OHSU Richmond Family Medicine Center Gets Federal Help to Expand Care for Medicaid, Medicare

08/06/04    Portland, Ore.

Oregon Health & Science University Family Medicine at Richmond now will be able to expand its care of Medicaid, Medicare and uninsured patients in its southeast Portland neighborhood.

Today, the clinic, 3930 S.E. Division St., received final approval to be a Federally Qualified Health Center (FQHC) Look-Alike.

"This is tremendous news for residents in our southeast community. All of our health care providers and staff at the Richmond clinic are incredibly dedicated to underserved patients. We are looking forward to increasing access to affordable health care and decreasing health disparities for low-income people in our community," said Ann O'Connell, R.N., M.S.N., executive director of the Richmond center.

Federally qualified health centers are non-profit health care centers that provide comprehensive primary care to vulnerable patients regardless of ability to pay. All federally qualified health centers have defined service areas from which they actively seek patients. The Richmond Clinic serves an area defined by the census tracts surrounding the clinic in southeast Portland. Patients living outside this area will be referred to an FQHC in their neighborhoods.

The Richmond center has seen a steady increase in the number of Medicaid and Medicare patients served since it opened in 1995. Of the patients currently receiving care at Richmond about 20 percent have Medicare insurance; 40 percent have Medicaid, and 10 percent are uninsured, for a total of about 70 percent of patients for whom care is not compensated fully. The center serves about 7,000 patients a year.

"I hope this can set an example for the entire health care community. It demonstrates that we and other health care providers have to be incredibly creative to find fiscally responsible ways to serve low-income and vulnerable patients," O'Connell said.

Richmond is different from many other health centers because OHSU shares its governance with a board of 11 community members, which is necessary to meet the requirement for community involvement as an FQHC Look-Alike. The majority of the people on the board live or work in the Richmond area. Other members contribute their expertise in business, law, health care and finance.

"The federal designation for Richmond is a relief. This is all about access to care and it is of paramount importance to our clinic and its patients," said Richmond board chairwoman Nancy Wilgenbusch, Ph.D. She is the president of Marylhurst University.

Nicholas Gideonse, M.D., medical director of the center, oversees the care provided by the family physicians, nurse practitioner, physician assistant and licensed clinical social worker at Richmond, and has made arrangements to refer patients to community providers and OHSU for additional dental, mental health and specialty services. "It is wonderful to have this federal designation. It helps to have some additional aid to meet our costs. This model of care emphasizes prevention and a broad role for the family care provider," he said. "This makes Richmond an exciting place to practice and to train new physicians and other practitioners in comprehensive primary care." Gideonse is an assistant professor of family medicine, OHSU School of Medicine.

Richmond Clinic has made many positive efforts to reach out to the underserved in southeast Portland. A schedule of discounts based upon income and family size helps patients without insurance afford necessary care, and center staff also help patients sign up for Medicaid if they are eligible. O'Connell points to other efforts to help patients overcome barriers to care.

"In hiring new providers and staff, we have emphasized recruiting people who want to care for underserved patient populations and bring language skills and cultural competency to their jobs. Anne Hails is the social worker who provides counseling services and helps with other patient needs, such as transportation to the clinic. Board member Astarté Rainbow has personally led projects to meet broad community needs, such as emergency food supplies for patients and voter registration drives.

"In preparing our application, we received support and encouragement from the Oregon Primary Care Association, Multnomah County Health Department, the new Tri-County Safety Net Enterprise, other community agencies, our patients, board and staff," O'Connell said.

FQHCs are cost-effective economic engines for Oregon. By providing comprehensive and preventive care, FQHCs save Oregon more than $10 million annually in state Medicaid expenditures from reduced pharmacy costs, reduced emergency department visits and fewer, shorter hospital stays. In 2002, Oregon's FQHCs created employment for 2,000 people and generated $120 million in economic output.

OHSU sees the FQHC Look-Alike designation of the Richmond center as an important strategy for preserving the primary care safety net. "As many as 18 percent of the residents of the Portland tri-county area have been estimated to lack health insurance," said Peter Rapp, vice president and executive director of OHSU Hospitals and Clinics. "The additional reimbursement we will receive for services provided to Medicare and Medicaid patients at Richmond will allow us to use our institutional resources to support care for the uninsured patients at Richmond, and provide southeast Portland with a new access point for comprehensive primary care."

Most health care providers have been unable to cover their expenses with the shrinking payments made by the state and local governments for standard Medicaid and Medicare patient services, leading to subsidies for this care. OHSU's financial position has also been hurt during the past several years by declining state general fund support. Rapp, who was recently appointed to the Tri-County Safety Net Enterprise Board, is concerned that the community problem of access to health care must be solved through community-wide efforts.

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