Health clinics pulling more into safety net
10% of Tucsonans get affordable care there, cut ER visits
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The national network of 952 federally approved community health centers serves more than 14 million poor and uninsured patients. By fall, 120 more health centers are expected to get federal start-up grants.
To qualify for federal funding, community health centers must:
● Provide comprehensive primary health care for adults and children.
● Treat people who meet the federal definition of medically underserved.
● Provide care to everyone regardless of insurance status or ability to pay.
● Charge patients using a sliding fee scale based on ability to pay.
● Provide translation services, transportation and case management.
● Maintain a governing board composed mostly of members who are also health center patients.
● Operate as a nonprofit, public or tax-exempt organization.
How community health centers charge patients:
Community health centers treat everyone, regardless of insurance status or ability to pay.
Those without insurance must document their income to care coordinators, who then determine payments based on a sliding scale that also takes into account family size.
At El Rio Community Health Center, office visits will cost at least $20 for an adult and $15 for a child. The maximum charge could be the entire cost of a procedure, depending on a patient's ability to pay.
www.maranahealthcenter.org, Marana Community Health Center
www.elrio.org, El Rio Community Health Center
www.hrsa.gov, Health Resources and Services Administration.
www.nachc.com, National Association of Community Health Centers
http://nhsc.bhpr.hrsa.gov, National Health Service Corps.
www.hhs.gov, U.S. Health and Human Services
Main clinic, 13644 N. Sandario Road
Obstetrics and Gynecology, 2055 W. Hospital Drive
Santa Catalina Health Center, 15631 N. Oracle Road, Suite 141
Ortiz Community Health Center, 12635 W. Rudasill Road
Flowing Wells Family Health Center, 1323 W. Prince Road
Clinica Del Alma, 3690 S. Park Ave.
Rita Ranch, 8045 S. Rita Road
Keeling Health Center, 435 E. Glenn Road
Freedom Park Health Center, 5000 E. 29th St.
Catalina Health Center, 3645 E. Pima St.
Erickson Health Center, 6750 E. Stella Road
Marana Middle School Teen Wellness, 11279 W. Grier Road
Marana High School Teen Wellness, 12000 W. Emigh Road
El Rio Community Health Center facilities
Congress Clinic and Congress Dental, 839 W. Congress St.
MEL Center (Sunnyside) Clinic, 5101 S. Liberty Ave.
Northwest Clinic, 320 W. Prince Road
Northwest Dental, 4009 N. Flowing Wells Road
OB/GYN Associates, 225 W. Irvington Road
Southwest Pediatrics, 1500 W. Commerce Court
Southwest Dental, 1530 W. Commerce Court
Special Immunology Associates, 1701 W. St. Mary's Road, No. 160
Summit View (Sunnyside) Clinic, 1900 E. Summit St.
Sunnyside Teen Clinic, 1725 E. Bilby Road
Pascua Yaqui Clinic, 7490 S. Camino de Oeste
El Pueblo Clinic, 101 W. Irvington Road
Broadway Clinic, 1101 E. Broadway, Suite 110
Birth & Women's Health Center, 2595 N. Wyatt Drive
39,750 patients in 2000
63,552
In 2007
MARANA HEALTH CENTER 7,500 patients in 200030,000
In 2007
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The percentage of Tucsonans who rely on community health centers has doubled in the past six years, reflecting a nationwide trend.
Six years ago, 5 percent of the population used such services. Now the figure is 10 percent, officials said.
Pima County's two major community health centers are expanding and constantly seeking to recruit doctors.
The centers, a safety-net system established by the federal government in the 1960s, offer affordable health care, prevent emergency room visits and treat sick people who might otherwise unwittingly spread diseases.
"They keep visits to the emergency room down because people know them and trust them," said Steve Nash, executive director of the Pima County Medical Society.
According to national studies, patients at community health centers get better continuity of care, the gap between diseases in whites and minority groups is reduced, women deliver fewer low-weight babies and patients are less likely to be hospitalized.
Since 2000, the Bush administration and Congress have nearly doubled annual spending on community health centers, to almost $2 billion.
Both the Marana and El Rio community health centers receive 12 percent of their annual budgets from the federal government. Marana's budget is $16 million, and El Rio's is $58 million. This fiscal year, El Rio will receive an additional $600,000 to pay for nurses and expand clinic hours, Chief Executive Officer Kathy Byrne said. Most of its funding is patient-generated, but the health center makes sure patients apply for whatever insurance they may qualify for.
The Marana center, which is celebrating its 50th anniversary this year, has spent the past six years expanding from one clinic in Marana to 13 clinics across the county.
