“We’re either going to have a green light to proceed with a CHC, or we’re going to have to abandon the idea,” said Bill Baker, who has served as spokesman for the effort. “There won’t be anything in between. We can’t string this out forever. We have to ... decide whether it would be beneficial for the community.”
The group formed a new nonprofit organization, the Powell Health Care Coalition, in September, then met in late October to select members for a board of directors and an advisory board.
Baker said the group intends to decide definitively within the next six months or so whether to apply for funding for a Community Health Center.
Dr. Larry Akin, a local dentist, is president of the board of directors. Other members are Dave Bonner, David Whittle, Bill Baker and Sharon Baker.
Akin said he joined the effort because of the need he sees for access to dental care.
Akin and his wife, Maureen, are in their 29th year owning and operating a dental practice.
“Every year since we’ve been in our practice, we have accepted Medicaid patients,” he said Friday. “During that 29-year period, we have noticed an increased demand for children’s dentistry in regards to Medicaid or Equality Care. It’s not unusual to get five or six calls a day. We do what we can, but we just can’t do it all.”
In recent years, Akin said he also has seen an increased need for dental care for adults under the program.
Previously, efforts to examine the possibility of establishing a Community Health Center here were centered around the Heart Mountain Volunteer Medical Clinic; it seemed logical to convert the free clinic into a Community Health Center.
But the volunteer clinic’s board members are divided on the issue and occupied with providing guidance for the clinic.
“They were not sure they wanted to become involved, and without making a definite commitment to become involved, it’s difficult to commit to anything other than talk,” Baker said.
Both have the same aim — to provide access to medical care for people who otherwise could not get it. But the volunteer clinic is funded and managed locally and operates one day per week in Powell. And it doesn’t provide dental or mental health care services.
Care through a Community Health Center
A Community Health Center would be funded by the federal government, would operate 40 hours per week and would provide care for anyone on a sliding-fee scale.
Community Health Centers also can provide dental and mental health care — and both are of significant need in the Powell and surrounding area, particularly for low-income, uninsured or underinsured residents, Baker said.
To determine the extent of those and other unmet needs, the coalition must conduct a survey of the area. To qualify for a Community Health Center, the coalition must prove that Powell and the surrounding area are medically under-served.
The coalition plans to apply for a state grant this month or in early 2013 to pay for the survey.
Strictly on a physician per population ratio, Park County would not qualify, while Big Horn County would, Baker said.
“However, when you’re talking about health care ... it really doesn’t matter how many physicians there are for the population if you can’t access it because of barriers” such as low income or lack of health insurance.
“We hope to have information showing that, while we’re not under-served, we did have specific populations in the area that were under-served,” he said.
As envisioned, the service area for the proposed health center would include zip codes for Powell and Ralston, Cowley, Byron, Deaver, Frannie and probably some from Cody and Lovell, he said. However, if a center were established here, it would serve anyone who walked in the door, regardless of where they live or what their income or insurance coverage is, he added.
Working cooperatively with local hospital
Bill Patten, chief executive officer for Powell Valley Healthcare, worked cooperatively with a Community Health Center in his previous CEO post at the hospital in Libby, Mont.
“The hospital actually coordinated the community effort to write the original grant for the CHC,” Patten said Thursday. “During its early stages, we provided support in a number of ways.”
For instance, a hospital employee served on the board and assisted the executive director.
Once the clinic was established, the hospital sold the clinic board some land on the hospital campus at a generous price for a new clinic building, and the hospital provided maintenance and groundskeeping services for a fee.
“Then we extended our hospital computer network out to their building so that they would access our medical records directly,” he said.
“In short, we were trying to do what we saw was in the best interest of the community, which at times meant compromising the individual interests of our organization.”
In addition, “we gave deep discounts for lab and imaging procedures,” he said. “We didn’t want them putting in their own, lab, so we thought it was better to give them a discount.”
He said the center was doing very well when he left Libby.
But, because Powell Valley Healthcare also employs physicians and operates its own medical clinic, a Community Health Center in Powell potentially could be a greater conflict with the hospital here than it was in Libby, he said. There, the hospital employed emergency room physicians, an orthopedic surgeon and a gynecologist, but didn’t employ primary care doctors.
“Unless we figure ahead of the game, this would be a separate primary care presence in the community (where one) currently exists,” Patten said.
Baker said one of the main goals for a Community Health Center is to work cooperatively with the local hospital.
“We have to have a relationship with the community, the hospital and other providers in the community,” he said. “We have to be able to work together to strengthen the position of the hospital in the community, rather than weaken it.
