Lawrence’s health care provider for uninsured running out of room / LJWorld.com

Archive for Thursday, January 15, 2009

Certified medical assistant and pharmacy technician Patty Webb turns to her computer monitor as she fills a prescription recently at Health Care Access, 1920 Moodie Road. Because of space issues, Webb’s desk has been placed in the room where supplies and medicine are stored at the clinic.

By Karrey Britt

January 15, 2009

Health care clinic bursting at seams

Tight times means a boost in patients for a Lawrence nonprofit that provides medical care for the uninsured. Enlarge video

While the building at 1920 Moodie Road may be small, the nonprofit agency located inside has a big job.

Health Care Access provides medical care to Douglas County’s uninsured, which is estimated at 12,000 people.

During the past year, it served 1,703 patients and provided more than $4 million worth of care through collaboration with volunteer doctors, donated services from Lawrence Memorial Hospital and more than 30 pharmaceutical companies.

Health Care Access saw an 11 percent increase in clients during 2008, and it expects the volume to rise this year.

“We are preparing for more and more people to lose their benefits and for more who can’t afford their portion of the premiums,” said Nikki King, executive director of Health Care Access. “Employers are making hard decisions about whether they can even offer that benefit anymore, so we are expecting an influx.”

But the agency has run out of room at its 3,200-square-foot office. The average wait for a routine office visit is about four to six weeks, and that’s mostly because there are only five examination rooms. The agency got creative and divided one room into two by using floral bed sheets, so now they have six.

“It’s not ideal,” King said, “There’s much less privacy.”

Two of the six rooms don’t have sinks and three of the rooms have carpeted floors, which isn’t good for sanitation reasons.

The agency also lacks space for its 11 employees and approximately 20 on-site volunteers. There is no meeting space, no storage space and no place for employees to eat lunch.

‘Up against a hard wall’

During a recent afternoon, two volunteers — Fred McElhenie and Ed Quick — were crammed into a small room working on files. Sometimes, the volunteers said, they have to work in the hallway or work standing up.

McElhenie has been a volunteer for eight years and spends between four and seven hours a week helping the organization. He does chores such as watering trees, sending letters and fixing things. In his time there, he has seen the space get eaten up.

“Frankly, it just gets smaller and smaller,” he said. “We are kind of up against a hard wall.”

King would agree. Armed with a $96,000 state-funded capital improvement grant, she has been looking for space to expand. She has until June 30 to match that grant in either in-kind or actual dollars.

“That’s our time crunch. If we can find a publicly owned property that reaches that same value, then our job is done,” she said.

If not, the agency may have to look to the private sector and do fundraising — something King hopes to avoid.

The agency pays the City of Lawrence $1 per year for its location. Among the options that have been considered in the public sector is the Community Health Facility, 200 Maine, which is owned by the city. But that option has raised eyebrows among Lawrence Memorial Hospital leaders and the Lawrence-Douglas County Health Department board, and it’s mostly because of the lack of available space. The building is used by the Douglas County Visiting Nurses, Rehabilitation and Hospice Care; the health department; and Bert Nash Community Mental Health Center.

“Those three agencies have been very open to the idea of collaboration and what can we do to synergize our services for our patients,” King said. “There’s nothing definite now.”

‘Campus of care’

Judy Bellome, VNA chief executive, said she thought locating Health Care Access in or near the building made sense because Health Care Access could share clinic and meeting space with those in the building. It also would be near the hospital and other health care providers such as the Douglas County Dental Clinic, 316 Maine.

“It just seems to make sense to be a campus of care,” she said.

King also would like to see Health Care Access on property closer to the hospital for a number of reasons:

• It would remain in their patient demographic. They did a survey of where most of their patients reside. Thirty-eight percent live in the ZIP code 66044 and 29 percent in 66046. Those ZIP codes represent mostly eastern and northern Lawrence.

• It would increase visibility for patients and volunteers.

• It would be easier for patients to get lab work, X-rays and follow-up care. They could be referred to other health agencies, and those agencies could refer patients to Health Care Access.

• It likely would be along a bus system route.

Challenging situation

King said the ideal location to expand also would include at least 5,000 square feet of space, which would be enough for 12 examination rooms, a meeting room, and educational space for classes on topics such as nutrition, diabetes and smoking cessation.

“It would be nice for the nurses not to eat at their desks,” King said.

They also hope to keep rent payments to a minimum.

“If we have to get into paying $3,000 to $5,000 a month, that’s going to hurt our staffing capabilities. We don’t want to have to make those sort of choices,” King said. “That’s why we have pushed real hard on some of these publicly owned properties.”

While King wouldn’t reveal other possible locations, she said they have looked at 20 locations.

