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WASHINGTON, Aug 10, 2004 (United Press International via COMTEX) -- Funding cannot keep pace with the need to build more community health centers around the country.
There are 1,000 centers serving 3,500 communities as the front-line of healthcare for millions of Americans in poor or medically under-served areas. Some centers have up to 73 percent of patients coming in without insurance and there are 35 million people in the United States who do not have a regular healthcare provider, many of whom rely on physicians at their local center, according to the National Association of Community Health Centers, which briefed reporters this week on its latest status report.
Last year, about 40 percent of patients treated at centers -- which charge fees on a sliding scale based on ability to pay -- were uninsured.
"Every dollar spent at a community health center comes back three-fold," Dr. Monica Sweeney, medical director at the Bedford Stuyvesant Family Health Center in Brooklyn, N.Y., told the briefing. "We're as close as you come right now to having a national healthcare system. We're in all 50 states."
The Bush administration's $2.2 billion, five-year plan to expand the community health center system began in 2002, with the goal of adding 1,200 new sites and increasing the number of patients served each year from 10.3 million to 16 million by 2006. So far, more than 3 million new patients have been seen, but only a small portion of new center applications seeking government funding actually are able to get money before it runs out. In 2004, fewer than one in 10 qualified center applications has been funded.
"As the first line of defense against poverty and disease, health centers hold a unique front row seat to trends affecting the national healthcare system," the NACHC's Dan Hawkins said. "(But) health centers are not a substitute for insurance."
Along with the continued trend of a growing population of uninsured -- estimated at 43 million-plus and expected to be higher when the Census Bureau releases its newest data later this month -- health centers also are victims of several years of state budget woes that have resulted in millions of dollars in cuts in Medicaid program support, the largest single source of revenue for centers.
Hawkins said one-fifth of operational revenues for existing centers comes from state and local funding but 17 states have reduced their support and three have eliminated it.
The NACHC estimates the average cost of care at a center is $1.30 per person per day -- far less than if the patients had gone to a regular doctor's office. If between 10 percent and 50 percent of non-emergency visits to hospital emergency departments could be redirected to health centers, it could save the healthcare system in the country between $1.6 billion and $8 billion each year. The question is whether the centers could handle the load.
"I've got two waiting rooms that are chocked full," said Nancy Stern, chief executive officer at Eastern Shore Rural Health System Inc. in the Delmarva Peninsula of Virginia. "This is not a Democratic issue. This is not a Republican issue. This is a bipartisan approach."
CAFE RX SERVES UP E-PRESCRIBING INFO
The how-to of setting up an electronic prescribing system for physicians and insurers can be found at Cafe Rx.
This initiative was announced Tuesday at the National Council for Prescription Drug Programs' Educational Forum in San Francisco. It includes nine healthcare interests representing information technology companies, consultants and an industry standards organization: Allscripts Healthcare Solutions, Capgemini, Cisco Systems, HP, Microsoft, the National Council for Prescription Drug Programs, NDCHealth, RxHub and SureScripts.
Health and government experts have stressed e-prescribing is one way to reduce medical errors -- the physician sends an electronic prescription directly to the pharmacy -- and save time and money -- fewer questions and calls by pharmacies about illegible prescriptions.
Cafe Rx -- at caferx.org -- will offer insurers and physicians best practice models and educational programs on how to set up an e-prescribing system. The group also will support lobbying efforts to get Congress and state government to create incentives for the industry to move toward e-prescribing.
Jodie Skyberg, senior manager for the pharmacy practice at Capgemini, told UPI's HealthBiz the Cafe Rx Web site is free and contains the best practices garnered from e-prescribing programs around the country. She said the goal is to help companies develop models that work for their specific needs.
"It's such a complex process and there is probably no single payer that does it point to point," she said. "You need that handshake (among participants in the process) to complete the process."
Most of the 3.7 billion prescriptions issued last year were handwritten -- generating an estimated 150 million phone calls from pharmacists to physicians' offices for clarification on handwriting, dosing and other issues.
MEDICARE DRUG CARDS -- TEACHING THE TEACHERS
The Medicare prescription drug discount program is so confusing even the pros need help explaining it. The Medicare Rights Center in New York City is offering free training for healthcare professionals on how to counsel people about the discount cards, which took effect in June and runs until 2006 when the permanent drug benefit in Medicare begins.
Presentations are available at the MRC's Web site at medicarerights.org and training programs have been customized 10 states: Arizona, California, Florida, Illinois, Michigan, New Jersey, New York, North Carolina, Ohio and Pennsylvania -- all states with significant Medicare populations.
Aside from information on the government's discount program the site also has data on alternative programs that could be better deals for seniors.
PROS AND CONS OF VIP DOCS
About 45 percent of physicians taking part in a Castle Connolly Medical Ltd. survey said so-called concierge practices can be beneficial for doctors while 31 percent said they would have a negative impact on patients.
Also called boutique or VIP medicine, patients who pay premiums for this type of service have 24-hour access to their doctors and same day appointments. Doctors who like the idea say it gives them more time with patients to deliver higher quality care and, at the end of the year, they see higher income levels.
One physician who did not like the idea told Castle: "We should not separate available services by caste. I provide 'concierge' services to all, regardless of wealth or poverty status."
Only 20 percent of the doctors surveyed said they would consider joining a concierge medical service -- many feeling like doing so would mean abandoning their patients.
The 785 physicians in the survey were all nominated by their peers and listed in America's Top Doctors or Top Doctors New York Metro Area.
Copyright 2004 by United Press International.