Despite a lack of marketing and a name that implies it serves only Marana, the health center's patient base increased from 7,500 in 2000 to more than 30,000 now, said the center's director of development, Jerry Farnsworth.
In January, the Marana health center opened its newest clinic at 3690 S. Park Ave., called the Clinica Del Alma. Soon, the clinic is expected to operate its own pharmacy and have a fully functioning lab.
On Wednesday, El Rio will open its Northwest Clinic at 320 W. Prince Road, for a total of 15 locations in the county. The clinic is for same-day appointments. Byrne said that since 2000, the number of patients served by El Rio has increased 59 percent, from 39,750 to 63,552.
Marana has a higher number of patients who have insurance, 26 percent as opposed to 12 percent at El Rio. Farnsworth said many people see the community health center as more than a place for the poor and uninsured.
Sandra Martinez, 41, visited the Clinica Del Alma for the first time Tuesday. She hadn't been to a doctor in nine years and was seeing Dr. Ramon Gutiérrez about a three-year-old knee injury.
Martinez, a recovering addict who runs a cleaning business, said getting off drugs made her realize how badly she had hurt herself. Her children, ages 18, 13 and 9, persuaded her to see a doctor.
"I've always hated doctors," Martinez said.
After her appointment, she said, "I feel good now. I think it's going to turn out pretty well."
She received a physical and was scheduled for a mammogram and follow-up on her knee.
Martinez was one of 26 patients scheduled to be seen that day and one of five new patients, Gutiérrez said.
"We're busy enough to bring in two more providers right now," he said.
The clinic has one doctor and a family nurse practitioner.
The number of Hispanic patients seeking care at health centers nationally grew by 52 percent to 4.8 million from 2000 to 2005, outpacing all other racial or ethnic groups, according to federal data.
Many centers have added interpreters, mostly Spanish-speaking, to help doctors and patients communicate. In Pima County, having doctors, nurses and other employees who are bilingual is a natural part of serving this community.
"Many of our staff are Hispanic, so it brings the culture," said El Rio's chief clinical officer, Dr. Arthur Martinez. "We have to be culturally confident."
The centers help serve the "working poor" - people who are too well off to qualify for state benefits but who don't have private or employer-sponsored health coverage.
"Our staff works really hard at the front end to identify a source of funding for them," Byrne said. "We find a medical home and the best available coverage for our patients."
Through the community health system, "We've been able to make health centers available to a lot more people in places that have never had health centers," said Elizabeth Duke, administrator of the federal Health Resources and Services Administration. "In the very best sense, (this) is what's right about America."
Both Marana and El Rio said recruiting enough doctors is "a challenge."
However, doctors do get a break on malpractice insurance because of the federal government's Federal Tort Claims Act, which reduces the expenditure of health center funds for medical malpractice insurance premiums. The Birth & Women's Health Center, 2595 N. Wyatt Drive, merged with El Rio in March because of rising malpractice insurance premiums.
There are more than 2,500 clinical vacancies at community health centers across the country, according to the National Health Service Corps. It offers grants, scholarships and student loan repayments to those who agree to work in medically underserved settings.
Marana's medical director, Dr. Osaf Ahmed, was sponsored by the state of Arizona to come from Pakistan and work in community medicine.
Ahmed, who did his residency in New York, said many who come through sponsorship programs are willing to stay beyond their three-year commitment.
While the two community centers have clinics all over Pima County, they do not consider themselves competitors.
"The need to serve the patients is huge in this county," Byrne said. "There's room for everyone."
Gannett News Service contributed to this article.
"Iam reading an educational book title Anglos and Mexicans in the Making of Tejas (Texas)."
First of all, the term "Anglos" is an racialist one used by "reconquista" writers. It is also used as an racial slur by people who support the radical,racist, anti-American, and anti-Semitic "Brown Power" groups in this country.
Second, why not give the name of the author?
Could it be David Montejano from the University of Texas who now teaches at Berkley? The same university system where Jose Angel Gutierrez teaches, and called for a "race war" against "Anglo" Americans?
Here is what Gutierrez had to say in 1995 at the UC in Riverside where his "Homeboy" Armando Navarro teaches:
"The border remains a military zone. We remain a hunted people. Now you think you have a destiny to fulfill in the land that historically has been ours for forty thousand years. And we're a new Mestizo nation. This is our homeland. We cannot—we will not—and we must not be made illegal in our own homeland. We are not immigrants that came from another country to another country. We are migrants, free to travel the length and breadth of the Americas because we belong here. We are millions. We just have to survive. We have an aging white America. They are not making babies. They are dying. It's a matter of time."
Thanks for the "memories" Carmen.
Y'All come back now....Ya'Here???