“This is the hardest part right now is just identifying where it is going to be,” King said. “None of our challenges in this process have been unreasonable because everybody’s in agreement that we need to try to find the most amount of space at the right price, so that we can continue to serve this hole in the health care system and that our ER is not overpopulated with primary care issues by the uninsured.”

Discussion

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15 January 2009
at 7:24 a.m.

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OldEnuf2BYurDad (Anonymous) says…

“Because of space issues, Webb’s desk has been placed in the room where supplies and medicine are stored at the clinic.”And they keep taking her Swingline stapler, so Webb plans to burn down the building.
15 January 2009
at 8:57 a.m.

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AnglNSpurs (Anonymous) says…

LOL OldEnuf! “Umm I am going to need you to come in to work this weekend, emm kay”
15 January 2009
at 9:26 a.m.

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xbusguy (Anonymous) says…

Lawrence, KS, where round-abouts are more important than health.
15 January 2009
at 9:48 a.m.

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jengaman (Anonymous) says…

They could save a little room by cutting out the 50” computer screens. That thing looks massive!
15 January 2009
at 10:01 a.m.

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cowboy (Anonymous) says…

If lawrence follows the national norm there are about 15-20,000 uninsured. Health care access has a scale for individual qualifying that cuts off at 16,000 per year income , maybe those under that number amounts to 12000. Then there are the other 8,000 or so that don't have it and also don't qualify for HCA. The tweeners so to speak. Lawrence has a start on community health care but it is far from where it needs to be.
15 January 2009
at 10:25 a.m.

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Informed (Anonymous) says…

While I see the need for Health Care Access, I'd like some clarification before we all go getting warm and fuzzy about this place.According to their web site, they are open 8:30-4:30, M-F. That's 8 hours of office visits per day. So, they are open 5 days a week, 52 weeks a year; That's 260 days of seeing patients. If we subtract an arbitrary 15 days to allow for various holidays, that still leaves 245 days to see patients.Now, here's where I start to have questions. The articles states that HCA saw 1703 patients in 2008. It doesn't say 1703 individual visits, just patients, so if we average 1.5 visits per patient, that comes out to 2555 visits on the year. (I rounded up, rather than split a patient.)2555 visits ÷ 245 days = 10.4 patients seen per day.10.4 patients per day??? Does anyone else have a problem with this? That's using an average of 1.5 visits per patient. Increase the visits per patient to 2 and the number of patients seen on a daily basis is still only 14 patients. It would seem to me that 5 exam rooms would be plenty as each room would see less than three patients per day.I realize my numbers are based on my own input, but they seem pretty reasonable to me, unless someone from HCA wishes to provide more hard data, without violating HIPAA laws, of course.
15 January 2009
at 10:26 a.m.

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Informed (Anonymous) says…

You posted while I was doing my own numbers, hawk. But it seems that we're thinking along the same lines.

15 January 2009
at 10:54 a.m.

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appleaday (Anonymous) says…

If you consider that probably most of these patients are children or are adults with chronic illnesses, 1.5 visits per year is unlikely. Infants have 7 or 8 well visits alone in the first year of life, not to mention an increased frequency of illnesses requiring evaluation by a physician. (Ear infections, RSV pneumonia, etc.) People with chronic illnesses often have to be monitored at very frequent intervals. All of this is important to keep these folks out of the hospital which, as you all know, is expensive.
15 January 2009
at 11:05 a.m.

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Informed (Anonymous) says…

Without more information, your postulations are as vague as mine, appleaday. However, by using a 2 visit average, under utilization still seems to apply. I refuse to believe that every patient of HCA has chronic problems or is a child.Also, keep in mind how many parents use the ER as their general practitioner, knowing that they can't be turned away, regardless of ability to pay. Many of the ear infections and RSV pneumonia patients will start, rather than end, at the ER.So, again, HCA would you care to provide some hard data?
15 January 2009
at 12:13 p.m.

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mom_of_three (Anonymous) says…

According to their 2007 annual report, they had 1621 patients served, with 3,757 on-site appointments. If they are open 245 days a year, that is over 15 appointments a day. And in 2007, they only had 4 rooms, I believe.Now, those are 2007 numbers. And how long do appointments take? We don't know and some medical issues are much more complicated than others. So if they served over 1700 patients in 2008, you assume the number of on-site appointments also went up. Babies and vaccinations, well baby checkups and kids often take multiple appointments. We also don't know how many nurses are there each day and doctors, so that might make appointments longer than at a usual doctor's appointment that we are used to. I don't think they are trying to scam anybody people. And HCA is probably thinking about the economy and how it's only going to get worse. I wish them the best of luck.
15 January 2009
at 12:18 p.m.

