Story and photos by Jeff Keeling
Tennessee Gov. Bill Haslam can expect a receptive audience Thursday as he pitches his Insure Tennessee Medicaid expansion plan at the Johnson City Community Health Center (JCCHC).
Silas Tolan, the center’s executive director since mid-2014, said last week Insure Tennessee’s implementation would be a boon to JCCHC. Nearly 50 percent of JCCHC patients have no insurance, and a number of them would be among those (with incomes up to 138 percent of the federal poverty level) to gain coverage if Insure Tennessee becomes reality.
“A shift like that would definitely help us,” Tolan said. “People who will qualify, when they see us now, are charged on a sliding scale, but even when they do pay those bills, it’s significantly less than the amount Medicaid would reimburse us.”
While many physician practices and other for-profit primary care providers have the option of not treating uninsured patients, JCCHC does not. It is a “federally qualified health center” that receives significant federal funding from the Health Resources and Services Administration. That fact, and its mission, compel it to accept and treat all patients regardless of insurance status.
This leaves Tolan’s view of Insure Tennessee closer to that of hospital administrators, who also must treat all patients regardless of insurance, at least at the emergency room level.
Once known as the Downtown Clinic, the center operated by East Tennessee State University and with nurse practitioners as its primary clinicians, has expanded its scope since moving into a new, much larger building across from Johnson City Medical Center in 2013.
The center’s core mission continues to be providing care to underserved populations, including many people without insurance. But to serve those patients effectively, Tolan said, JCCHC is striving to become more entrepreneurial, and to attract more insured patients.
“The downtown clinic started out in 1990 with a mission to provide services to homeless people in Johnson City, and also provide some clinical outlets for faculty,” Tolan said. “Now we have this large facility, and we still have a mission of serving the underinsured and uninsured and those most in need, but the game plan is much bigger. Without having income, without having a margin, we can’t fulfill that mission.”
So, just as Haslam’s plan includes elements of choice and consumer responsibility different from the general Medicaid expansion Tennessee rejected two years ago, JCCHC’s new approach aims to sell the clinic’s positives to a broader audience. Trish Mims, a nurse practitioner and Navy veteran with an MBA, runs the Johnson City facilities (there are two smaller ones as well) bringing a business mindset to the clinical services. Carter Wade, who like Mims and Tolan arrived last year, works strictly on the business development side.
The clinic boasts a broad array of services under one roof – including pediatrics, women’s services, audiology, physical therapy and speech/language pathology – and is branding itself as a provider of choice for patients of all income levels. The more it can increase the now-tiny sliver of higher-income patients with standard third-party insurance, Tolan said, the better it can afford to serve its traditional patient base.
“One market we’re looking at with a few initiatives is Medicare,” Tolan said. “That is a good, sustainable population to target as far as helping finance your health center, and we have room to grow our patient volume.”
Grants are not getting any easier to come by, Tolan said. And the $1.5 million annual HRSA grant that undergirds much of JCCHC’s operating budget could be subject to a 70 percent cut if not renewed next year. Tolan said there is bipartisan support for it, but added that it shows the wisdom of broadening revenue streams.
While Tolan’s reasons for supporting Insure Tennessee are fairly straightforward, a major ally came fully on board last week when the Tennessee Medical Association (TMA) announced its board had unanimously voted to support the proposal. TMA’s president, Dr. Doug Springer, is a Kingsport gastroenterologist who discussed the issue Friday at his office.
When Haslam announced the initiative six weeks ago, TMA offered qualified support, saying its 8,000 members needed to thoroughly vet the proposal and citing several specific concerns. Springer, who met directly with Haslam, said in large part those have been addressed.
“We know, and the TMA is absolutely in support of this, that people with health insurance have a higher quality of life,” Springer said. He said Insure Tennessee would inject $1.5 billion into medical care provision, and if it works, physicians will get paid to treat people at the appropriate level of care.
“You’re not having people go to the ER, the most expensive place in the world to visit, when they’ve got something wrong,” Springer said. “They get treated before that to prevent something from going wrong.”
Some of the huge costs currently borne by hospitals as they treat people with advanced problems will abate, lowering overall health care expenditures – again, if Insure Tennessee works as envisioned, Springer said.
“This should allow for getting things taken care of like unknown hypertension, diabetes, obesity, chronic illnesses – catching up on all the screening that should be done on people that don’t have any money, don’t have insurance and therefore won’t go get screening.”