State of shock 

County health clinic struggles with patient surge

Missoula's Partnership Health Center (PHC) might well need a hit of high flow oxygen to make it through the next few months. Patient numbers have skyrocketed in 2009, stretching an already limited staff of doctors seeking to meet demand for affordable health care.

PHC, one of the state's 12 nonprofit community clinics, treats an estimated 10,000 repeat patients each year. Kim Mansch, the clinic's executive director, says PHC has already seen an increase of 1,200 new patients since January. Patient numbers increased by only 1,000 in all of 2008, and Mansch expects to double that figure by December.

Medicaid statistics alone show a growing need for affordable health care across the state. According to a recent report from Montana's Department of Health and Human Services, 75,218 people received Medicaid-funded treatment in May 2009, compared to 62,428 Medicaid recipients in May 2008. More than 8,000 of those cases were in Missoula County.

click to enlarge Alison Forney-Gorman, medical director at Missoula’s Partnership Health Center, heads a staff now struggling to handle a surge of new patients in the county. - PHOTO BY CHAD HARDER
  • Photo by Chad Harder
  • Alison Forney-Gorman, medical director at Missoula’s Partnership Health Center, heads a staff now struggling to handle a surge of new patients in the county.

Mansch says 55 percent of PHC's walk-in clinic patients lack health insurance. She hears stories about lost jobs, slashed hours and pricey deductibles at other health care facilities. Many patients have chronic health problems such as diabetes, high blood pressure or heart disease. Most haven't seen a doctor in almost a year.

"What you tend to see when the economy gets really bad and people are uninsured or underinsured, is people put things off because they can't even afford the basic office visit," Mansch says. "They can't afford blood pressure medicine, they can't afford diabetic strips. They get themselves into an emergency-type situation and end up in the hospital and it's tens of thousands of dollars."

It's easy for people to back themselves into a costly corner when it comes to health care, says PHC Medical Director Alison Forney-Gorman. Sometimes individuals who require immediate treatment can't get it anywhere but the emergency room, where it costs "about $500 just to walk in the door."

"When a patient calls an office and their next appointment is in three months and they're sick now, then they're going to go to the emergency room because they don't have access to care," Forney-Gorman says.

PHC aims to avoid the expenses associated with costly emergency room or private physician visits. Under the clinic's sliding-fee scale, a visit can cost as little as $12. Medication for chronic ailments, such as back pain and arthritis, is often so costly that people are forced to choose between it and food, Mansch says. PHC works with patients to secure significant discounts on those same medications.

But Mansch says PHC is quickly reaching its maximum capacity. Increased traffic at the facility prompted her to extend the clinic's summer service hours past 5 p.m. on weekdays, and to open for four hours on Saturdays. Stimulus money from the federal government allowed the clinic to hire another mid-level physician, providing some relief for the three full-time doctors and one mid-level already overwhelmed by current demand. Mansch adds that a fourth doctor will start work in October.

PHC isn't alone in facing a crush of new patients. The U.S. Department of Health and Human Services distributed $338 million in stimulus grants to 1,128 federally qualified community health centers–PHC among them. The money is expected to serve 2.1 million new patients over the next two years. The department reports community health centers treated 16 million patients nationwide in 2007. Forty percent had no insurance coverage.

With the stimulus funding, PHC remains fiscally stable in spite of the increased demand. Stimulus money specifically helped cover the new hires and increases in pay-hours. Medicare and Medicaid foots the bill for much of

PHC's patient base. Additional federal dollars cover whatever expenses are left, as well as minor contributions from the city and the county, Mansch says. The clinic's annual budget rounds out to $5 million.

PHC's primary obstacle in handling such large patient numbers is space. With only 12 exam rooms, hiring new doctors will only serve to further crowd the clinic, Forney-Gorman says. That's why the clinic looks forward to completing renovations to the Creamery Building on Railroad Street. The new space will more than double the

clinic's size and Forney-Gorman is heading numerous fundraising campaigns–including a 100-mile bicycle

ride in the Bitterroot Valley–to help pay for the project.

"As soon as we started the walk-in clinic [two years ago], we quickly realized the demand was out there," Forney-Gorman says. "When we were just doing scheduled appointments, a lot of people were being turned away because there wasn't an open appointment. Now that there's all this walk-in time, we're realizing what the demand is in the community."

If all goes according to plan, PHC will move completely by 2011. According to Montana Primary Care Association analysis of 2000 census data for Missoula County, an additional 30,000 residents qualify for PHC health care but aren't getting it. Mansch says with the move to a more spacious building, she intends to rectify that.

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