The Health Center: May 2011 (Volume 7, Issue 2)

May 2011

Volume 7 Issue 2

www.mo-pca.org

Featured Articles:• The MoHealthNet

Oversight Committee Welcomes New Members

• Health Center Highlights

• Spotlight: 2010 Samuel U. Rodgers Achievement Award Recipients

• SEMO Health Network: A Helping Hand in a Time of Crisis

• A Ready-Made Medical Home: Federally Qualifi ed Health Centers [Expert Insight]

Health

Our Mission:

Missouri’s CHCs Witness Strong Support from State Legislators

n April 20, the Missouri Senate passed the State’s Fiscal Year 2012 operating budget. For FQHCs, it was an eventful and successful day. All MPCA legislative priorities were included in the budget and our primary legislative adversary's att empt to eliminate funding for health services for the underserved was soundly defeated.

During the debate, the Senate departed from tradition by allowing amendments to be off ered on the budget. Two amendments to House Bill 11, the appropriations bill which funds the Department of Social Services, were considered and defeated. Each would have had a signifi cant and negative impact on FQHCs. As has been the case for the past several years, the debate regarding state funding of FQHCs was the most substantial discussion of any item in the entire state budget.First, Senator Rob Schaaf (R-St. Joseph) off ered an amendment which would have completely eliminated funding for FQHCs. His rationale was that it is unconstitutional to provide state funding to FQHCs and that state funding creates unfair competition. Schaaf was immediately challenged by the Senate Appropriations Chair Kurt Schaefer (R-Columbia), Senator Maria Chappelle-Nadal (D-St. Louis), Senator Jack Goodman (R-Mt. Vernon) and Senator Kevin Engler (R-Farmington).

To be Missouri’s leader in shaping

policies and programs that improve access

to high quality, community based, and

aff ordable primary health services.

O The support expressed for FQHCs and opposition to Schaaf, and the way it was delivered, was dramatic, intense, and strong. Many incredible things were said about FQHCs. Senator Engler said that FQHCs were the best thing to happen to his rural district. Senator Goodman sternly rebuked Schaaf, noting the positive impact FQHCs have on improving people’s lives. Senator Chappelle-Nadal stated that Schaaf’s amendment would hurt the poor in her district. Senator Schaefer stood his ground supporting our funding. The vote was taken by voice. Schaaf was the only Senator voting in support of cutt ing FQHC funding. Every other Senator shouted a thunderous NO! The second amendment was off ered to strip out of the budget federal funds for the meaningful use incentive payments. This too was soundly defeated.Aft er the debate on FQHC funding took place, the Senate voted on and approved the FY 2012 Budget. All of MPCA’s legislative priorities were included at the same levels by both the House and Senate, and are therefore considered fi nal. These items are listed below. The fi nal step will be implementation by Governor Nixon and his administration, which we expect full support. • $10,000,000 for Medical Home for

MO HealthNet Patients with Chronic Conditions

• $3,020,000 for Service and Oral Health Expansion funding

• $1,114,750 for Women and Minority Health Outreach Program

• $1.5 million for Mental Health and Primary Care Integration Initiative

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Officers

Robert Massie, President Family Care Health Centers

Alan Stevens, Vice PresidentCommunity Health Center

of Central Missouri

Dwayne Butler, Treasurer BJK People’s Health Center, Inc.

Christine Stewart, Secretary Katy Trail Community Health

Board of DirectorsJennifer Buehler

Jordan Valley Community Health Center

Sherilyn Clark Missouri Highlands Health Care

Gloria Crull Family Health Center

T.R. Dudley Great Mines Health Center, Inc.

Ben Ernst Northwest Health Services, Inc.

Alan Freeman Grace Hill Health Centers, Inc.

Hilda Fuentes Samuel U. Rodgers Health Center

Archie Griffin Myrtle Hilliard Davis

Comprehensive Health Centers

Andy Grimm Northeast Missouri Health Council

Don McBride Access Family Care

Pat Richards Southern Missouri Community

Health Center

Verneda Bachus Robinson Swope Health Services

Richard Sims Missouri Ozarks Community Health

Robert Walters Central Ozarks Medical Center

Ron Camp Cross Trails Medical Center

Cheryl White Southeast Missouri Health Network

Karl Wilson, P.h.D. Crider Health Center

Joseph Pierle, CEO Missouri Primary Care Association

The MoHealthNet Oversight Committee Welcomes New Members

I n 2007, the Missouri State Legislature created the MO HealthNet Oversight Committee to evaluate the MO Health Net program and its implementation. MO HealthNet strives to maximize quality of life and independence by focusing on providing excellent health care access to Missouri’s low income and vulnerable citizens.Recently the MO HealthNet Oversight Committee welcomed two new members, who are affiliated with MO CHC's: Dr. Kecia Leary, Associate Dental Director at the Jordan Valley Community Health Center in Springfield, and Mr. Mark Sanford, Executive Vice President of Betty Jean Kerr People’s Health Centers in St. Louis.

