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Thursday, November 13, 2014

Non-profit is Not Synonymous With Good Health Care-Anti-Consumer Practices at a Federally Subsidized Clinic

Non-profit is Not Synonymous with Good Health Care-Anti-Consumer Practices at a Federally Subsidized Community Health Clinic
On October 31st, I took my teenage son to Peninsula Health Clinic in Bremerton, for evaluation of a clinical intervention for depression. My regular readers will recall the trauma center blog I posted in October 2012, when my son was hit by a pickup truck and sustained a traumatic brain injury. Head injuries can take a long time to heal and depression often follows. As a healthcare advocate I am compelled to share my experience to illustrate the complexity and failings in primary care in the U.S.A.
Teen Denied Care at State and Federally Financed Community Health Clinic
Arriving at the health clinic after a 2 hour commute walking and via public bus in a driving rain storm, I went to the counter to get my son checked-in for his appointment. There was no queue of patients standing in line, and I was informed we were 6 minutes late for our appointment. I explained that we had traveled by bus and we got to the clinic as soon as possible, and we were still within 10 minutes of the scheduled time. After several minutes, the administrative staff informed me that the doctor was unwilling to see my son, even though he was not a new patient and this had been his primary health care location for over 5 years. At this point, I was incredulous that we were being urged to leave and stated my son was there for evaluation for depression, which had been discussed with the school nurse. What happened next will floor you.
Clinic Staffer Encourages Dumping Practice of Referring Patients to the Local Hospital for Non-Emergency Treatment
Peninsula Health Clinic which actually denied care for my son, which was not of an unusual nature, encouraged us to use the emergency room of the local hospital. My son’s health did not merit an emergency intervention, which is why we were at a primary health care clinic or in layman’s parlance, the doctor’s office. This behavior is referred to as “dumping” when patients are unable to get care at appropriate primary care facilities and sent to the ER of hospitals. In Chapter 9, of Unraveling U.S. Healthcare-A Personal Guide, I explain how people in the United States should access health care wisely from an economic and health outcome basis. The emergency department of hospitals is the most expensive place to obtain primary health care and is thus to be avoided. Patients are often derided for over utilization of the “ER”, but there is more to this picture than meets the eye, as the options for obtaining health care are limited in many areas of the country. If the clinics which receive government funding to provide primary health care are insolent and unwilling to serve their community members, what choice do these folks have but to go to the hospital? In my son’s case we elected to defer treatment because he had to get back to school. As a parent I am concerned about his health and we do have a follow-up appointment scheduled at Seattle Children’s Hospital In December.
How Money Impacts Treatment
Peninsula Health is a designated federally qualified health center located in Bremerton and other sites in the county.[1]  In 2014, Peninsula Health received $1,572,083 from our federal government to provide primary health care.[2] This means that the clinic is charged with serving patients who may not have access to other health care options or for which there are obstacles, such as lack of transportation, or clinicians who refuse to treat them.  The community of Bremerton has a disproportionate share of low income residents, in large part due to zoning laws which allowed less restrictive housing per parcel from World War II. Harrison Medical Center is the hospital for nonmilitary personnel in Bremerton and the Franciscan Order, which acquired the publicly financed facility wants to close the hospital. The reimbursement mix just doesn’t work for their bottom line, religion or not.  Consequently, the ability to obtain health care for those who are most in need is becoming more tenuous in this community. As a federally funded facility the clinic must adhere to certain practice standards, which in theory, should provide basic or primary health care more effectively than other options.
As a healthcare insider some of you may wonder why I choose Community Health Plan’s Peninsula Health Clinic and the answer is, we ended up there as a last resort. Briefly, over the course of the past eight years the following circumstances gave us no choice but to use the Sixth Avenue Clinic or take the longer commute into Seattle for health care: 
  1.   In 2006, when my son and I relocated to Bremerton, largely due to the walk-on ferry access to Seattle, we initially sought care with a private practice physician. With each appointment the doctor complained about his reimbursement, the staff wasn’t very nice, and getting there required a 10 mile round trip bike ride and a ferry trip to Port Orchard. Still, we persisted until the clinic was closed, meaning the doctor moved his clinic to a more lucrative location. 
