Local adult Medicaid access difficult

Doctors Hospital, 2828 N. National, opened its new Primary Care Clinic July 1. According to Paul Taylor, interim administrator of Doctor's Hospital, the clinic itself isn't unique, but what is, is the fact that it accepts only Medicaid patients.

"The reason we did it is be-cause there's a fairly well-publicized access problem for adult Medicaid patients in Springfield area. Many of those Medicaid patients have been forced, since they can't establish a continuing care relationship with a pro-vider ... to go to the urgent care clinics in town or to the emergency rooms in town," which must accept patients regardless of whether they have insurance or are able pay, Taylor said.

"We've set up a primary care and continuing care clinic, so that when a patient comes in, they establish a physician-patient relationship. So it's unlike an urgent care clinic or an emergency room, where a patient will come in when they're sick and they don't know who they're going to see," he added.

The Medicaid problem

Taylor said many doctors and individual clinics cite low reimbursement rates as the reason for not seeing Medicaid patients, and he noted that the reimbursement is better for children than it is for adult patients. Because of that, it's the adults on Medicaid who have trouble getting in to see a primary care physician.

"For a typical office visit, if someone just comes in ... and they're not particularly ill, but they've got a few health problems that they want to see somebody about, and they come in to see a family doctor, in terms of what that physician will get paid for that visit, versus what (insurance companies) will pay ... for (a) Medicaid visit, they'll get less than half ... ," Taylor said.

He said because doctors are having to make do with less from commercial insurance payments a result of managed care it can be hard to convince them to accept Medicaid for children or adults.

Doctors Hospital's Primary Care Clinic is run by its medical director, Dr. Lewis McKay, and it has a nurse practitioner, Tammy Whipple-Manes, and a support staff.

Although the patient rolls are filling up, Taylor said it's not likely the clinic will ever turn a profit.

"We're going to lose money on the clinic. I don't expect that clinic to break even," he said.

Even so, he said he felt it was an important project for Doctors Hospital to undertake.

Taylor attended several meetings of the Greene County Indigent Care Task Force, which explores, among other things, ways to solve the area's health care access problems.

"It just seemed to me that the thing I could do rather than to just continue to go to meetings was just to say, all right, we're going to do a little bit of something,'" he said.

"What we're doing here is such a small thing, it's almost symbolic ... the problem is access," Taylor said. "It's not that there are not enough doctors or nurse practitioners, it's that the doctors that are out there, for reimbursement reasons, don't really want to see very many Medicaid patients."

At some point, the Doctors Hospital Primary Care Clinic will be full and unable to accept new patients, and Taylor said that point might not be far away. Ideally, he'd simply add doctors and staff to increase the patient load, but Doctor's Hospital doesn't have the resources.

"We're a real small hospital here ... I can do this much, but I can't do much more," he said.

Increasing access

Fortunately, Doctors Hospital isn't alone in its efforts to increase Medicaid access in the Springfield area. Kevin Gipson, administrator of health planning with the Springfield-Greene County Health Department, also is involved with the Greene County Indigent Care Task Force.

Gipson said the Health Department does provide health care services for the poor, but for the Health Department, indigent, or poor, is defined as those individuals who have $350 or less in income each month.

Gipson said about a year and a half ago, the task force worked with the Missouri Primary Care Association on a community assessment designed to identify problems with health care access in Springfield and Greene County.

"Out of that, we talked to several groups focus groups, community leaders, heath care leaders ... and we know there's a lot of people providing health care, kind of in a fragmented way," Gipson said.

"We certainly believe that the hospitals do a heck of a lot of indigent care through their emergency rooms, through their missions and different facilities," he added.

Gipson noted that in this area, access to Medicaid-funded dental care is perhaps the biggest problem, and Missouri Gov. Bob Holden recently vetoed more money for those services because of the state's tight budget.

Gipson said 12 percent to 14 percent of the Springfield-Greene County population is on Medicaid, and another 14 percent of the population has no insurance at all.

Federal funds

One solution the task force is exploring to answer the needs of Medicaid patients and uninsured residents is the possibility of a federally qualified, or community, health center, which would be subsidized by the federal government.

Gipson said there are about 800 such clinics now in the United States, and the centers are a major priority for the Bush administration and U.S. Sen. Kit Bond.

According to a news release from Bond's office, Bond's REACH, or Resolution to Expand Access to Community Health Care, initiative is designed to address the health care access problem by doubling the funding for community health centers and other health centers to $2 billion by 2005.

Such an increase in funding would allow 6 million to 10 million more Americans to receive health care by 2005.

Statistics from Bond's office said that as of March 2000, Missouri had 15 rural and urban health centers that sponsored nearly 50 separate clinics across the state, and those clinics serve more than 200,000 Missourians.

The Kitchen clinic

The Kitchen Inc., which operates a medical clinic at 1630 N. Jefferson is considering applying again to become a federally qualified health center, according to Sister Lorraine Biebel, its founder and chief executive officer.

She said the board of directors met Aug. 8, and appointed a committee to re-examine the pros and cons of becoming a federally funded clinic.

She said The Kitchen applied twice before for the funding, "the first time, was, I think, in about 1993. We had just moved into this building, and so, I suppose naively, we thought this building could be renovated to accommodate a larger clinic. The second time, the funding wasn't there when the application was sent in," she said.

Biebel noted that because The Kitchen already has a working clinic, it is the logical entity to apply for federal qualified health center funding, but, she said, "We might complicate matters. The clinic is part of our whole Kitchen Incorporated corporation, and so that might have to be dealt with, too, should we become the applicant," Biebel said.

Although the clinic building, which houses The Kitchen's administrative offices, likely would not be big enough even if the clinic took over the whole facility, Biebel said she's not ruling the FQHC option out.

The board committee should have a decision on the FQHC application by Oct. 1, and it is possible, that if the board decides in favor of it, The Kitchen could submit an application as early as November, she added.

The Kitchen's clinic has a small paid staff, and it relies on community physicians to volunteer their time and services, including Dr. John Bentley, who volunteers as the medical director. Right now, Biebel said, The Kitchen doesn't accept Medicaid or any type of insurance, and it also doesn't require any payment, but "if they want to give us a little donation, we take it," she said.

Acceptance of insurance is one thing that would change if the clinic did become an federally qualified health center.

Gipson said FQHCs receive about $640,000 a year to supplement their needs, but to make the clinic work, it has to accept all forms of payment and be available to anyone who needs it whether they're self-pay, commercially insured, have Medicaid, or simply cannot afford to pay.

And opening the clinic up to federal monies has Biebel concerned about several aspects.

"Our concern, our biggest focus, is that we don't want poor people left out in the lurch by this (or) any new thing that comes in.

"Our concern is that if they build a clinic that's not near where the people are, the people aren't going to get to it anyway," she said.

"Then, I'm concerned about the homeless people that live in our complex, because most of them do not have any form of transportation, or the funding to get to another location either, and so there are many angles for us to look at," she added.