Kecia Leary, DDSIn addition to being a tireless advocate for improving dental care for the developmentally disabled population, Dr. Kecia Leary is a leading voice in the effort to ensure that all Missouri’s children have access to comprehensive oral health services, from prevention services to oral surgery. After achieving a BA from Truman State University, she went on to attain a Doctor of Dental Surgery (DDS), an MS in Dental Public Health, and a Certificate in Pediatric Dentistry from the University of Iowa College of Dentistry. She is a Diplomate of the American Board of Pediatric Dentistry, a member of the American Dental Association, the American Academy of Pediatric Dentistry, and the American Association of Public Health Dentistry. She has been a vital resource on pediatric dental issues to the Missouri Primary Care Association.Dr. Kecia Leary’s incontrovertible commitment to bringing a higher quality of life to underserved Missourians through improved healthcare access makes her an excellent addition to the MOHealthNet Oversight Committee.

Mark SanfordAfter graduating magna cum laude with a Bachelor’s degree from Washington University, Mark Sanford went on to achieve his Nursing degree from St. Louis Community College, and a Master’s degree in Health Care Administration from St. Louis University where he was honored as an A.U.P.H.A. Fellow. Since 1989, he has served BJK People’s Health Centers in many capacities. His responsibilities progressed from performing as an outreach coordinator, a planning and development officer, a chief financial officer, and finally to his present position. Prior to working for BJK People’s Health Centers, he served as Vice President of St. Mary’s Hospital in East St. Louis. Through twenty-nine years of hands-on experience in health administration Mark Sanford has gained a unique understanding of principles and practices of community health, healthcare delivery systems, and program development. Over the years, his community has benefited from his involvement in the American Heart Association, the Promise Center for the Developmentally Disabled, as well as many others.

Today at BJK People’s Health Centers, Mark supervises the program, outreach, and business development areas of senior healthcare management including: service expansion, project development and implementation, grant writing, community development, facility maintenance and patient navigation. His unwavering dedication to serving the needs of his Missouri community both personally and professionally makes his appointment to the MO HealthNet Oversight Committee an inspired choice.

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The entire fact sheet is available at:www.nachc.com/client/documents/20090929_Rising_Patient_Demand.pdf

Health Center HighlightsNorthwest Health Services, St. JosephNorthwest Health Services has added a new provider to their Family Medicine Associates location in St. Joseph, MO. Chery Wormington, FNP, practices Monday-Thursday during the extended hours of 8:00 am – 6:30 pm. Dental outreach has also kept Northwest Health’s Outreach Coordinator, Sandy Trosper, quite busy through the months of January – March. She, along with dental hygienist, Bertie Cronbaugh, and dentist, Dr. Aaron Hiegert, have provided twenty-one schools and Headstart Programs in the Northwest Missouri area with dental screenings and education.

Samuel U. Rodgers Health Center, Kansas CityOn March 23, 2011 Samuel U. Rodgers Health Center(SURHC), in partnership with the Communities Creating Opportunity, marked the one year anniversary of the signing of the Aff ordable Health Care for America Act by hosting a press conference. The celebratory event included remarks from Congressman Emanuel Cleaver II, Dr. Rev. Wallace Hartsfi eld, Captain Jose Belardo, Crystal Wallace, Elder Joseph Forbes, and Geneva Price. The event symbolized the community coming together to alleviate suff ering and reduce health care burdens for the people of Kansas City. A notably increasing number of Kansas City’s most vulnerable have discovered that access to critical medical care is available to them, and SURHC hopes this newfound awareness will continue to grow, drawing more to seek out and utilize these life-changing services.

Southeast Missouri Health Network, New MadridSEMO Health Network is proud to announce the opening of The Francis Pulliam Building, a new medical and dental clinic in Bernie, Missouri. The ARRA – CIP funding allowed SEMOHN to construct a 7000 sq/ft building housing medical and dental. The new facility has ten exam rooms and six dental operatories and is furnished with state of the art equipment. An Open House was held on Friday April 8, 2011 from 1pm to 3pm at 741 South Walnut Street in Bernie. Everyone joined SEMOHN for fun, food and festivities.

