David Sanford, CEO of GraceMed community health clinic, hung a picture of his dream building in his office.
It’s of a new, 20,000-square-foot clinic for south Wichita between Broadway and Hydraulic along I-235. It would be operated in partnership with the Richard A. Devore South YMCA and would potentially offer low-cost health care to about 150,000 people in that part of the county. It also would cost $8 million.
GraceMed is one of the three federally qualified health centers in Wichita, which offer affordable primary health care to the underinsured and the uninsured. The potential expansion of Medicaid – as part of the Affordable Care Act – paired with a still-difficult economy and an aging Kansas population could soon overload the health centers and perhaps even Wichita’s private medical community, Sanford said.
“We see all these factors kind of swirling and collecting to where there is going to be an earthquake,” he said. “Gradually, through 2013, 2014, 2015, we’re going to see an increasing demand for care that we don’t have the capacity to meet.”
In the past couple of years, community health clinics in Wichita have seen more and more people looking for affordable health care. Many of the new patients lost their jobs during the recession and, with those jobs, their health insurance.
“We noticed, when people walk into our lobby, that a number of them have never been here before,” Sanford said. “People that had the gold plan of a health insurance are now coming to community health centers for care.”
Teresa Lovelady, CEO of the Center for Health and Wellness near 21st and Grove, said that some of her patients who lost their jobs got re-employed, but at jobs that pay less.
“If you’re earning 12 bucks an hour and your family health care plan is $500 a month,” she said, “are you going to purchase insurance or are you going to pay your rent, or are you going to buy food?”
Hunter Health Clinic grew from about 24,500 patients in 2008 to more than 33,800 in 2011. GraceMed, which serves about 30,000 people, has seen patient visits increase around 30 percent per year in the past three years. And the Center for Health and Wellness doubled its number of patients to 3,600 from 2009 to 2011.
They all expect the increases to continue.
Another increase in patients might come through the Affordable Care Act. One of its provisions includes the expansion of Medicaid.
The program, which now covers poor children, pregnant women, and people who are elderly or disabled, would expand to cover all adults who earn less than 133 percent of the federal poverty level, $14,856 annually. An estimated 110,000 to 130,000 Kansans who currently don’t qualify for Medicaid would be covered if Kansas adopts the provision.
Community health clinics expect many of the newly insured to seek their services because private physicians often limit their number of Medicaid patients. That means more resources, but also more work for the clinics.
‘We’re for everyone’
The mantra of community health clinics is that they serve everyone who comes in, regardless of their insurance status or their ability to pay.
About 68,000 people don’t have health insurance in Sedgwick County, according to Anne Nelson, director of Project Access, a program which coordinates donated specialty care for the uninsured in the county. The number represents more than 13 percent of Sedgwick County’s population.
Patient profiles vary slightly from one clinic to another.
Hunter sees the largest number of people without insurance – around 70 percent of its total patient count, according to CEO Susette Schwartz. Hunter also serves the homeless population and, because it was founded as an American Indian health center, the American Indian community.
GraceMed, which is owned by the United Methodist Church, has an uninsured patient rate of about 50 percent. The people who wait in the lobby for their doctor appointment are regular people, Sanford said. They often come wearing uniforms from companies where they work.
“These are all folks working just as hard as people who have insurance,” Sanford said. “But, unfortunately, they work for a company that either can’t afford health insurance or maybe they’re limited to a certain number of hours per week so that they don’t qualify for health insurance.”
The uninsured rate at the Center for Health and Wellness is 43 percent, according to Lovelady. Many of the clinic’s patients are African-American, reflecting the neighborhood’s population. All are “everyday people,” Lovelady said.
“We’re talking the hair stylist, the lawn people, construction workers, people that come and clean the city at night,” she said.
“These are people that do not have access to health care.”
Among them is Shirley Walker, 64, a retired dry cleaning worker. She started going to the center in 1999 after she met Arneatha Martin, a co-founder of the clinic, who dropped off her clothes at Walker’s workplace.
Three years ago, Walker was diagnosed with a blood disorder, which required surgery. Community health clinics offer only primary care. If their patients need to see a specialist, such as a surgeon or an oncologist, clinics reach out to Project Access, which coordinates donated specialty care from more than 620 physicians in Sedgwick County.
Through Project Access, Walker ended up seeing seven different doctors. She went through surgery last October. This year, after she turned 64, the center assisted her in applying for Medicaid. Now that she’s insured and theoretically has more options, Walker goes to the same clinic.
“They have truly been a blessing for me,” she said.
Although they offer affordable care, community health clinics are not free. If a patient has Medicare, Medicaid or private insurance, the clinic gets reimbursed just like any other medical provider. If the patient is uninsured, the clinic will operate on a sliding fee scale, which means that it bills the patient according to his or her income.
Apart from the income they get from insurance companies and from their patients, clinics rely on federal and state grants and on donations.
“The business model that we have allows us to cover our operational cost every year,” such as doctor salaries and supplies, Sanford said. “What we don’t have is money for capital expenses.”
Bricks and mortar
On a Friday in mid-July, Schwartz – the Hunter Health Clinic CEO – took a day off work.
She got on her John Deere tractor, which she brought from her farm in rural Kansas, and spent the day cleaning up the area behind the Hunter building at Central and Grove. That’s where the new clinic will be built.
In April, Hunter was the only community health clinic in Wichita to receive a $4.6 million capital grant from the Department of Health and Human Services. The grant will be spent on a new, 45,000-square feet facility, which will probably open by late 2014.
“The new facility will be attractive and more welcoming to people who don’t know us,” Schwartz said. “They might look at the facility and assume that we’re good. Whereas, they look at this (current) facility and assume ‘poor clinic, poor people.’ Which they shouldn’t, because we provide great care.”
GraceMed and the Center for Health and Wellness competed with Hunter for the capital grant.
GraceMed wanted the money for its clinic in south Wichita – the project on Sanford’s wall.
The Center for Health and Wellness wanted to build a $5 million facility near its current building, at Grove and 21st. The new clinic would have a range of services that don’t fit in its smaller, current building: dental care, mental health counseling and a fitness center, among others.
Lovelady hasn’t given up on her plan. She doesn’t expect another capital grant to come along soon – there aren’t many grants for “brick and mortar,” she said – but she’s working on an alternative.
In mid-July, she met with an architect specializing in modular buildings who will develop a plan for building the facility in stages, as money comes in. Lovelady hopes to complete the project in the next five years.
“Health centers should mirror the community,” Lovelady said. “You are there for their need. And that’s why community health centers grow out of need.”
The clinics’ main hope for a better financial future is that Kansas will agree to expand Medicaid as part of the Affordable Care Act. The potential revenue brought by patients with Medicaid would stabilize the clinics’ operations and help them expand, the managers said.
For example, if Medicaid were expanded, 20,000 of Hunter’s patients would automatically qualify.
“If there’s not an expansion we’re right back where we started, and we’re struggling financially,” Schwartz said. “With 80 percent of our patients below poverty and 70 percent of our patients without insurance, we can’t continue to operate without some help.”
Clinics managers contend that both hospitals and taxpayers would benefit from the expansion of Medicaid because the underinsured could seek more preventive care and reduce expensive visits to the emergency room.
But it’s not for them to decide.
“You never know what the politics are going to be around health care,” Lovelady said. “It’s just so questionable right now. It’s a scary time in the health care industry, especially when you’re at the bottom of the industry.”
Rather than hoping for favorable politics decisions, clinics managers rely on the community’s support.
“I look at it that way: Everybody has somebody in their family that’s at least one paycheck away from being uninsured,” Lovelady said. “So why not do it for them?”