RCHC Community Project Abstracts

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Hermiston Mental Health
Date of project: 12/30/2002

In this project I sought to assess the quality of health care in Hermiston, a rural community of 15,000 population with no established Psychiatric Doctor, but a Psychiatric Nurse Practitioner who rotates his time in between Hermiston and two other neighboring communities. Although Tri-Cities are not too far away (30 min) and boasts of more than one well trained Psychiatric Physician and other mental health practitioners, this is not a viable option for local residents due to insurance constraints as Tri-Cities are in the state of Washington. Among this backdrop, I set out to explore some of the primary problems that mental health in Hermiston faces. Some of the problems Hermiston mental health faces today remain constant or have magnified from yesteryears : increasing needs and restricted/limited resources and funding, unique geographic and cultural challenges to service delivery, lack of available professional staff; service providers struggling to operate under models and assumptions imposed by managed care that don’t hold up in rural settings, dealing with the stigma of mental health in small towns, and misunderstandings of the cultural diversity and assumptions. I have sought to assess these problems with the local mental health professionals and have attempted to come upon the reasons and solutions for these problems.

Starting a Rural Family Practice and Staying Afloat. A case study in Hermiston, Oregon.
Date of project: 8/12/2002

This case study explores the challenges met by physicians starting a rural family practice. Dr. Bolanos-McClain and Dr. McClain started their clinic 1' year ago with 4 patients in Hermiston, Oregon. Today, they have between 1,200 and 1,300 patients. They work approximately 35.5 hours per week more and earn up to $90,000 less than the national average for private family practices in 1997. When interviewed about his practice, Dr. McClain stated that "there are really good days and bad days, good weeks and bad weeks, with extremes of both." This brings into questions whether physicians will continue to be able to serve these communities while working under these conditions.

Comparisons of the Medical Office Staff Needs in Rural Hermiston Oregon Versus Urban Portland Oregon
Date of project: 2/11/2002

This study sought to determine the differences between the staffing needs and availability of trained office staff in the rural Hermiston Oregon area versus the urban Portland Oregon area. The design was to survey practices in Hermiston and Portland metropolitan areas and compare the results. It was found that the physicians in Hermiston preferred staff with a higher level of education and had a harder time finding trained office staff of any level of education to work in their offices, where as the Portland clinics preferred staff with a lower level education and had less difficulty finding staff of any educational level. The report discusses that more research is needed in the area to better identify needs and gives some recommendations on recruiting better trained office staff.

The Importance of Efficient Office Practice in Meeting the Health Needs of the Community
Date of project: 5/6/2002

Working with the neediest members of the community results in lower reimbursement for the physician meeting these needs. The lower reimbursement rates for patients on publicly-funded insurance have made it impossible for physicians in some communities to continue caring for these patients. For physicians who continue to see patients with public insurance, the expense of caring for these patients must be kept to a minimum. By creating efficient processes for billing and other functions in the office, expenses can be kept to a minimum, which helps enable a practice to continue to care for the most vulnerable patients. This project focused on creating an efficient billing process that gathers all of the necessary information for making successful claims to insurers for services rendered. Additionally, time was spent training staff on using billing software to streamline the process and maximize efficiency.

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