Southern Missouri Community Health Center, West PlainsSouthern Missouri Community Health Center (SMCHC) is committ ed to providing comprehensive health and dental education to the community. As such, the dental clinic has cultivated an ongoing relationship with Ozark Action and, as a result, has for many years provided dental care, screenings, and education, as well as dental varnish for Head Start students. Recently SMCHC Medical Clinic received a request from Ozark Action to provide education to Head Start teachers regarding childhood obesity and Clinical Support Coordinator, Erin Bonham, R.N. happily obliged. SMCHC has also hosted an interactive learning session for individuals who have been diagnosed with diabetes and their families.

Community Health Center of Central Missouri, Jefferson CityCommunity Health Center of Central Missouri (CHCCM) has experienced rapid growth in the past year. In August 2010, CHCCM opened a new dental clinic at the Linn, MO site. In January 2011, CHCCM began off ering Pain Management Services on a full-time basis. This approach integrates the delivery of primary care with behavioral health interventions and the pain management specialty. The OB clinic continues to see an increase in deliveries, with over 200 babies delivered in 2010. CHCCM is also in the process of applying for level three recognition as a Patient Centered Medical Home through the National Committ ee for Quality Assurance (NCQA).

Crider Health Center, WentzvilleSince moving into its newly expanded Wentzville facility, Crider Health Center has begun the process of renovating its former medical clinic. The space will be transformed into a dental clinic that will house eight state-of-the-art dental suites. The renovation is planned to be completed in October of 2011. Additionally, Crider has partnered with HBD Construction, Inc., to begin construction of a new 15,000 sq. ft . health care facility located in Warrenton. The Warrenton facility will off er primary and behavioral health care, pediatrics, and dental services and is slated for completion in the spring of 2012.

Cross Trails Medical Center, Cape GirardeauCross Trails Medical Center is pleased to announce that Ron Camp has been hired as the Chief Executive Offi cer of the organization. Ron was formerly the Chief Financial Offi cer for SEMO Health Network for nine years and brings a wide array of Community Health Center experience to his new role as CEO. Commenting on the transition, Ron had this to say: “It’s with heavy heart I am leaving SEMO Health Network, but I am truly excited about coming to Cross Trails Medical Center with all the new opportunities and fi ne people I will be working with.” Cross Trails Medical Center is excited to welcome Mr. Camp and confi dent that he will be fi ne asset to the community.

Jordan Valley Community Health Center, Springfi eldOn April 15 and 20, Jordan Valley Community Health Center in Springfi eld held its spring “Care to Give” event, reaching out to members of the community who lack the fi nancial means to pay for dental care. Visitors to the Benton Street Dental Clinic in central Springfi eld were off ered free dental screenings, dental remedies for severe tooth pain, and dental extractions. The Kitchen, Cox Health, and AIDS Project of the Ozarks partnered with Jordan Valley Community Health Center to provide this essential community service. For more information about this and future events at the center, please visit www.jordanvalley.org

Missouri Highlands Health Care, EllingtonMissouri Highlands Health Care is proud to announce the opening of the NEW Ellington Family Clinic. The new clinic, located at 61 Hwy Y in Ellington, MO, opened for business on March 7, 2011. Construction on the site, funded by an American Recovery & Reinvestment Act (ARRA) grant, started in September 2010 and was completed in February 2011. The clinic moved from its 2,420 sq. ft . space to the new 5,647 sq. ft . building, which includes expanded exam rooms, extra offi ce space, updated x-ray facilities, and the addition of Behavioral Health services at the clinic.

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Spotlight: 2010 Samuel U. Rodgers Achievement Award Recipients

n 2000, the Missouri Primary Care Association Board of Directors established one of its most prestigious awards – the Samuel U. Rodgers Achievement Award, named aft er a true pioneer in community health, Dr. Sam Rodgers.In 2010, seven individuals from diverse backgrounds who share the same vision for empowering lives and improving health, were made recipients. In our next three issues, the MPCA will proudly highlight these individuals and their remarkable service to their communities.

Dr. Charles Bentlage Since 2007, Dr. Charles Bentlage has served ACCESS Family Care as Medical Director. Prior to 2007, he spent the previous 27 years serving as a general surgeon, Medical Director, and Corporate Compliance Offi cer for Freeman Hospital in Joplin, MO. He has been a great friend to his community through a variety of ways. As such, the Samuel U. Rodgers Achievement

Award is not the fi rst award bestowed upon Dr. Bentlage. He has been honored numerous times and, in 2008, he was recognized by the Missouri Legislature as Outstanding Missouri Citizen. Dr. Charles Bentlage’s heartfelt, untiring advocacy for the underserved population is truly an inspiration to us all.

