The Doctor is In: Moving the Needle on Rural Health Care in Missouri
Posted on Tuesday, June 29th, 2010 at 10:09 am
by Julia M. Johnson
Living in rural Missouri has its benefi ts, but it can be a daunting place if you’re ill and uninsured. You may live in a county without a hospital. Tough economic times may mean you can’t afford health coverage. You may not know when your child should see a health professional. Or your town may be so remote that the nearest clinic can’t recruit new medical professionals.
All of these are real problems faced daily by the rural resident. They result in poor health, missed school and work, overuse of costly emergency room services, untreated chronic illness, serious pain and a host of other consequences.
Rural health clinics can play a vital role in solving these challenges. But they often feel like David faced with a Goliath of a problem — budget cuts and staff shortages that hamper their ability to serve the population’s needs. St. Louis-based Missouri Foundation for Health helps fill these gaps, awarding millions of dollars in grants each year through its Primary Care funding program.
To date, many rural health clinics (RHCs) and federally qualified health centers (FQHCs) have been able to expand services to the uninsured and underserved with the help of Primary Care grant funding. Their ability to hire a single new doctor or dentist can mean the difference between poor health and proper health for hundreds, even thousands.
Last year, doctors faced a perplexing problem at Scotland County Memorial Hospital in Memphis. Patients at the northeast Missouri medical center were showing serious complications from obesity and diabetes, but there was no facility nearby to handle the management of both. With the help of a Primary Care grant, the hospital’s Memphis RHC added a Center of Excellence for Diabetes and Obesity, which began enrolling patients in March 2010.
“There’s a staff of people for each patient — doctor and nurse practitioner, dietitian, therapy and exercise specialists, respiratory therapist, mental health professional, podiatrist, eye care and diabetes educators,” says Marcia Dial, the hospital’s chief executive officer. “Once patients are enrolled, they are carefully evaluated, and a care plan is established. Then we make sure they have every necessary component of treatment and follow-up, and their progress is reported to their primary care doctors. That system didn’t exist here before.”
Dial said another Primary Care grant for its Lancaster clinic also brought necessary services that weren’t previously available. That grant enabled the clinic to set up Telehealth, a medical videoconferencing system. It allows the offi ce to connect remote patients to health professionals for evaluation.
Andrew Grimm, chief executive officer of the Northeast Missouri Health Council in Kirksville, says grant funding has enabled his health center sites to add critical programs as well. “We are using it for expansion of oral health services,” he says. “It’s allowed us to hire another dentist and dental hygienist. We’ve been able to increase dental outreach and screenings for kids who are uninsured. It’s tough to get 30 or 40 kids to a dentist at one time, so we send dental care out to them.”
Grimm says the new staff freed up another dentist with training in pediatric surgery, who now can provide free surgical services in a single visit. “A large number of kids under six have major tooth decay and can’t tolerate eight or 12 visits to correct their problems,” Grimm said. “Now, they can go under anesthesia in the hospital in Kirksville and have an entire mouth restoration done at once.” Procedures of this kind cost thousands and wouldn’t otherwise be feasible for many families, he says.
Southern Missouri Community Health Center in West Plains also is using its funding to make a dental difference. The center originally received a grant to hire a third dentist, but “we had a terrible time trying to recruit one,” says Travis Shearer, the center’s dental director. “Part way through, our grant was changed to do capital improvements instead. We thought we might be able to attract a new dentist by having improved facilities. It worked.”
With the new dentist, the center can accommodate an additional 1,400 dental visits a year, for an annual total of more than 8,000. “One of the biggest impacts we’ve seen is that kids are missing fewer school days,” he says. “We’re getting fewer school nurse calls about kids with toothaches, and that’s encouraging. We’re hoping to reach more children before they get to that stage.”
Jana Witt, administrative project coordinator at Cedar County Memorial Hospital in El Dorado Springs, says her facility is using its funding to improve the mental health for patients in southwest Missouri. “Mental health services are greatly needed here,” she says. “We are using the funds to recruit a licensed clinical social worker to work half time at our RHCs in El Dorado Springs and Stockton.”
Witt said from July 2008 to June 2009, the hospital and clinics saw a total of 548 patients whose primary diagnoses were mental health conditions. And in one year, 7.3 percent of the hospital’s emergency visits were attributed to mental health concerns higher than the state average,according to Witt. “So there’s clearly a need,” she says.
With the new social worker, Witt expects to see a reduction in suicide and emergency room visits due to mental health issues. “Once the primary care providers diagnose patients with attention deficit disorders, drug addictions or other conditions, they’ll be able to send them to our social worker, who will work closely with them to develop a health care plan,” she says.
At Pike County Memorial Hospital in Louisiana, grant funds are making the health care system less intimidating. “We are implementing a Patient Navigator Program to help patients and families with financial, social, physical and emotional barriers that impact care delivery,” says Ronna Roberts, laboratory director for the hospital. “The navigator will link people to a health care home through rural clinics and educate them on how to access primary care resources.”
That means developing a resource plan for each patient at the hospital’s rural clinics in Bowling Green and Louisiana, Roberts says. The patient navigator will explain complex issues such as sliding scale fees, Medicaid enrollment, local charity funding, government aid, drug payment assistance programs, transportation and food pantry services.
At Madison County Medical Center in Fredericktown, grant funding has taken the form of a new primary care doctor. Administrator Lisa Twidwell said the center has recruited a new physician who will begin seeing patients this summer. The new doctor also will provide services at local schools.
“She also brings experience in emergency care and will be able to pick up some shifts at the emergency room,” Twidwell says. “That will make it more comfortable for patients, who’ll have someone they know providing that care. It’s all about making the health care experience more patient-centered.”
Alan Stevens, executive director of the Linn-based Community Health Center of Central Missouri, says the experience of one patient sums up the critical role rural clinics play. He cites the case of a young man who struggled with diabetes. “He got to the point of considering suicide,” Stevens says. “He had no money and didn’t know how to manage the disease. Then he came to our clinic and worked with a doctor who offered him education, medication and other important tools.
“He is now happy and productive, working and has a family. He says our health center is the reason he is here today.”
While solving the health care problem in rural parts of the state will require many more partnerships, the Missouri Foundation for Health is making a difference. “The Primary Care funding program has had a significant impact on many counties in Missouri,” says Martha Gragg, MFH vice president for program. “All of these are critical to improving the health of Missourians.”
Johnson writes for the Missouri Foundation for Health, an independent philanthropic organization based in St. Louis.
