The health care safety net

<p>Petaluma Health Center is getting ready to buy more property so it can double the number of exam rooms.</p><p>Sonoma Valley Community Health Center is working on a financial deal that will help pay for a new $10.5 million facility.</p><p>And Southwest Community Health Center, which in the past two years has taken over three neighborhood clinics in Santa Rosa, is planning yet another major expansion in 2011.</p><p>Even as private family practices close and some hospitals struggle to stay open, Sonoma County’s seven community clinics are undergoing dramatic growth as they take in even greater numbers of patients who can’t afford care. Patients range from farmworkers to high-tech professionals who have lost their jobs and their insurance.</p><p>This growing safety net, which now serves 20 percent of the county’s population, could play a central role under President Barack Obama’s push to reshape the medical care landscape.</p><p>“In health reform, community health centers will form the foundation of primary care services in almost every community in the country,” said Petaluma Health Center CEO Kathie Powell.</p><p>The explosion in community care has been fueled by federal dollars that began flowing under former President George W. Bush and have continued with a torrent of federal stimulus dollars.</p><p>Health care legislation now before Congress would target such centers across the country with nearly $40 billion in additional funds over the next 10 years.</p><p>In Sonoma County, the health centers encompass the entire county. They are Southwest Community Health Centers in Santa Rosa; Petaluma Health Center; West County Health Centers in Sebastopol, Guerneville and Occidental; Sonoma Valley Community Health Center; Alliance Medical Center in Healdsburg; Alexander Valley Regional Medical Center in Cloverdale; and the Sonoma County Indian Health Project.</p><p>They have been flooded with patients since the beginning of the decade, growing from about 55,000 in 2002 to more than 93,000 last year.</p><p>Because of a special federal government classification, health centers receive a higher reimbursement from Medi-Cal, the state’s Medicaid program. Such patients, which private physicians avoid, represent health centers’ livelihood and help them cover the cost of those who have no insurance at all.</p><p>“We’d be in a mess” without health centers, said Andrea Michelsen, community benefit manager for Kaiser Permanente in Marin and Sonoma counties.</p><p>“It’s very hard for private-practice physicians to care for Medi-Cal patients, and the clinic gets a better rate for that,” she said.</p><p>As the money has come in and patients have flocked to the centers for care, they also have become a home for more physicians. With the infusion of $2 million in stimulus funds, local health centers and clinics are hiring six family practice doctors, one pediatrician, one nurse case manager, two physician assistants and six support staff.</p><p>One of them is Dr. Julie Kiser, who was doing her medical residency in the mid-1990s at Community Hospital, now Sutter Medical Center, in Santa Rosa. Back then, health care overhaul under former President Bill Clinton was dead, hospitals were expanding and community clinics were still small players in the county.</p><p>Kiser, 47, has gone to work for Southwest Community Health Center on a part-time basis, putting in 24 hours a week.</p><p>“I see people who are really sick, fractures, bad infections, pneumonia, chest pain, elders with diabetes and hypertension,” said Kiser. “I take the</p><p>spillover.”</p><p>Kiser, who worked on the universal health care campaign during the Clinton era, came back to Sonoma County in January after eight years working in Guatemala. She said the health care crisis has given rise to the “public will” for change, “because people can’t cope anymore.”</p><p>Last month, Kiser treated a 53-year-old Santa Rosa woman named Kimberlee at Southwest’s Chanate Family Practice Center.</p><p>Kimberlee, who is is unemployed and asked that only her first name be used to maintain her privacy, had been out walking her dog in the woods, taking a break from job hunting, when a tick burrowed into the back of her leg, behind her knee. A few days later her knee became stiff and sore, and the spot where the tick had embedded itself had become dark.</p><p>She called Southwest on a Monday and was told she could not be seen until Wednesday. But by Tuesday, the back of her knee had looked “like a pancake, like a thin red pancake and the skin was raised up. It was angry, red hot.”</p><p>She called Southwest and was told to come in immediately. Kiser said she had a skin infection.</p><p>“If she had waited one more day, she would have had to be hospitalized,” said Kiser, who gave her antibiotics, both oral and injected, hot soaks, elevation and a next-day follow-up. “She was able to be seen the next day because I was there.”</p><p>Kimberlee, a certified personal coach and former business marketing rep, said she’s been searching for a job since 2007. She recently did temp work at a local high-tech company that helped her build up some savings, but it’s not enough for medical coverage.</p><p>“I haven’t had health insurance since I was 50,” she said. “Because the premiums are so dang high, I said forget it.”</p><p>For her treatment at Southwest’s Chanate clinic, Kimberlee paid $148.33, a cost that included three doctor’s visits at $20 a visit, two antibiotic injections at $19.08 a shot and prescribed oral antibiotics. She paid out-of-pocket for the treatment, which likely would have been far more expensive in a hospital emergency department.</p><p>Most medical professionals agree that as the health center safety net grows, the number of patients using an emergency room as the only access to medical care should decrease.</p><p>“When people have a medical home, they’re less likely to need to go to the emergency room,” said Kaiser Permanente spokesman Carl Campbell.</p><p>Health centers in California have put themselves in a competitive position as primary health care providers, becoming a “medical home” for those who lack a family doctor or Kaiser membership, said </p><p>Robert Phillips, director of health and human services for California Endowment.</p><p>Phillips said that in some ways many health centers are returning to the roots they fashioned during the 1960s and ’70s.</p><p>He said clinics in the state see about 3 million patients a year for about 4.2 million yearly medical visits. He compared that to the 7 million California members at Kaiser Permanente, which has the largest market share in the state.</p><p>The number of patients at local health centers, he said, is “likely to go up, not down,” as the recession claims more health insurance plans.</p><p>Large health care institutions now work closely with the growing safety net provided by local health centers.</p><p>For example, Southwest Community Health Center took over Chanate Family Practice Center at a time when Sutter Health was trying to close the nearby medical center, helping save the Santa Rosa Family Medicine Residency program, said Pedro Toledo, a spokesman for the Redwood Community Health Coalition.</p><p>Sutter gave the local health center coalition $250,000 last year to help bring electronic health records to local clinics, a $14 million project. And St. Joseph, which operates Santa Rosa Memorial and Petaluma Valley hospitals, runs the dental clinic next to Southwest Community Health Center’s campus on Lombardi Court in Santa Rosa.</p><p>Over the years, Kaiser has provided hundreds of thousands of dollars in grants to the county’s health centers. It recently gave a capital grant of $250,000 to Southwest Community Health Center to support its expansion plans.</p><p>“We recognize that they serve a real need in whatever health care system, in the current system and in the future,” said Kaiser’s Michelsen.</p><p><i>You can contact Martin Espinoza at 521-5213 or martin.</p><p>espinoza@pressdemocrat.com</i></p>