  2. When my son was in middle school we sought family health care in a neighboring community, but found the transportation options unworkable. 
  3. Services to deal with pediatric or youth depression are extremely limited in Kitsap County, yet the State of Washington under Senate Bill 6312, has just approved a new plan to make the entire Olympic Peninsula and Kitsap County one service area.[3] The few services available for mental health are for adults and drug offenders in the area. My son and I have found it more efficacious to spend 2 hours on the ferry and 1 ½ hours busing to appropriate services in Seattle, for which I have paid 100% of the cost out of my pocket, as it is deemed out of our service area. 
  4. Given that my son was in grade-school when we moved here, I felt it was prudent to seek health care that was local, hence the Sixth Avenue Clinic, located less than two miles from our house.
Increasingly Those Providing Primary Health Care Are Getting Squeezed
Firstly, we don’t have enough primary clinicians in the United States, so this creates a problem with patient access. Secondly, there is high employee turnover in health care, which exacerbates the problem. Thirdly, clinics serving a higher proportion of low-income patients are dealing with grittier issues than in more affluent areas. It all comes down to the money, Medicaid doesn’t pay enough for 46% of the doctors to accept Medicaid patients.[4] This means federally qualified clinics, public health departments, and the public emergency room are where patients seek care.  But the fiscal situation of the clinic is not the fault of the patient, nor should patients be refused treatment.
What You Should Do To Advocate for Your Child to Get the Health Care They Deserve
Fast forward, Peninsula Health sent a letter to our house indicating my son was a no-show for his appointment, which of course was not true. As your advocate for patient rights, here is what I did; composed a single page letter with our grievance on patient care, sent it to the local clinic-Peninsula Health, to Community Health Plan of Washington the affiliated insurance provider, and to the State Medicaid office which provides funding for the clinic. Next steps- to date there has been no written response from any of the clinic representatives, because they are demanding a HIPAA form be completed first. If getting refused for health care doesn’t kill you, the paperwork will.
A Little Respect
Having commuted by bicycle and public transportation in multiple locations since 2003, my son and I have learned to be resourceful, which is not always met with appreciation by health care providers. In an era when a third of the nation’s children are overweight, getting regular exercise is the surest way to maintain a healthy weight. And I am happy to say, I do not take any medication, because of my diet and exercise regime. We are doing our part not to add to the burden of the U.S. health care system, so rather than being treated with derision, how about encouragement. Though I am loathe to share personal information, this situation really shows how people are dumped in the health care system and it is even worse for those patients who lack my education and tenacity. As for the clinic admissions representative who refers to me as “the mother,” even Safeway personnel manage to get my name right and add a salutation. Yes, I am “the mother” who will stop at nothing to assure my son and others like him get decent health care because that is the right thing to do. 

This is the healthpolicymaven signing off, encouraging all of you to resource your health care wisely and stick up for yourselves. Don’t think that everyone behind a desk has your best interests at heart. Feel free to share this article virally but please provide appropriate attribution to the author and Praevalere!

For more information on federally qualified health centers and other resources read my book which is found in public libraries throughout the land and of course, on Amazon, ranked #35 for health and medicine books.

[1] *Peninsula Community Health Services is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).


Peter Parker said...
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Connie Simoni said...

It is so distressing to continue to hear stories like this. Why can't there be more emphathetic people! This whole issue could have been avoided if the person at the desk approached this whole situation with a little compassion! She could have said-"I understand-let me see if he doctor can see you for an abbreviated appointmen," and that doctor most definitely should have seen your son! I could understand if you were 30 minutes late but 6 minutes! Even if you were only allowed a 20 minute appointment you still had half of that time left. To think that they instead chose to argue with you and not be concerned about possible depression (which is an epidemic) is absurd to me! Feeling your frustration......

Jim Tracy said...

I think we need to create netter ways for people to obtain health insurance. That is really important I feel like. You have to make sure that if you need help with health insurance, you can get it.

Stem Cell Therapy said...
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