By Heidi Zemach for SCN -
The new Community Health Clinic, (CHC) opens its doors in Seward Monday, March 10th, in the Providence Seward Medical & Care Center building, exactly where the former clinic was. Patients who spoke with Sharon Montagnino, the CHC board and clinic interim executive director at a meet and greet Thursday evening were saddened to learn that none of the people working at the former clinic have transferred over to the new clinic facility, especially their provider Ellen O’ Brien, an advanced practice nurse. The clinic has hired two new front desk workers, however, an outreach person and an administrative assistant/ billing person, but no permanent clinical staff have yet been hired. Finding physicians or physicians assistants willing to move to Seward to work at the CHC, given a short two-month window of time, is proving to be the toughest job so far, Montagnino said. Even her own position is temporary, and she won’t be staying long.
When the clinic opens Monday morning, there will be a temporary PA (physician’s assistant) in place from Washington State, however, with community health clinic experience and a great bedside manner, Montagnino said. She’ll be working in Seward for a few weeks while the CHC attempts to hire a permanent, full time physician and a mid-level clinician. Montagnino and staff members are talking with an MD from Outside who has expressed an interest. The CHC board may hire additional providers later, if there is enough client demand.
Thursday evening Montagnino spent an hour answering the questions of residents in the CHC waiting room, which appears exactly the same as the one at Seward Providence. She assured people that behind the swinging doors, the six clinic exam rooms all have fresh new coats of paint, new exam tables, stools and wall equipment. The waiting room may also one day become more child-friendly, and equipped with a magnetic play table and picture books.
During the month-long transition, Glacier Family Medical Clinic, a small private medical practice outside of town, owned and run by PA-C Brent Ursel, has seen a notable increase in business. Ursel attended the CHC’s meet and greet, and introduced himself Seward Providence Hospital’s General Manager Joe Fong.
Perhaps the biggest difference people attending the clinic will notice is that fees for services will be offered on a sliding scale for those who qualify, Montagnino said. Those wishing to apply for that sliding scale will be asked to bring in a variety of documents such as their social security cards, last couple of pay stubs or old tax forms. Those who meet the federal criteria set, may discover that the cost that they are charged to obtain preventative health care is considerably lower. Meanwhile, CHCs serve everyone, whether they have private insurance, inadequate insurance, or no insurance at all. Walk-ins are allowed, and will be accommodated when possible. Those needing appointments typically can expect to be seen that day or soon after, Montagnino said.
The point of these federally-funded CHC’s, is to encourage more people to obtain early, preventative health care, and regular care for chronic conditions such as diabetes or heart disease, so that they don’t have to seek more costly emergency treatment in the ER. The clinic will indirectly help Seward’s hospital, therefore, by keeping ER costs down for those who can’t pay.
In order to reach more people, CHCs also are required to have extended hours. For the present, the Seward CHC will be open in the evenings Tuesdays and Tuesdays until 7:00 p.m, and the rest of the week from 8:00 am -5:00 pm. The clinic may offer limited hours on Saturdays during the busy summer season, Montagnino said.
About 400 residents have already requested that their medical records be transferred to the new CHC. All records will remain with Providence Seward, and can be transferred to the new CHC at any time in the future, with written client permission. Providences’ electronic records-keeping software system and the new clinic’s systems are not compatible with one another, so medical records are copied onto paper and filed in boxes, and will have to be inputted later into the CHC’s electronic records system.
As before, prescriptions will be filled at the client’s choice of retailers, including Safeway. CHC board members are hoping for the clinic to apply to qualify to become part of the national 340 B Pharmacy program by which clients can get their prescriptions more cheaply. The clinic also may offer its own in-house physician dispensary, where drug prices are typically 60-70 % the cost of those sold at a retail pharmacy.
CHC clients needing lab work will still use the hospital’s laboratory, just down the hall, for which they will be billed separately. The clinic physician meanwhile can perform simple things like urine tests.
One woman asked whether the Seward CHC would hire a women’s health provider. It will not because CHCs use generalist family providers, Montagnino said. But many CHCs do contract with outside women’s health providers who visit at certain times for those who would prefer to be examined by a female provider who specializes in gynecology and women’s health. CHCs also hold special women’s or men’s health clinics at certain times of the year.
The Seward CHC Board also will contract with the local dental and behavioral health providers in the community, thus enabling the clinic to address the health of the whole body. CHCs are required to regularly conduct health surveys in their communities to learn about its unmet health needs, and then try to meet those needs, Montagnino said.
Meanwhile, the problem of finding and hiring qualified medical providers is troublesome, but is not only an issue for the new Seward CHC, or even for Seward Providence, which has been trying hire two full-time physicians to work in the Seward hospital and Seward Mountain Haven long-term care facility. With the new Affordable Care Act in place, CHCs, and other medical facilities are ramping up their numbers of clinical staff, especially generalists because they are expecting to be able to serve more clients with newly-acquired health insurance than ever before, Montagnino said.
Other things possibly adding to the difficulty of hiring clinicians for Seward is that CHC’s can’t offer wages as competitive as private hospitals and federally-funded Native-health centers. So the Seward CHC is hoping to make up for the comparatively lower wages by offering better benefit packages, including health insurance, vacations, student loan forgiveness, retirement and other desirable benefits. That’s why the City of Seward has created a unique class of city CHC employees for at least the first three years, sharing the city’s longstanding benefits package, but not its overtaxed state retirement plans. Prospective employees also are looking closely at things like Seward’s Cost of Living, the availability of affordable housing, and the other kinds of quality of life amenities available in the area.