otherwise might go without prenatal care, cancer screenings, diabetes treatment and a long list of other services.
New Jersey has 19 such centers, including centers in Plainfield -- the Plainfield Health Center -- and New Brunswick -- the Eric B. Chandler Health Center.
"I have no idea where else I would go for health care," said Shirley Dorsey, 51, a patient at Baltimore Medical System's health center. "It's important to have some place where poor people who don't have insurance can come and not be afraid of being turned away."
Since 2000, the Bush administration and Congress have nearly doubled annual spending on community health centers, to almost $2 billion. That's the largest increase in the history of the public health program, born during the 1960s War on Poverty.
Over the same period, the number of centers has increased by more than 200 and the number of patients they treat has risen by 4.5 million, or 53 percent.
The centers, located in areas deemed medically underserved, rely heavily on Medicaid payments and federal grants and must meet a number of requirements to qualify for federal funding. Most of their patients are minorities, with Hispanics far outpacing other racial and ethnic groups in growth.
Since 2000, the number Hispanic patients has surged to 4.8 million, a 52 percent increase.
How many of those patients are in the country illegally isn't known. Community health centers are required to treat everyone, regardless of ability to pay or immigration status.
Taxpayer-subsidized services for illegal immigrants is a focus of contentious debate nationwide. So far, community health centers appear to have escaped the controversy, perhaps because much of their care is delivered to pregnant women and newborns.
By fall, an additional 120 health centers in high-poverty counties will get federal startup grants.
"We've been able to make health centers available to a lot more people in places that have never had health centers," said Elizabeth Duke, administrator of the Health Resources and Services Administration. "In the very best sense, (this) is what's right about America."
Studies show community health centers are more cost-effective than other treatment options. But rising demand for their services underscores their limitations.
The number of people treated at community health centers represents less than a third of those who need such services, according to the National Association of Community Health Centers.
Demand far exceeds the number of available doctors.
"We're looking for clinicians to work in our centers and we can't find them," said Alvin Jackson, director of the Ohio Department of Health and former medical director of Community Health Services in Fremont, Ohio. "It's a tragedy."
The centers focus on preventive care and don't offer surgery or specialty care for heart disease, cancer or other serious problems.
"We oftentimes have clinicians who, frankly, beg specialists to take on patients," said internist and pediatrician Kyu Rhee, chief medical officer for Baltimore Medical System.
About 56 million people, including many with health insurance, live in places where there are acute shortages of primary care physicians and little prospect for improvement, according to the National Association of Community Health Centers.
Without a community health center, they lack clear options for treating problems --- such as an infected tooth or high blood pressure --- that can develop into more serious conditions.
"The toll of unmet health care needs among these health care have-nots is incalculable, and the tragic outcomes they experience are appalling," Joseph Feaster, a board member of the Whittier Street Community Health Center in Boston said at a congressional briefing this spring.
Family practitioners, pediatricians and obstetrician-gynecologists are in short supply, especially in urban neighborhoods and rural towns where the centers are located.
There are more than 2,500 clinical vacancies at community health centers across the country, according to the National Health Service Corps. It offers grants, scholarships and student loan repayments to those who agree to work in medically underserved settings.
The number of doctors, dentists and other medical professionals employed at community health centers through the corps has increased by 74 percent since 2002, but that hasn't been enough.
Some of the reasons have to do with money.
Funding for the National Health Service Corps, a vital source of medical professionals for community health centers, has not kept pace with the growing need.
Because community health centers depend so heavily on federal, state and local government money -- and to a lesser extent on grants from hospitals and charities -- doctors at the centers make less than they would in private practice.
And fewer medical school graduates are choosing to go into primary care, one of the lowest-paying disciplines.
Those who choose to work at a health center say they're motivated by a sense of public service.
"During residency, I realized I didn't necessarily like taking care of the worried well," said Jessica Osborn, medical director of the school-based health program at Baltimore Medical System. "You see where there's need and I don't know that you can actually turn your back."
Focus on efficiency
Despite their problems finding doctors, community health centers deliver better continuity of care than private physicians or hospital outpatient facilities, according to a 2000 study published in the Journal of the American Medical Association.
Other studies show community health centers can outperform private physicians, hospitals and emergency rooms in price, quality of care and efficiency.
The centers give expectant mothers greater access to prenatal care, increase childhood vaccinations, lower infant mortality rates and improve the prognosis of patients living with chronic conditions such as diabetes and high blood pressure.
Health centers also reduce the disease gap between whites and minority populations.
African-American women who receive care at community health centers, for example, deliver significantly fewer low-birth-weight babies than the national average, according to a 2004 analysis published in the Journal of Public Health Policy.
Patients at community health centers also are less likely to use a hospital emergency room for nonemergency treatment, saving money for hospitals and patients.
A 2001 study of 50,000 Medicaid beneficiaries concluded that patients who got most of their care at community health centers were significantly less likely than other patients to be hospitalized or seek emergency room care.
"Emergency rooms all over the country are providing too much primary care," said David Sjoberg, vice president of strategic services for the Baptist Health Care hospital system in Pensacola, Fla. "You have people coming in sick because they have not taken their insulin, people with the flu. Instead of going to a $40 primary care visit at a health care center, they're spending $1,500 to $3,000 to get treated in an emergency room.