Ms. Jean FrazeeMs. Jean Frazee joined the Grace Hill Health Centers Board of Directors in 1989. Since that time, she has demonstrated extraordinary, unrelenting commitment to aiding underserved St. Louis residents in gaining quality health care access. Though keenly equipped to tackle the extraordinary obstacles inherent to her role as an advisor and advocate, Ms. Frazee has served generously and with humility, placing patients, communities, and Grace Hill staff , forefront in her eff orts. Such selfl ess diligence both inspires and motivates the colleagues and community she so graciously serves.

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“Dr. Bentlage exemplifi es by word and deed the leadership style of servant-leader adopted by ACCESS Family Care. He goes above and beyond the call of duty to ensure that the clinical team remains patient-focused in their service to patients.” ~ Don McBride, Executive Director, Access Family Care, MPCA Board Member

“Ms. Frazee is one of the most diligent and dedicated board members, volunteer or elected, that I have worked with in my career…Dr. Rodgers would readily recognize [her] commitment as reminiscent of his own.” ~ Alan Freeman, Executive Director, Grace Hill Health Centers, MPCA Board Member

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“Dr. Doyle epitomizes the highest standards in the medical profession. He is beloved by his patients, held in high esteem by the local community and city/county leaders, and highly respected by [his colleagues].” ~ Denzel Garner

“Dr. Doyle is the best thing that ever happened to Bollinger County. Dr. Doyle is more than a doctor, he is a true friend.” ~ Cross Trails patient

Dr. Edward DoyleDr. Edward Doyle joined Cross Trails Medical Center in November 1998. He currently serves as the only practicing physician in Bollinger County. Subsequently, “normal business hours” constitute a much larger part of his day than for most physicians, but his compassionate dedication to patient access is unwavering. Serving in a remote area (35 miles from the nearest emergency room) also brings the challenges of providing critical, stabilizing care to those who must be transported for further treatment and Dr. Doyle has met those challenges. In addition, he has championed integral Chronic Disease Management, improving the daily, long-term health of Southeast Missouri residents. Dr. Edward Doyle has literally “gone the extra mile” to save lives and infuse them with the rich rewards of healthy living.

SEMO Health Network: A Helping Hand in a Time of CrisisIn recent weeks, Missourians have watched as the southeast region of the state has been batt ered by devastating fl ooding. The fl ooding was so extreme that evacuation became necessary in the communities of Butler, Dunklin, Mississippi, New Madrid, Pemsicot, Scott , and Stoddard counties. SEMO Health Network, with emergency funding from the Missouri Foundation for Health, stepped up to the challenge by implementing the successful “Love Thy Neighbor” project. By engaging the public via social media sites like Facebook, and through a partnership with offi cials, churches, merchants, and community residents, SEMOHN was able to provide essential supplies, storage facilities, and safe havens to fl ood victims. Their fast-acting and effi cient response to a neighborhood crisis saw over 40 displaced families safely housed within a 24 hour period.

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s hospitals become accountable for the entire continuum of care within their communities, the opportunity to provide preventive care and chronic care management to vulnerable populations can reduce readmission rates and improve quality outcomes—and Federally Qualified Health Centers (FQHCs) provide precisely that opportunity. FQHCs already serve as the medical home for more than 20 million people in the US at approximately 8,000 service delivery sites, providing one-quarter of all primary care for low-income Americans. Roughly half of FQHC patients live in economically depressed, inner-city communities and the other half reside in rural areas.An FQHC is defined as a public or private nonprofit, charitable, tax-exempt organization that receives funding under Section 330 of the Public Health Service Act or as determined by the US Department of Health and Human Services to meet requirements for funding without actually receiving a grant (ie, an FQHC “look-alike”). It is estimated that FQHCs save the national health care system up to $24 billion a year by providing preventive care and chronic condition management for the under- or uninsured. This includes $6.7 billion in savings for the federal share of the Medicaid program. Health centers provide high-quality, comprehensive care at low cost, averaging $600 per patient per year, 24% lower than costs for patients seen elsewhere. Savings are driven by lower utilization of costly specialty care, emergency departments (EDs) and hospitals. And, beginning in fiscal year 2011, the Patient Protection and Affordable Care Act (PPACA) will offer $11 billion in new funding for FQHCs over the next 5 years. While the details have not been released, the PPACA requires insurers participating in the new health insurance exchanges to contract with FQHCs and other safety net providers. According to the bill, insurance exchanges, which provide a choice of health plans for individuals without access to employer-sponsored coverage, must be implemented by January 1, 2015.

