Benton County : Clinics for poor get 1st aid
Posted on Sunday, October 7, 2007
A clinic serving low-income and uninsured patients in Washington County is rushing to use federal money for an expansion into Benton County, where patients have faced the threat of dwindling access to such services.
In January, Tree of Life Family Health Center in Rogers announced that a financial crunch might force it to close.
A larger clinic in neighboring Washington County, Community Clinic at St. Francis House in Springdale, offered to help the Rogers clinic try for federal grant money, but the two are still in talks about a possible partnership.
Community Clinic decided not to put everything on hold pending the Rogers clinic’s decision. It landed a $ 750, 000 grant to open a satellite location in Benton County next year and is looking into whether the grant could involve a partner clinic.
To the west, St. Francis Clinic, which serves the working poor in Siloam Springs, has received a steady stream of calls since a state Department of Health satellite unit there closed in late January. The clinic doesn’t offer the preventive care the patients were able to get at the public health unit.
In Benton County’s lowincome spots, those without health coverage often must invest time and money getting to the nearest clinic that will accept them or go without care.
Jose A. Ballesteros, who lives in the Monte Ne area of Benton County, said he must go to Washington County every three months to keep his diabetes under control.
When he lost his health coverage three or four years ago, someone suggested Springdale’s Community Clinic could provide a wide range of services.
“There’s no clinic over here that will help like the clinic over there,” said Ballesteros, who travels 30 to 45 minutes one way to a clinic that offers checkups, treatment and nutrition counseling for a sliding-scale fee.
POVERTY POCKETS Benton County’s population of have-nots is growing at a faster rate than the number of available health-service providers, clinic directors say. When Community Clinic announced the grant to establish the new Benton County clinic, a common response in Arkansas was surprise. Benton County, regarded as one of the state’s wealthiest, was only one of three in Arkansas that qualified for money under President Bush’s “High Poverty County Initiative,” which identified what it said were the 200 poorest counties in the nation. The other Arkansas clinics receiving the grants were in Lake City in Craighead County and Mount Ida in Montgomery County. It’s easy to forget that there are pockets of poverty and a growing economic disparity brought on by rapid population growth in Benton County, said Kathy Grisham, Community Clinic’s executive director.
Raquel Beck, director of St. Francis Clinic in Siloam Springs, said those traveling Interstate 540 don’t see places the federal government has designated as “medically underserved areas,” such as Gentry or Decatur. “The 540 corridor absolutely masks that western Benton County is not as affluent,” said Beck, whose clinic’s patients are 59 percent white and 36 percent Hispanic. The federal government considered a certain specific criteria for the grant, Grisham said.
It boiled down to the county’s low-income pockets, combined with a person’s limited access to affordable health care. Grisham relied on U. S. Census Bureau data and federal health statistics in preparing the grant application. “We looked at target populations within Benton County that were at or below 200 percent of the federal poverty level,” she said, referring to poverty guidelines the government uses to determine eligibility for certain federal programs. During the 2000 U. S. Census, poverty guidelines show the 200 percent level was $ 34, 100 for a family of four.
Among their findings: More than 41 percent of the target population, or 12, 785 people, living in the clinic’s service area met this criteria, compared with 39 percent throughout Arkansas and 30 percent overall in the United States. The service area covered low-income neighborhoods in Rogers and rural areas that include Gravette, Decatur, Pea Ridge, Siloam Springs and Gentry.
In addition, more than 21. 5 percent of respondents to a federal Centers for Disease Control and Prevention behavioral risk survey in the Fayetteville-Springdale-Rogers Metropolitan Statistical Area said they had no health coverage, compared with 14. 5 percent nationwide.
DEADLINE TO OPEN CLINIC Grisham’s agency must move fast. The grant requires that the new Benton County clinic open to patients by Jan. 2. Community Clinic has been in talks with Decision Point, a drug rehabilitation center, about remodeling 6, 000 square feet of space next to its offices in the former Bates Memorial Hospital in Bentonville, Grisham said, but that may prove too expensive so the clinic is weighing other options. “It might be that we temporarily use their clinic and then later establish our own clinic somewhere,” she said of Tree of Life.
The Community Clinic Benton County Medical will offer comprehensive primary and preventive services. These will include general family medicine, pharmaceutical programs, childhood immunizations, laboratory and X-ray services, health-education and smoking-cessation classes, diabetic and nutrition consultation, and referrals for mental-health care and substance-abuse services.
Community Clinic already has expanded its dental service to Benton County, opening Community Clinic Rogers Dental in July. The dental clinic, which had a grand opening Sept. 25, plans to provide 4, 500 low-income or uninsured patient visits in the startup of its first year.
About 60 percent of Community Clinic’s patients are Hispanic, more than 32 percent are white, and about 5 percent are Pacific Islanders-Marshallese, Grisham said.
