The Seward Community Health Center opened a clinic inside the Providence Seward Medical & Care Center building five months ago, replacing the outpatient clinic there. To date the SCHC has seen 600 patients for 1000 visits, and the numbers are climbing, said Patrick Linton, SCHC’s new executive director. But since opening March 10th, Seward’s new community health center has been unable able to hire a permanent physician or even a mid-level practitioner. Rather, it has a visiting nurse practitioner, or “Locum,” working on a 6-month contract as the health center continues to search.
“We only have one temporary provider now, trying to do everything herself,” Linton said, addressing the Seward Chamber of Commerce at an August 1st luncheon forum. She’s an excellent, hardworking nurse practitioner, who will remain on staff through the end of October, he said.
But it appears that many local clients would prefer to deal with someone who will be familiar with their medical history, and will be there each time they visit.
“The question we’re all being asked is, ‘When are we getting the doctor?’” Linton said. “The answer is we’re recruiting constantly”. Recruiting has been “very challenging”, however. “The feedback is positive but it’s not like you turn on the faucet and they come through”, Linton said. A physician from Wyoming has expressed interest in the position, and another physician from Texas is planning a site visit in mid-September. The CHC board’s current goal is to hire one physician and two mid-level providers who will be stable, full time providers, and to have a couple of providers on contract, available to fill in.
Meanwhile, there’s a nationwide shortage of primary-care physicians, estimated at 50-70 thousand, Linton said. In Alaska, where the shortage is even greater, there are 27 federally qualified community health centers serving more than 100,000 clients, and many other private medical facilities recruiting for providers. New physicians and mid-level providers looking for jobs in Alaska have a wide range of choices, even if CHCs like the one in Seward are particularly attractive to new young providers as they may pay off one’s hefty medical school loans, and provide decent health insurance and malpractice coverage. There are 1,400 CHC’s in the U.S. and the number of federally-qualified health centers is growing.
“Those aren’t excuses, just the territory,” Linton added. For every one or two physicians who have expressed interest in working at the Seward CHC, the health center gets inquiries from 5-10 mid-level practitioners, Linton said, so he expects to be able to fill the latter two positions before the CHC gets a physician.
A related factor is the Affordable Care Act, which is making primary care at CHC’s and at private medical facilities widely available to people who weren’t in the mix before: formerly uninsured people who normally would only seek medical care in emergencies, not for preventative care.
Seward Providence Medical & Care Center, a separate facility, also is continuing to recruit for another permanent physician to join its Seward staff. The physicians currently holding permanent positions at Seward Providence hospital and ER include Michelle Hensel, Rob Reeg (the hospital medical director), Amy Bukac and Allison Smith. Smith will be transferring into a locums (temporary) role, but Providence recently hired a new physician, Dr. Will Bemben, to replace her. Dr. Karen Mailer and Tim Katsma, a physician assistant, work at Seward Mountain Haven long-term care facility. Mailer is the medical director.
On a daily basis, the new CHC staff are still dealing with local patients who don’t understand that the new CHC is not part of Seward Providence anymore, Linton said, and that their records and billing, physicians and providers, are separate.
“SCHC is not part of Providence! We’re not the old clinic. We’re just located there,” he repeated. However, the CHC can refer clients to Seward Providence’s ER, or refer them for services such as radiology and basic lab tests, and the two entities do collaborate in several other ways.
The CHC has established agreements with a few of the other local health service providers thus far, including Michael Moriarty, the only Seward-based dentist, and SeaView Community Services which provides behavioral and substance abuse services. The CHC will continue to expand those agreements into other areas, Linton said. He’s also working to establish contractual agreements with Anchorage-based providers, such as with visiting obstetricians for pre-natal care, OB/GYN, orthopedics outreach, specialty clinics, case management, patient and community health education. Seward CHC has not yet provided an after-hours schedule or established a locally-based advice line call service due to the limited number of providers. But the clinic may contract with an advice service outside Seward, and hopes to provide a local nurse line in the future, when fully staffed.
The CHC also has been negotiating individual agreements as a preferred provider with the health insurance providers, starting with the bigger ones, Linton said. Thus far the center has signed such contracts with Aetna, Premera Blue Cross Blue Shield, First Choice Health, Medicare and Medicaid, after working out details such as the prices they will pay for different services.
At the same time that the CHC is getting preferred-provider status in place with insurance companies and health plans, they are also developing referral agreements with local health service providers to provide services required as a federally funded CHC but not provided by the CHC directly, Linton said. Even though SCHC is required to offer sliding fee scale discounts based on income and family size, these other local providers do not have to offer sliding fee-scales, or deep price reductions for their services. However, while establishing referral agreements with those providers, the Seward CHC is required to at least request them to do so. If there are other referral providers in the area that offer sliding fee scale discounts, the CHC might choose to contract with those providers as this is more in keeping with the intent of the federal CHC requirements, Linton said.
Patient records, billing, and other record-keeping, are moving toward being slowly integrated into an electronic records system, but those things have not been accomplished yet either. Going from paper to electronic medical records is a very complex process, Linton said. Registration and billing began in June. Patient records will go electronic in October, along with inter-systems connections, and billings went electronic in July.
Linton had high praise for the CHC Board of Directors. It’s a large, dedicated board of individuals, he said, and an unusually high percentage of them attend the board meetings.
The SCHC does not discriminate based on one’s ability to pay. It offers quality, affordable health care to all, accepting Medicare, Medicaid, and most 3rd party insurances. For those without insurance, it offers discounted services based on a person’s own ability to pay. Services include family planning and health, general primary care including minor office procedures, management of chronic diseases (such as diabetes, hypertension, hypothyroidism, etc), wound care, school and sports physicals, nutrition counseling, health education, and immunizations.
Clinic hours are MWF 9:00 a.m.-5:00 p.m; Tu, Thurs 11:00 am-7:00 p.m.
Appointments call 224-2273(CARE)
The CHC Board of Directors meet the fourth Thursday of each month at 6:00 p.m. at the Seward High School Library. The meetings are open to the public. Dick Cruse is the board president.