Of Hospitals and Safety-Nets

Crain’s Chicago Business recently pointed out in “Wealthy hospitals owe their heath to ‘safety nets’.” (Crain’s Feb 9) out that Chicago area hospitals cannot operate in isolation when it comes to serving the health care “safety net” population.

Hospitals and policy-makers cannot ignore the fact that the safety net health care system involves much more than acute care academic and community hospitals. The network of federally qualified health centers (FQHCs) and other clinics such as the Cook County system and free clinics should be important partners. FQHCs provide comprehensive primary care to over 500,000 individuals in the Chicago metro area and to almost one million in Illinois regardless of the ability to pay. They keep ill patients out of the hospital emergency room and help to reduce costs in health care system. They manage a high burden of complex chronic maladies such as diabetes, asthma and high blood pressure.

Perhaps existing expanding hospitals should partner more with FQHCs and others so that emergency rooms are not the first point of care for so many safety net heath care patients.

Such is the case with several hospitals already, including Northwestern Memorial Hospital, which was mentioned in the Our View editorial. Northwestern works with two FQHCs on the North and North West Sides of Chicago to enhance diabetes care, improve mammogram screening rates, and to increase access to hospital-based diagnostic testing and inpatient admissions. Efforts have focused on attacking specific diseases and measuring the outcomes in a results-oriented approach.

There is no question that hospitals and government need to do more in partnership to address challenges of the heath care safety net. Strengthening partnerships with community-based health care providers is part of the solution.(End of post. Thank you for reading.)

Retail Store Clinics Fill Nice Niche Above Your Waist -- But Stop Short

Word last week that CVS will cut some of its in-store MinuteClinics, opening some of them only in flu season got me thinking about the pros and cons of these types of clinics. In addition to CVS, Walmart and Walgreens also have clinics in their stores for a total of about 1,100 locations nation-wide.

These clinics are good for a spur of the moment need but do they really help address the need of the uninsured and those who are really diagnosed with something long term? The answer is more no than yes.

First, the advantages.

In-store clinics offer the basics such as basic physicals, checks for diabetes, cholesterol, and high blood pressure. Some offer help you to quit smoking (you’ll be buying your anti-craving pills and nicotine gum in their pharmacy, of course). They also provide shots for flu and pneumonia prevention and the basic childhood vaccinations. Their web sites provide the full lists of services offered.

Additionally, the clinics probably help keep people who have simple problems such as strep throat, ear aches, bladder infections, rashes, ear wax, the flu, a cold, pink eye, sprains and other acute minor problems from clogging up busy emergency rooms. Think you may be pregnant? Come on in for a test.

They are relatively affordable. The average charges are around $60 - $80 for the common conditions listed above or for a check up such as a school physical, sports physical or health screening. Additional charges may apply. For example, the price of shots is added on to your visit charge in some cases and if you need a prescription filled, you still have to buy it (at the in-sore pharmacy, of course, and pick up some shampoo, deodorant and toothpaste while you’re at it).

Convenience is probably the major advantage, with hours 7 days a week and no appointment necessary. Evening hours are available which is good for working families and kids who are in school.

The clinics are staffed by advanced practice nurses (nurse practitioners) and physicians assistants. Both classes of  these professionals are uniquely qualified to provide the services the clinics offer.

This is all good. It’s hard to argue against making acute care, screening and prevention more conveniently available.

However, the clinics do fall short, especially in the area of comprehensiveness, the ability to diagnose and treat complicated chronic illness and the promotion of continuity of care rather than episodic care. Patients registering at an in-store clinic should lower expectations. (Read more.....)


These are basically “above the waist” clinics, unless you have athlete’s foot. They do treat that. Below the waist? Find another option.

In-store clinics are set up to skim off the easy diagnoses and treat them, leaving the complex medical issues to other health care providers. For example, babies younger than 18 months, women and men with possible or overtsexually transmitted diseases, HIV testing, women needing pap tests for cervical cancer breast exams with a connection to a mammogram are not served. If you have a gynecologic problem you may be out of luck. Colon cancer screening with a take home test? Not on the list. Family planning? Not advertised on the list. And if you actually have diabetes, high blood pressure, heart disease, asthma, arthritis, a pinched nerve, or any chronic condition, you will be referred to your primary care provider – if you have one. If you don’t and you have no insurance, to where will you be referred?

Although there are 1,100 in-store clinic locations around the country, a quick survey of the ones located in the Chicago area show that they generally avoid areas with the highest concentrations of poverty and the uninsured. By contrast, community health centers have over 7,000 locations nation-wide, located in the most highly impacted communities, and provide services regardless of ability to pay. Unfortunately, many community health centers struggle with rapid access as they are overwhelmed with uninsured and low-income patients trying to get in, and few probably offer Sunday hours, although most offer evening and Saturday hours and 24-hour answering services for telephone advice.

The fee at in-store clinics seems reasonable, but can be a barrier. At our health center, many low-income, uninsured patients struggle to pay their flat $30 fee per visit and, as a result, we collect an average of $21 per visit. We never decline services based on the ability to pay. In-store clinics will not slide your fee down based on your income and will not accept a payment less than the full charge.

I am a big fan of the talents and skills of advanced practice nurses and physicians assistants. In Illinois, these professionals may practice without a physician on-site. Our health center uses this model in some of our school-based health centers. Advanced practice nurses and physician’s assistants in Illinois must have a collaborating physician. At in-store clinics, the collaborating physician will never be on site and available to lay eyes and hands on, an advantage we have at our health center’s comprehensive care locations. It is more difficult to collaborate with a physician when the physician is off site.

Overall, I’m glad the in-store clinics are out there. They fill a specific niche. But a smart health care consumer should realize their limitations. Policy makers should pay attention to the growing need to manage chronic care and to provide quick access to complex medical problem solving for safety-net populations. Big box clinics are an “above the waist” entrepreneurial approach but not a solution to the care of the uninsured.

What do you think?
END OF POSTING – THANK YOU FOR READING

Federal Stimulus Dollars Flow to Community Health Centers

Federal stimulus dollars have been directed by Congress to community health centers. Health Centers are economic engines that provide hundreds of thousands of health care jobs nation wide as well as stimulus to the economy through purchasing of supplies and equipment.

The American Investment and Recovery Act of 2009 includes (read more):


$2 billion for community health centers. There are over 1,000 community health centers nation wide with over 7,000 service sites. For example, Erie Family Health Center is 1 community health center with 8 service locations.

Included in the $2 billion mentioned above:

$340 million has just been announced for health centers to immediately increase the number of uninsured patients served by hiring more health care workers, increasing hours of operation, and increasing existing health center services. Applications are due on March 16th to compete for these funds.

$155 million has been already awarded to community health centers who applied to launch new sites last year and were not funded. In Illinois, the following community health centers just received $1.3 million each to add a new service site: Lawndale Christian Health Center (Chicago), Lake County Health Department/Community Health Center, Community Health and Emergency Services (Carbondale), and Friend Family Health Center (Chicago, and affiliate of the University of Chicago).

$1.5 billion for construction, renovation, equipment and health information technology systems at the community health center level. We do not yet know how community health centers will be able to compete for these funds. Buildings such as Erie Family Health Center's, Humboldt Park location  (Chicago, pictured above) are in need of state of the art upgrades.

Community health centers are cost effective providers of primary health care. Health centers provide primary care for 17 million individuals in the US, over 1 million in Illinois and over 500,000 in the Chicago metro area. Currently at least 45.7 million Americans are uninsured. This does not count the underinsured and those who are not residents of the US but who are workers and their family members who need health care.