“Our purpose is to find out, is there a need, and is there a desire, and can it work to the benefit of the community, the under-served in the community and to those who are providing service in the community? If that all works out, we can fill out an application to form a CHC.
“Within the next two or three months, we want to start a discussion on how can we work together? How can we cooperate?”
Patten said he questions the need for a Community Health Center for medical services in Powell.
“My sense is that we need it for dental, and we probably need it for mental health, but I don’t think we need it for regular care. ... If you can’t get a yes to that, then all the other questions don’t matter.”
That’s because a government-funded CHC must provide medical as well as dental and mental health services. If a community needs dental service but has sufficient medical services, it won’t qualify for a Community Health Center, he said.
“The other perspective that the CHC would be designed to address is the issue of those who can’t afford care,” he said.
Some of that need is being met by the Heart Mountain Volunteer Medical Clinic, he said.
“On the hospital side, is there an opportunity for us to do a better job with our charity care program?” Patten asked.
That could be done by proactively developing a patient evaluation and designation process that would allow people who don’t have insurance and can’t afford it to still receive care, he said.
“In other words, doing what we’re already doing, but doing it better,” he said.
Providing dental care
Akin said he believes adequate dental care also could be provided in the Big Horn Basin if all practicing dentists were willing and able to see a proportionate number of Medicaid patients.
“I did mention to everybody on the board that, if we could get every dentist in the Big Horn Basin to accept a certain share of the Medicaid children and adults, we could meet the need,” he said. “But until we could get every dentist to take his or her part in treating these children and adults, we can’t meet the need without a CHC.”
But that isn’t happening, largely because the federal government reimburses dentists at only 50-60 percent of their normal fees, so they write off a considerable amount, Akin said. On the flip side, dentists who work for Community Health Centers are reimbursed at a higher rate.
Akin said the number of dentists practicing in the Basin has increased in recent years, making it easier for patients to get in to see a dentist when needed.
He said he is somewhat concerned that bringing in another dentist or two in a health center could work a hardship on dentists already practicing here.
“Dentists have to have a certain number of patients to keep their doors open,” he said.
Long-term feasibility for Community Health Center?
Patten said he is also concerned about the long-term feasibility for a Community Health Center here.
“With president Obama being re-elected, it now seems certain that, in one way or another, health care reform is going to move forward, and people who currently don’t have insurance will have insurance. The population a CHC is designed to serve will be going down as a result of that one change.
“Today, the CHC is a golden child of the federal government. As priorities change, I’m not confident that the status won’t change. I’m not anxious to see a program get started, and then within just a few years, have its funding get cut,” Patten said.
Baker said Community Health Centers have a 40-year history in the United States and provides care for 20 million patients who will continue to need care.
“It’s a working model that provides quality care — quality check points have to be met every year. Last year, 350 new sites were approved,” Baker said.
A health center must comply with federal requirements, Sharon Baker said.
“You have to ensure you’re providing certain types of service, then do it,” she said. “It’s not onerous.”
One of those is in Hardin, Mont., and the Bakers visited that new center last month. It received a federal grant of $605,000 per year, plus a revenue stream through Medicare and Medicaid patients. The Hardin center employs 12 people full time, Bill Baker said.
The center’s director is willing to provide guidance as Powell’s efforts continue, he said.
Akin said Community Health Centers provide needed dental care for millions of people who can’t afford it otherwise.
He provided a copy of an article in the Winter 2013 “Inscisal Edge” on Community Health Centers that indicates the Affordable Care Act will expand CHCs and access to dental care.
According to that publication, 59 million Americans currently cannot afford dental care.
Among its many provisions, the Affordable Care Act allocates $11 million to CHCs — $1.5 billion for new construction. More than 1,200 Community Health Centers operate in 8,000 rural and urban communities nationwide, and each CHC is required to have a dental clinic. New CHCs are high-tech and attractive, the story said.
Bill Baker said that, while many people object to federal funding for health care, it’s already happening through Medicare and Medicaid.
“You can hate the Affordable Care Act until your eyes cross, but health care for the under-served is a goal that nobody (doesn’t) want to achieve,” he said.
Baker, who serves on the boards for both the free clinic and the new Powell Health Care Coalition, said, “I would guess that, maybe somewhere down the road, the free clinic is going to be looking at it again, that this is something that would work for us.”
In the meantime, the new Powell Health Care Coalition will coordinate the effort to find the answer that, so far, has eluded the community and surrounding area.