Who depends on community health centers?
About 40 percent of people who seek treatment at community health centers have no health insurance. Two-thirds are racial and ethnic minorities.
Health center patients are predominantly female, relatively young and most -- approximately 70 percent -- have family incomes below the federal poverty level of $20,650 for a family of four.
About the same number of patients are treated at health centers in rural communities and urban neighborhoods, according to the National Association of Community Health Centers.
Health centers at front lines in War on Poverty
The federal community health center system was born in the 1960s, one of the many programs born from President Lyndon Johnson's War on Poverty.
The first two clinics -- then called neighborhood health centers -- opened in a public housing project in Boston in 1965 and in Mound Bayou, Miss., in 1967.
Since then, community health centers have evolved and expanded while remaining focused on the program's founding philosophy of providing health and social services to poor and medically underserved communities.
To qualify for federal funding, community health centers must:
- Provide comprehensive primary health care for adults and children.
- Treat people who meet the federal definition of medically underserved.
- Provide care to everyone regardless of insurance status or ability to pay.
- Charge patients using a sliding fee scale based on ability to pay.
- Provide translation services, transportation and case management.
- Maintain a governing board composed mostly of members who are also health center patients.
- Operate as a nonprofit, public or tax-exempt organization.
How community health centers charge patients
Community health centers treat everyone, regardless of insurance status or ability to pay.
Many patients at community health centers have some form of insurance, typically Medicaid, the federal-state health insurance program for low-income Americans.
Those without insurance must document their income to care coordinators, who then determine payments based on a sliding scale that also takes into account family size.
At the eight federally approved community health care centers in Baltimore, the full price for an appointment with a primary care physician is $120. Patients with the lowest incomes pay just $12.
On the Web:Contact Larry Wheeler at email@example.com.
www.nachc.com, National Association of Community Health Centers Inc.
http://nhsc.bhpr.hrsa.gov/, National Health Service Corps.
www.bmsi.org, Baltimore Medical System.
www.hrsa.gov, Health Resources and Services Administration.
Link to online story.
Hispanics, uninsured, drive growth at health centers
By LARRY WHEELER
Gannett News Service
WASHINGTON -- A dramatic increase in Hispanic patients and those without health insurance has crowded waiting rooms at community health centers nationwide.
The number of Hispanic patients seeking care at health centers grew by 52 percent to 4.8 million between 2000 and 2005, outpacing all other racial or ethnic groups, according to data from Health Resources and Services Administration, which oversees the centers.
Final numbers have not been published, but Hispanic patients likely surpassed whites last year in demand for care at community health centers.
Many centers have added interpreters, mostly Spanish-speaking, to help doctors and patients communicate.
"We started preparing ourselves seven years ago," said Jay Wolvovsky, president of Baltimore Medical System, which runs eight community health centers. "By hiring outreach people, bilingual staff and interpreters, we've become the premier provider to the Latino community in Baltimore."
The number of Hispanic patients treated at BMI's centers has increased fourfold to 4,500 since 2000, Wolvovsky said.
Inevitably, some of those patients are in the country illegally. No one knows how many because community health centers must treat everyone, regardless of ability to pay or immigration status.
But many in Congress and elsewhere fiercely oppose using taxpayer dollars to cover routine health care for any illegal immigrants.
"Taxpayers should not be required to pay for health care, other than emergency services, to people who are in this country illegally," said Ira Mehlman, national media director of the Federation for American Immigration Reform, an interest group that advocates tougher border security and limited legal immigration. "We're dealing with a finite resource. There are millions in this country who are underserved already, and you are draining resources away from them."
Elizabeth Duke, administrator for the Health Resources and Services Administration, says community health centers have not become the default health care network for illegal immigrants.
She agrees the number of Hispanic immigrant patients has grown but prefers to talk about those who are in the country legally.
"We have many established communities where you've got folks who are settled," Duke said. "They have roots. They have (green) cards."
Congress recently passed legislation requiring individuals applying for Medicaid coverage to prove they're in the country legally.
But community health center officials said that won't stop the flow of patients through their doors.
"What is likely to happen is those individuals who need to produce documentation and can't will just become uninsured patients," said Ann Lucas, executive director of Bridge Community Health Clinic in Wausau, Wis. "We will still treat them, but if they don't have insurance or sufficient money to pay, it squeezes our bottom line, and we're not getting any more money from the feds to take care of these people."
Community health centers also are coping with a significant increase in patients who lack health insurance. The number of uninsured seeking care at health centers grew 46 percent to 5.6 million patients between 2000 and 2005, according to federal data.
An estimated 46 million Americans under 65 have no health insurance.
All community health centers charge patients on a sliding scale based on ability to pay. But many patients can't pay at all. To compensate, health centers rely on Medicaid and Medicare payments, on federal, state and local grants, and on private donations.
For all their effectiveness in treating the growing population of uninsured patients, community health centers will not solve the problems that created that population, according to executives and physicians.
"Community health centers are a critical part of the solution, but we're not the answer by ourselves," said Virgilio Licona, a family physician at a Fort Lupton, Colo., health center.
Contact Larry Wheeler at firstname.lastname@example.org
On the Web:
www.bmsi.org, Baltimore Medical System.
www.hrsa.gov, Health Resources and Services Administration.
Link to online story.
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