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Archive for: September 2010
But recently, the 73-year-old has shown fidelity not to a hospital but to the Whittier Street Health Center in Roxbury, where she found a ready supply of interpreters and a van service. A new urgent care center and reduced wait times solidified her loyalty — and helped her break the habit of going to hospital emergency rooms for routine care.
Whittier has added nearly 3,000 patients with such features and soon will add more.
Tomorrow, the health center will break ground for a $35 million facility that will accommodate two-thirds more patients than its current cramped quarters.
As the national health overhaul rolls out, the experiences of Whittier and other neighborhood health centers in Massachusetts could prove instructive.
The state’s federally funded health centers treated nearly 40,000 additional patients in 2007, the year after Massachusetts became the first state to place insurance cards in the hands of most of its residents. Many observers expect a similar surge under the federal health care law.
The government is counting on community health centers nationwide to double their capacity by 2015, treating 20 million additional patients — a large chunk of the more than 30 million Americans expected to gain insurance.
If the community clinics don’t figure out how to absorb many of the newly insured, there won’t be enough primary care doctors in private practices to treat them, and many could end up seeking care in more expensive ERs.
“This is the acid test for health centers,’’ said Daniel Hawkins, who heads up public policy research for the National Association of Community Health Centers. “Can they do the job? I believe they can, but only time will tell.’’
A recent analysis of health care costs by George Washington University researchers found that, in 2006, Americans who relied on community health centers had yearly savings of about $1,000 per person compared with those who frequented hospitals.
“In the United States, we’re very much a fix-it-now, fix-it-immediately, instant gratification kind of people. That’s why I think a lot of people head to the emergency department,’’ said Dr. Derek Trapasso, a pediatrician at the North End Community Health Center.
Trapasso also works in the pediatric emergency department at North Shore Medical Center in Salem. He said he often treats basic ailments — fevers, coughs, colds — during the day, when cheaper, but usually overbooked, doctors’ offices are open.
For community health centers to succeed in drawing patients, they must make their services attractive — or at least more palatable than the hours of waiting often required of emergency room patients, he said.
To cut down on long waits, health centers in the Allston and Fenway neighborhoods, and in Waltham and Worcester, used one-year federal grants in 2007 to redesign how they deliver patient care. Whittier on its own produced similarly encouraging results, cutting its wait time for adult appointments from three weeks to one, making pediatric visits available the same day, and moving patients through the waiting room faster.
It did so in part by reducing the number of appointment types and lengths, which simplified scheduling, and balancing out each medical team’s caseload.
After these and other changes, Whittier added nearly 3,000 patients, bringing its roster this year to more than 14,500.
Whittier is one of eight Massachusetts health centers sharing $80 million in federal stimulus money to erect buildings and upgrade technology. Jobs for 450 construction workers will be created and when completed, the expanded clinic, near the Reggie Lewis Track and Athletic Center and Boston Police headquarters on Tremont Street, will hire about 50 new medical workers.
Expansion is a step that many health centers nationally will also take, given the several billion federal dollars dedicated to increasing their capacity. But as Frederica Williams, Whittier’s president and chief executive, said in an interview, a new building alone won’t bring in newly insured patients.
“If it means sending transportation to pick somebody up, if it means going out in the community with laptops and registering people for health insurance and then bringing them to the health center, if it means going to the schools, doing all kinds of creative outreach at taxicab stands — that’s what we do,’’ she said. “Just because someone has a health insurance card doesn’t mean they’re going to access it.’’
Whittier administrators say another aspect of their success is consistent and continuous care offered by the clinic’s medical teams, which consist of a doctor, nurse, nurse practitioner, medical assistant, and patient navigator. They share responsibility for thousands of patients so they can treat and track them over the long term. Team members share cubicles in a single room, where they confer about a particular patient’s case, plan for the next day’s round of appointments, and hold impromptu group meetings.
Abdi’s physician, Dr. Elizabeth Moran, said having a team has helped her to focus on what she does best — healing patients — while her bilingual medical assistant makes sure her Spanish-speaking patients understand what the doctor has prescribed.
Nurses and nurse practitioners handle much of the paperwork associated with ordering lab tests and authorizing medicines, and they treat their own set of patients under the doctor’s supervision. Since everyone on the team is familiar with all of the patients, the quality of medical care remains high, even when Moran goes on vacation.
Even so, Whittier hasn’t solved all its problems: Once patients arrive, they wait an hour on average to be seen, and the no-show rate for appointments hovers at more than 20 percent.
And though community health centers are seeing more patients, state data show that ER visits in Massachusetts climbed 9 percent from 2004 to 2008, an increase that mirrored national gains.
As health centers nationally begin to grapple with how best to provide care to the neediest populations, one of the most effective changes might be one of the simplest: staying open longer. Whittier, now open on Saturdays and until 8 p.m. during the week, is considering adding Sunday hours and seeing patients until 10 on weeknights, Williams said.
“Even bankers don’t keep bankers’ hours anymore,’’ said Hawkins. “If Best Buy is open until 10 or 11 at night so you can buy a flat-screen TV, shouldn’t health care?’’
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8:00 pm, August 22, 2010 By Sherri Welch of Crain's Detroit News
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