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appleaday (Anonymous) says…

You're right; informed, the Journal-World should provide more hard data. I actually did a lengthy paper on HCA when I was in graduate school and have some idea about the types of patients they see. I'm also in a health care field. I don't have current hard data, however, but I can say with certainty that they see well over 10.4 patients a day. They are very busy and a lot of the care they provide comes from people who volunteer, including doctors and other health professionals. This is a well-run agency that provides a much needed service. The beauty of the Lawrence medical community is that when Health Care Access was started, the local hospital, physician offices, pharmacies, and others all offered services at zero or reduced cost. The hospital administrator at that time (who was a real penny pincher) knew that donating services at a preventive and secondary care level could save thousands of dollars in the long run.
15 January 2009
at 2:38 p.m.

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edjayhawk (Anonymous) says…

Ban Round-a-bouts! Ban Health Care Access!
15 January 2009
at 2:39 p.m.

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edjayhawk (Anonymous) says…

Informed: Would you be willing to volunteer for a few hours a week?
15 January 2009
at 3:01 p.m.

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lawthing (Anonymous) says…

Holy Crap!! How much do they spend on one patient?”During the past year, it served 1,703 patients and provided more than $4 million worth of care”
15 January 2009
at 3:18 p.m.

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Informed (Anonymous) says…

No, edhayhawk, I would not be willing to volunteer for a few hours a week. I am not a health care professional. I am not completely dissing HCA; I'm asking for clarification either from them or perhaps the JW. I broke down the information and extrapolated from what was given and based on my best guess. According to the provided 2007 data, it looks like my average of 2 visits per patient was not far off from the 2.3 of the actual data.WTF are you talking about, notnowdear? Nursing shortage? Nursing job shortage? Who mentioned either? And your stroke crap? It looks as if you've been taking c&p lessons from Heckler. Thank you, mom and appleaday. You've both provided some information that is missing in the article. As I posted earlier, I definitely see the need for HCA. I am very, very thankful that I have great medical, dental and vision insurance available to me at very little cost. I know that not everyone is as fortunate.

15 January 2009
at 5:48 p.m.

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edjayhawk (Anonymous) says…

Yeah its probably part of a vast left-wing conspiracy brought about from the liberals in Lawrence…Of course Hawk would never think of donating time or money to the organization. Only bitch about the people who need the service. I bet he has health insurance.
15 January 2009
at 6:15 p.m.

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GardenMomma (Anonymous) says…

Care is more than just medicine. It is the building, the utilities, the machines, the medicine, the supplies, the office supplies, computers, software, etc. So $4+ million in expenses just about covers it. Besides that includes some of the “in-kind” donations. What goes in as a donation (e.g. LMH performing an MRI gratis) needs to be expensed as well. It's part of accounting transparency.
15 January 2009
at 7:06 p.m.

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cowboy (Anonymous) says…

I'd like to see it get real frigging simple , if you don't have health insurance , have a low cost health clinic to handle the everyday needs of the uninsured without a six week qualification process . charge for the visits but don't rip off the uninsured. The local prompt / first med / and others charge a hundred dollars just to get in to see a doc for 3 minutes. I think that is just a rip off. I have no particular beef against the HCA model , I just find it absolutely NOT meeting the needs of the the vast majority of uninsured folks.
15 January 2009
at 7:22 p.m.

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staff04 (Anonymous) says…

Having worked on the issue extensively at the federal level, I can tell you that, despite what anyone else has said, there IS a nursing shortage. Nursing schools are at capacity, regularly turning away thousands of qualified students. At least one more populous state that I worked directly with turned away nearly 15,000 qualified students last year because they simply didn't have the advanced practice nurses to teach them all.Meanwhile, we are importing thousands of foreign nurses each year while nurses work mandatory overtime to fulfill the need.It is a bigger problem than some would make it out to be—just ask a few nurses.
15 January 2009
at 7:48 p.m.

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Informed (Anonymous) says…

How about you, edjayhawk? Can we expect to see you volunteering at HCA?
16 January 2009
at 1:49 a.m.

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KansasKel (Anonymous) says…

HCA also provides medication coordination services with Patient Assistance Programs. People may not necessarily be seen frequently for office visits, but there is still an expense involved in coordinating their medications. I believe the $4 million figure represents donated services as well as actual care provided by HCA, as someone mentioned above.This is a resource sorely needed by our community and I am thankful it is there. I've seen it help many people that otherwise would have gone without care. They have helped me before.I'm a nurse, by the way, and don't have health insurance.
16 January 2009
at 4:57 p.m.

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edjayhawk (Anonymous) says…

How about you, edjayhawk? Can we expect to see you volunteering at HCA?Already have, wise guy,