In the News

Knoxville News Sentinel

For millions, health clinic is 'family doctor'

LEE BOWMAN, Scripps Howard News Service
Monday, May 11, 2009

When you're poor and sick, you can go to an emergency room and federal law says you must be treated. But when you're poor and want to try to stay well, you might have a harder time finding the care you need.

For more than 18 million Americans trying to stay healthy, primary care is accessible mainly through thousands of community health center clinics.

They're the "free clinic," or the community clinic, or the evening clinic, or simply the place where you can go and get seen, paying what you can, sometimes even if it's nothing.

"I tend to go about every three months to get blood work done,'' said Mark Southern, an uninsured diabetes patient at Georgia Mountain Health Services in Morganton, Ga. "If something occurs, I go back. No other place is close. I can't afford to go anyplace else."

A recent study by the Morehouse School of Medicine in Atlanta found that emergency room visits were one-third fewer in counties with community health centers. And the National Association of Community Health Centers - which represents federally subsidized clinics - says a complete network of centers across the country could reduce spending on ER care by more than $18 billion a year.

That's because, in large part, community health centers focus on preventive care. "Primary health care is so important, because it's the first line of care," said Kathy Wood-Dobbins, chief executive officer of the Tennessee Primary Care Association, an organization for community health centers in the state. "Pap smears, cancer screenings, tobacco cessation - all of these preventive services are provided at community health centers."

And in rural East Tennessee, better health comes from not just changing patients' habits, but from changing their mindsets.

Jada Stanley, chief operating officer of Community Health of East Tennessee in LaFollette, said many of the health center's patients become fatalistic with a diagnosis of a chronic illness like diabetes or hypertension." They (assume) they're going to die from it" because their mother or uncle or brother did, Stanley said.

Especially in small communities, the relationship between patient and provider becomes very personal, she said: "We want to see them get better, and we believe that they can, that if they'll trust us and take care of themselves, we can help them actually get better."

Stanley's center, which employs about 30 people and also includes a behavioral wellness component and three school-based clinics, served 4,478 patients in 2008, including 582 with hypertension and 387 with diabetes. About 1,500 of them were uninsured; another 1,250 had TennCare. More than half of them were below the federal poverty level.

While some people who use federally subsidized community centers have Medicare, Medicaid or private health insurance, about 40 percent also have no health coverage and pay only what they can on a sliding scale.

Stanley's center is one of three in Campbell County, where more than 60 percent of residents are considered medically disenfrancised. The centers work together, she said. Dayspring Family Health Center in Jellico, separated from LaFollette by the physical barrier of Jellico Mountain, is a "sister organization," even though the two centers are run by different companies, she said.

The federal government subsidizes community health centers with grants totaling about $2 billion a year, yet this covers only about half of uninsured patient costs. The centers try to cover the rest from grants by state and local governments, and charitable donations.

The recent federal economic stimulus spending package recognized the importance of the centers, providing $500 million in extra funding over two years in anticipation that more people would flock to them.

And the government is also planning to spend $1.5 billion toward the construction of 126 new community health centers around the country, which are expected to serve an additional 700,000 people.

But the Tennessee Primary Care Association maintains that community health centers are themselves economic drivers. They're often among the largest employers in a community, buy local goods and services, and can attract investment and business to a community.

In 2008, the community health centers in Tennessee generated 1,663 full-time jobs, the association said, and "injected $134.3 million of operating expenses directly into the local economy."

Yet filling health provider positions tends to be a challenge.

"Our staff takes below-market wages to make the books balance," said Mark Watt, chief executive officer of Dayspring. "They see it as a mission." Many staff members are from the surrounding area.

In many rural counties, the community health center becomes an institution, as well as a place to get care not otherwise available without driving long distances.

"We're the only group that delivers babies from Corbin (Ky.) to Knoxville," Watt said. "We added an ob/gyn last year."

Community health centers aren't limited to rural areas. Knoxville-based Cherokee Health Systems is one of the state's largest, operating satellite facilities in Blount, Sevier, Jefferson, Cocke, Hamblen, Grainger, Claiborne, Union, Loudon, McMinn and Monroe counties. Cherokee takes the uninsured, the indigent and TennCare patients but also has private-pay and commercial insurance patients. In the past year, the adult primary-care clinic in Knoxville had more than 4,000 patient visits.

Cherokee has had success with one of the Tennessee Primary Care Association's major goals: providing each resident with "a primary-care home, with a provider who knows them and can provide continuity of care," Wood-Dobbins said. Last month, at its annual conference, the organization put a lot of emphasis on the primary care "home" model.

"We want to be able to get to know the people in our communities, to better serve them," Watt said. "We want to provide as many services as we can reasonably provide for them. The health care industry is now so complex, most people have difficulty navigating it. We want to be trusted members of their extended family."

News Sentinel health writer Kristi L. Nelson contributed to this report.