For Community Health Centers, An Era Of Explosive Growth

By: Brian Kehrl
Published: 08/17/12

With a new addition expected to be completed next month, Community Health Center of Cape Cod will offer a host of new and expanded services, including more than tripling its dental facility.

Duffy Health Center is growing by 20 percent per year, just recently having moved into a new home near Main Street in Hyannis.

Patient visits to Outer Cape Health Services, which operates facilities in Harwich, Provincetown, and Wellfleet, increased from 31,000 to 61,000 visits year over year.

Mid-Upper Cape Health Center in Hyannis is planning to expand from an approximately 5,000-square-foot facility, where it is open 363 days a year, to a building of more than 20,000 square feet.

The health centers in the region are registering 700 new patients per month.

The leaders of four community health centers from across Cape Cod told similar stories at an event on Wednesday morning in Hyannis marking “National Health Center Week.” They have each experienced explosive growth recently, and each is either preparing for or has just undergone significant expansion. But the landscape for the nonprofit health centers remains uncertain, with questions about state and federal funding and the consequences of the state healthcare reform bill signed this month by Governor Deval L. Patrick.

The health centers aim to provide health care mainly to patients who would otherwise have challenges getting it due to financial, insurance, language, or social barriers. They served 33,000 patients on the Cape last year, up from 23,000 in 2007. They offer a wide range of services, from primary care to mental health, dental, women’s health, a pharmacy, insurance policy assistance, and case management. Engrained in each of their missions is to provide health services regardless of the patient’s ability to pay.

US Rep. William R. Keating (D-Quincy) was in attendance, as well as staff from three members of the Cape’s state legislative delegation, Sen. Daniel Wolf (D-Cape and Islands), Rep. Sarah K. Peake (D-Provincetown), and Rep. Demetrius J. Atsalis (D-Barnstable).

The event was an opportunity for the health center directors to highlight their successes and plead their case for additional funding and support from the state and federal government.

Expansion Due To Regulation

The recent expansions have come by necessity to meet the requirements of the state’s health insurance reform from 2006 and with funding provided by the federal reform and the stimulus bills of 2009, according to Karen L. Gardner, CEO of Community Health Center of Cape Cod, which primarily serves patients from Mashpee, Falmouth, Bourne, and Sandwich.

The Community Health Center of Cape Cod, for example, now serves one in six residents of Mashpee and Falmouth. The coming, 20,000-square-foot expansion is expected to allow the facility’s patient load to grow by at least 50 percent.

Ms. Gardner said the health centers have responded to the shortage of primary care doctors by using “alternative delivery methods,” like pairing patients with teams of providers ranging from nurse practitioners to mental health specialists.

Their growth is a boon for taxpayers, according to Duffy Health Center CEO Heidi R. Nelson. Health centers across the country save approximately $24 billion a year, she said. For example, while health centers bill $140 for an average patient visit, the average visit to an emergency room is billed at $600.

Ms. Nelson said Duffy is working to avoid turning away any patient at any time based on the belief that if they cannot be seen at the health center, the patient is likely to walk across the street to Cape Cod Hospital’s emergency room. Working for a population that is often transient, Duffy can be one of the few sources of stability in their lives, Ms. Nelson said.

However, Ms. Gardner said the healthcare environment is changing rapidly and the health centers need further federal and state assistance.

Several of their complaints were aimed at state government, with Sally Deane, CEO of Outer Cape Health Services, saying that state assistance for vaccinations has been particularly problematic. She lost $90,000 in vaccine funding from her budget last year, she said.

State Cuts Impacting Health Centers

Ms. Gardner said the licensure program under the state Department of Public Health has been cut to the point that it is causing delays because the state does not have the staff to come and provide the necessary inspections for the facilities to receive their licenses.

“Yes, DPH has been decimated by budget cuts,” said David B. Reidy, executive director of Mid-Upper Cape Health Center in Hyannis.

Ms. Gardner also asked for consideration as the state begins to implement the recent healthcare cost control legislation.

The importance of dental care, and the need to expand dental services on Cape Cod, was a recurring theme throughout the session. Ms. Deane, for example, noted that untreated dental pain is the number one reason for employees missing work on Cape Cod.

Mr. Reidy said the health centers are preparing to expand their dental services from 19 to 37 chairs, but even more growth is needed.

Ms. Deane said the government should consider a program to attract more doctors into primary care, like a system in which medical school debt would be forgiven if the doctors spent time in primary care training in rural areas.

Ms. Nelson expressed concern about the consequences of the major, across-the-board cuts in federal spending scheduled to take effect at the end of the year. Health centers are in better shape than many other programs, however, as their budget reductions are limited to only 2 percent, while defense programs will see cuts of up to 7.5 percent.

The directors had a supportive audience in Rep. Keating, who praised the health centers for the service they provide to the region and their cost-effectiveness. The health centers here are a model, he said, one that he touts to his fellow legislators on Capitol Hill as a “laboratory” for the rest of the country.

“You are forging a trail,” he said, promising to fight to preserve federal support for them.

Rep. Keating noted that between the different health centers, they represent a broad array of community types. While Outer Cape Health Services provides more convenient access to a rural, remote area with otherwise limited options, Duffy Health Center primarily serves patients who are homeless or at risk of being homeless in Hyannis, he said.

Partisan Support For Health Centers

However, he described support for the centers and their work as a partisan issue. He noted that his colleagues, Republicans in the House of Representatives, have fought to repeal the recent health insurance reform law, the American Care Act, which provided much of the funding for the health centers to expand. If the country changes course now, he said, the progress made over the past few years will be lost, medical care will be more expensive, and the issue will need to be revisited in another eight to 10 years.

The health centers received $14 million in federal funding for their recent expansions, including $6 million for the expansion now underway at the Community Health Center of Cape Cod in Mashpee.

Support for health centers, as well as much of the rest of federal programs, is also at risk of reductions as a result of the looming budget cuts scheduled to come into play at the end of the year, a scenario he blamed on the Tea Party threatening to push the country into default on its debt.

Further, programs like Women, Infants, and Children (WIC) under the US Department of Agriculture and women’s health services are also being threatened by Republicans.

“If they are cut, be ready to be asked to do even more with even less,” he said.

The directors in turn thanked Rep. Keating for his past support.

“You have always been a supporter of social justice,” Ms. Deane said.

“Well, I don’t care what perspective you are coming from. If you are coming from being a cheap person, this is the way to go,” Rep Keating responded. “I am confident that there is no other direction to move things than the direction you are going here.”