Opportunities arise from health care bill

At Piedmont Health Services on Monday morning, Dr. Carol Klein gave a four-year-old boy named Thomas his annual checkup: A clean bill of health and a book for being such a good patient.

Thomas could soon be joined by more people looking for affordable primary care from a community clinic.

As a result of the health care reform bill, 32 million more people will have health insurance — some of them thanks to an expansion of Medicaid — and they’ll be directed to community care clinics like Piedmont Health.

“The opportunities in the future for health care are enormous,” said Brian Toomey, CEO of Piedmont Health Services Inc.

And one of the biggest opportunities for Piedmont is the chance for expansion.

“We will expand, absolutely,” he said. “The demand for us providing services will expand, absolutely.”

Toomey expects to build more sites in addition to Piedmont’s six locations. But just how many sites the business will add won’t be decided until the health care reform measures take full effect in 2014.

As the state’s oldest community clinic, Piedmont has been a strong force in serving rural populations with few options for health care.

The nonprofit business focuses its efforts in serving low-income patients, and that hasn’t changed much in 40 years, Toomey said.

Fifty-two percent of the clinic’s patients are uninsured, Toomey said. The rest are billed through Medicaid, Medicare or private insurance.

With health care reform, that percentage will change, Toomey said, and Piedmont will change with it.

Not only are community clinics like Piedmont likely to serve the increasing number of people with health insurance, but they’re a key foundation in the new emerging health care model, said Tom Ricketts, a professor of health policy and management at UNC.

By signing the health care bill, legislators tapped community care clinics that promote primary and preventive care to reduce the burden currently faced by hospitals in delivering quality, affordable care.

“It’s almost a primary care oriented health reform bill,” Ricketts said. “The goal is to make a more seamless system to fit primary care in the center.”

Whatever the role of rural health care in the coming years, Toomey said he’s happy to be a part of it.

“We are at the beginning of a huge change in how health care is delivered in this country, and I think it’s one of the most exciting and terrifying times to be in health care,” Toomey said.

The health care reform bill would still leave some without health care, and UNC medical students working in a unique coalition with Piedmont Health will work to fill that gap.

Every Wednesday evening, the Student Health Action Coalition fills Piedmont Health Service’s Carrboro center to continue a tradition of free health care.

“There’s still going to be a gap who does not qualify for those services, perhaps based on their immigration status or for other reasons,” said Jessica Hubbs, a UNC medical student and co-chairwoman of the coordinating council for SHAC.

SHAC

The volunteers represent an array of schools, including social work, pharmacy, nursing, physical therapy and foreign language translators.

Hubbs said access to these different services provides patients with affordable care they might not be able to get anywhere else.

But with limited time and resources, SHAC volunteers are better equipped to treat patients with acute illnesses. Patients with chronic ailments, even those interested in accessing long-term primary care, should look beyond SHAC, Hubbs said.

“SHAC is not meant to become their primary care physicians,” Hubbs said.

“We are a first-line defense, but dealing with patients with chronic sort of problems is very tough. Trying to find them ways in which they can continue their care given limited means and resources is very difficult,” she said.

This prompts SHAC volunteers to think creatively about how patients can receive specialty services like radiology exams or colonoscopies in spite of their economic realities.

Medical students and attending physicians at SHAC frequently refer patients to Piedmont and to UNC Health Care.

Toomey said one of the main priorities of PHS is accepting referrals from SHAC.

“One thing SHAC is forced to face is new models to deliver health care,” Hubbs said.

Each year, SHAC members brainstorm new ways to serve their patients effectively and efficiently, Hubbs said. Right now, they’re working on ways to bring health care to the patient. The Health on Wheels van, a mobile laboratory, is one way SHAC is trying to go beyond their clinic walls to serve their patients.

The SHAC clinic is a reminder of what is really at the center of the new health care model, Hubbs said.

“The patient is at the center of everything,” she said.

Contact the City Editor at citydesk@unc.edu.