NACHC’s Board Chair, Gary Wiltz, MD, published the following commentary today in Modern Healthcare magazine. Dr. Wiltz is the President and CEO of Teche Action Clinic in Franklin, LA.
As a young doctor, my first job was serving in one of the poorest and most rural parishes in Louisiana. I had a three-year commitment to serve with the National Health Service Corps, which, in return, paid for my medical education. Thirty-two years later, I’m still there, leading the same Community Health Center where I started. I chose to stay because access to care—a key issue in the ongoing national discussion—is a struggle for people in my community.
Yet, progress made so far to improve access to care in the nation’s fragile and rural communities is now threatened.
Some 62 million Americans lack access to primary care because of a variety of factors that include geography, income and a shortage of available doctors, according to the National Association of Community Health Centers. People from all walks of life are affected. Nearly half (42%) are low-income and 28% live in rural areas. Surprisingly, the vast majority do have health insurance.
People need both insurance and access to care. In my corner of Louisiana, we are open six days a week from 7:30 a.m. to 7:30 p.m. because our patients, who are low-income and often chronically ill, need care before and after working hours. By making access more convenient, we not only improve our residents’ well-being, but reduce unnecessary visits to hospital ERs by more than 40%.
The Affordable Care Act provided resources to double the size of Community Health Centers like mine. This critical funding is scheduled to expire after 2015. Without a fix from Congress, the centers face a 70% reduction in grant funding. The impact would be disastrous. Our clinic alone would be forced to shelve plans to open two needed clinic sites, close some sites and lay off staff. Over 3,000 patients would have to find care elsewhere, much farther away. Programs focused on growing the supply of primary-care providers also would be hurt.
Let’s not reverse course. Community Health Centers have delivered high returns on the investment for the past 50 years—improved access, cost savings and more jobs. This is a resource our nation cannot afford to squander.
What we have…. is failure to communicate the fact that designs for health spending and designs for health professional training will continue to leave more millions of Americans behind.
My latest calculations include declines in rural and smaller hospitals with closures expected to reach 100 per decade as in the 1980s. The resulting counties without hospitals lose workforce, income, jobs, and economic impact – joining the 1558 other counties already without a hospital. The increase in population in such counties should reach 20% per decade or over 3 times population growth from 2010 to 2040. And these are counties with higher proportions of elderly and those increasing fastest in care demand.
These are locations that require permanent generalists and general specialties – not the current mix of “name only” primary care training that fails to yield primary care. The nation needs core specialties, not graduates that subspecialize and subsubspecialize.
Specific revenue and specific training designs are required – the opposite from the current designs. Going upstream in revenue is important to see the chaos created by more specialties with more in each specialty – the route to higher salaries and revenue. Going upstream in training designs results in the logical conclusion of permanent family practice as the requirement of substantial portions of MD, DO, NP, and PA training – no other source has population based distribution to CHCs, rural locations, counties without hospitals, and all locations and populations left behind by training and payment designs.
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