Springdale is home to the largest population of Marshall Islanders in the continental United States, said Cambre-Horne Brooks, Community Clinic’s development director.
Marshallese face cultural and legal barriers to health care, Horne-Brooks said. Because their marriages are informal and not legally binding, private insurance companies don’t recognize their spouses on policies, she said. With the exception of pregnant women, Arkansas does not extend Medicaid to foreignborn Marshallese.
Health officials have long said that adequate primary and preventive services are far less expensive than treating acute and chronic illnesses, and that lack of access to them results in overused emergency rooms and higher overall health-care costs.
Under the federal Emergency Medical Treatment and Active Labor Act, hospitals must treat everyone who comes in the emergency-room door, offering an “appropriate” medical screening examination, and stabilization of all medical conditions. GRANT-SEEKING AUTHORITY Community Clinic is what’s known as a federally qualified health center, one of 12 in Arkansas.
Such a center must meet a number of federal criteria of the Bureau of Primary Health Care. They must be nonprofit, consumer-directed health-care corporations offering a comprehensive array of medical treatment, including preventive services.
Among other things, the federal designation makes such a center eligible for direct federal grants under the U. S. Public Health Services Act.
Community Clinic accepts on a sliding-fee scale uninsured patients as well as patients with Medicare, Medicaid, ARKids First or private insurance. Nearly one-third of its 70 employees are bilingual. It expects about 26, 000 patient visits this year.
In December 2006, Community Clinic applied for a grant under an earlier federal health initiative in hopes that it could help Tree of Life expand its services to the poor and uninsured.
Tree of Life announced in September 2005 it was changing its name from Poplar House. The clinic, operated by Mercy Health System of Northwest Arkansas, planned to expand its services to Medicaid patients. Officials said their ambitions included eventually taking on Medicare patients and putting the clinic on track to become a federally qualified health center.
A month after its fellow clinic’s grant application on its behalf, in January of this year, Mercy officials made a surprising announcement: They had given themselves 45 days to decide whether to close Tree of Life, a financial decision that would be wrapped up in a larger restructuring effort. Mercy later extended the deadline for the decision to June 30.
In the meantime, Grisham’s center learned it didn’t get the first grant, but could apply for another one for Benton County. When Community Clinic couldn’t get a commitment from Mercy officials, it tailored the second grant application toward a brand-new clinic there, but continued talks with the Rogers clinic. Tree of Life still hasn’t closed. “The decision has been made to keep it open, but we are still looking for sustained sources of funding,” said Dr. Steve Goss, a physician executive for Mercy’s medical clinics division. “We certainly think the problem is bigger than what Mercy itself can take care of it,” he said. “There just needs to be wider community buy-in into it.” Mercy hopes either to find a different means of community support or to look for gifts that have more lasting impact, such as endowments. Goss wouldn’t say why Mercy had declined help so far from Community Clinic. He said health-system officials had not ruled out accepting its help, knowing that potential donors might prefer a focused effort at improving medical access in Benton County. COMMUNITY SUPPORT HELPS At the Siloam Springs facility that Beck runs, St. Francis Clinic, community support has been generous and partnerships numerous.
The small clinic is in the second year of the two-year, $ 175, 000 grant from the Johnson & Johnson Community Healthcare Program that allowed it to go from volunteer physicians to adding a paid nurse-practitioner and Beck’s director position.
“When we first opened in 2002, we were only open two nights a week,” she said.
Many of the clinic’s patients are working people who cannot afford or have no access to health insurance, she said.
The clinic started a system that allowed its volunteers to triage people, record their vital signs then send them with a one-time voucher to local doctors at the private-practice Community Physicians Group.
Siloam Springs Memorial Hospital helped, too, providing rent-free clinic space and lab work, Beck said. She believes the voucher system got Johnson & Johnson’s attention during the grant process. The clinic cannot provide preventive services, such as immunizations, Beck said. When the state Health Department’s Benton County satellite health unit closed in the early 2007 because it lost its rental space, its displaced patients turned to St. Francis Clinic. The clinic receives three calls to five calls daily, Beck said, but can’t help those patients.
“We’re only able to do what we’re doing now because of a grant,” Beck said.
The state Health Department based its closure decision for its Siloam Springs satellite clinic on the loss of a lease for its clinic space, spokesman Ed Barham said.
The clinic had been renting the space for $ 600 a month, a figure that included utilities, from Allen Canning Co., which decided not to renew the lease.
The $ 600 monthly rental was all the department had budgeted for, so it closed the site, Barham said.
“For all intents and purposes, we ceased service at the end of January,” he said. “We physically vacated by mid-February.” Barham knows of no final decision, but thinks the satellite will reopen once officials find an affordable location that is easily accessible to patients.
“The decision that hasn’t been made is when or where,” he said.
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