Health centers pressed to handle patient influx


While the state grapples with setting up the details of implementing the universal health care law, which mandates all Massachusetts residents have some sort of health insurance by 2009, two of the four local community health centers are not accepting adults looking to sign up for primary care.

A steady increase in patient demand, awareness of the quality of community health centers and state and private initiatives to provide more access to health care for more residents have stretched the centers’ resources. All of them serve
patients regardless of their ability to pay.

The Southern Jamaica Plain Community Health Center, across from the post office on Centre Street, is not accepting new patients until April. Brookside Community Health Center, located at 3297 Washington St., is not accepting new patients until it can hire another physician to accommodate patient volume.

According to Paula McNichols, director of Brookside, the center has had four full-time adult primary care physicians and four nurse practitioners for years. Both Brookside and Southern JP are affiliated with Brigham and Women’s Hospital in the Longwood Medical Area (LMA).

Dimock Community Health Center on Dimock Street in Egleston Square, and Martha Eliot Community Health Center on Bickford Street in Jackson Square, are accepting new adult patients for primary care.

This reporter walked into Martha Eliot, which is affiliated with Children’s Hospital Boston, last Friday morning, and was able to apply for MassHealth, see a nurse practicioner and schedule an appointment for a general physical examination in under an hour.

All that was required to apply for MassHealth was basic residential information, identification, pay stubs and a copy of a birth certificate. Only a driver’s license was produced, but the process continued, allowing for additional information to be faxed or dropped off in person later. Translators are also available at the center.

Earlier that morning, when the reporter walked into Southern JP, he was told by the receptionist that the center is not accepting new patients until April. He was, in a respectful and polite tone, instructed, in the case of emergency, to go to either Brigham and Women’s or Faulkner Hospital. Faulkner is located on Centre Street in Moss Hill.

In a telephone interview, McNichols said a number of factors have contributed to the problem. She said now more people know about the high quality of care available at community health centers and want to use them. But there are not enough doctors available.

“A small part of it is the process of the state continually looking at trying to enroll more people in and expand MassHealth,” she said.

“That kind of demand is difficult to put up with. It is irresponsible to take on more patients than you can responsibly manage…In the interest of care, you do not want to do that,” said McNichols.

“The health centers are kind of experiencing the same thing as primary care because of the lack of doctors choosing to go into primary care,” said Karen O’Toole of the Massachusetts League of Community Health Centers, in a phone interview. “It hits the health centers harder because they can’t compete with a hospital salary.”

O’Toole also cited growing patient demand at community health centers as one of the main factors bottlenecking their resources. She said this is testament to the quality of care provided, and added that the league continues to work to reform health care, as the state increases its focus as well.

Two years ago, the Massachusetts Legislature passed a law that said the state would no longer compensate hospitals for primary care to Uncompensated Care Pool (UCP, also known as the “free care” pool) patients in outpatient departments located at hospitals. At the time, it was unclear what effects redirecting over 400,000 patients in the state’s UCP, to community health centers would have.

Now, as the state implements its universal health care law, the health centers are developing their own strategies to expand care to more residents and to get the word out about the quality of care being offered.

“I believe every clinic is under pressure about accepting new patients,” said Dr. Myechia Minter-Jordan, chief medical officer at Dimock, in a phone interview. Dimock is affiliated with Beth Israel Hospital in the LMA. “One of the ways [we are doing that] is expanding our hours,” she said. “Part of my job is to change the thought that health care centers have lower quality physicians.”

In June, Dimock will extend its hours to 8:30 a.m. to 7 p.m., Monday through Thursday. It will also add adult, pediatric and eye care Saturday mornings, from 9 a.m. to noon. Dimock is accepting new patients in all five of its clinics.

The center will also host a women’s health forum May 11. Managed care organizations will be present to help people understand the new health care law and to help people sign up for Commonwealth Care.

One benefit of JP’s community health centers is their association with major teaching hospitals. The services of the hospitals are then available through the center. Medical staff at those institutions are often world-renowned.

According to McNichols, if an individual walked into Brookside today who was not already a patient, there are three full-time staff positions dedicated to finding that person an appointment in some other local center. The same would happen if an individual walked into the emergency room at Brigham and Women’s.

At Brigham and Women’s, a full-time access coordinator position was created to direct UCP patients to primary care sites in the community.

According to an e-mail from Lori Shanks, a spokesperson for Brigham and Women’s, the program has seen over 1,200 patients in the last 16 months and has placed more than 700 in a variety of community settings.

According to O’Toole, community health centers serve one out of every eight people in Massachusetts. Of those patients, 40 percent are in Medicaid, a longstanding program paid for by the state and federal governments for low-income individuals. Thirty-five percent are uninsured, underinsured or in the state’s UCP. The rest have some sort of commercial or private insurance.

According to O’Toole, the League of Community Health Centers relies heavily on public funding—namely, the money received from Medicaid patients.

The National Health Service Corps helps selected medical providers, including doctors, repay educational loans, if the doctor delivers primary care in high-need areas like JP. It pays up to $50,000 to any medical clinicians who practice for at least two years in a community health center after completing school. Generally, the slots go to urban areas in need of help. Because Boston has such prestigious hospitals, it does not receive as much money as it needs, O’Toole said.

She said Bank of America realized the need for more money, and developed a $5 million loan repayment program for doctors who choose to work at primary care centers.

According to O’Toole, when the universal health care law does come into effect, there will need to be public resources and funding available to pay for supplying added services, including for doctors.

“We’re up to the test, but we’ll need investments to hire more primary care physicians and to upgrade information technology services,” said O’Toole. “It’s one thing to have a health insurance card but another thing to have access to care.”

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