A Host of Benefits FQHCs offer the coordinated care that many health care organizations are struggling to provide as they enter the outpatient arena. Specifically, FQHCs provide services related to family medicine, internal medicine, pediatrics, obstetrics and gynecology, as well as diagnostic laboratory and radiological services, pharmaceutical services as appropriate, and defined preventive health services. FQHCs also are required to provide community outreach activities, including:

Patient case management services

Assistance for patients utilizing FQHCs, including transportation servicesEducation of the general population, as well as health center patients served by FQHCs, about the availability and proper use of health services

For hospitals, increased patient access to care through FQHCs will decrease ED visits, potentially avoidable admissions (PAAs) and readmissions, and provide a medical home for patients who would otherwise have no primary care follow-up after discharge. Medicaid beneficiaries who use FQHCs are 19% less likely to use the ED compared to patients relying on other providers. FQHCs encourage standardization of care through clear referral pathways, common clinical protocols and integration of inpatient, outpatient, specialty and primary care providers. Other benefits include:

Decreased duplication of services through improved communication between outpatient and inpatient settingsFewer expensive inpatient and specialty care services since fewer patients will present to the hospital with complex advanced stage diseasesIncreased preventive services, such as immunizations and access to prenatal and well-baby care, and a decreased prevalence of high-risk behaviors, such as smokingImproved clinical outcomes, such as reduced lifetime incidence of diabetes complications, lower cholesterol levels and increased blood pressure control

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A Ready-Made Medical Home: Federally Qualified Health Centers [Expert Insight]By Julie Schulz, MD, Consultant, Sg2, www.Sg2.com

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Reimbursement and Legal ProtectionsFor the most part, FQHCs will receive a higher rate of reimbursement from Medicaid, Medicare and the Children’s Health Insurance Program (CHIP) for their benefi ciaries than other health care entities do for similar services. Specifi cally, FQHCs have access to reimbursement for Medicare, Medicaid and CHIP services through the prospective payment system or an alternative, state-approved payment methodology which, for Medicaid and CHIP services, is predicated on a cost-based reimbursement methodology. They also receive cost-based reimbursement for Medicare services. Additionally, FQHCs and their providers receive coverage under the Federal Tort Claims Act as well as discount drug pricing under Section 340B of the Public Health Service Act and federal anti-kickback statute protection under the safe harbor for FQHC grantees.Partnering With an FQHCFQHCs rely heavily on philanthropic support and grant funding, and require aggressive fundraising eff orts. It is of utmost importance that FQHCs and their partners consider statutory, regulatory and policy requirements throughout the evaluation and implementation of any affi liation. A thorough review of legal considerations will help ensure that the partnership is appropriately structured, reduces exposure to liability and protects an FQHC’s designation. Finally, it should be noted that while some FQHCs have managed to provide high-quality, cost-effi cient care with slim margins, others continue to struggle.In the short-term, federal funding expansion will increase the number of FQHCs and the number of patients receiving care through them. The impact of health insurance exchanges will depend on state-level implementation timelines and local provider trends. As the number of people served by FQHCs is expected to double to 40 million patients by 2015, expect to see rapid expansion of existing facilities, as well as considerable new FQHC construction. There will be a defi nite “fi rst-mover” advantage to hospitals that

develop relationships with existing, well-run FQHCs, as the costs, expertise and risks associated with developing a new program are signifi cant. Finally, state support for FQHCs is variable, and some states may use increased federal funding to justify state-level cuts.FQHCs present an exceptional opportunity to provide preventive and health maintenance services to underserved and vulnerable communities, keeping patients out of the ED and reducing PAAs and readmissions. Because FQHCs serve primarily low- and middle income patients—71% of FQHC patients have family incomes at or below the federal poverty level—hospitals looking to improve care for these patient populations will benefi t most from partnerships with FQHCs in their community.Sources: Feldesman Tucker Leifer Fidell LLP for the National Association of Community Health Centers (NACHC). Partnerships Between Federally Qualifi ed Health Centers and Local Health Departments for Engaging in the Development of a Community-Based System of Care. www.nachc.com/client/Partnerships%20Between%20FQHCs%20and%20LHDs_Final_11_03_10%20(2).pdf. Published October 2010; Falik M et al. J Ambul Care Manage 2006;29:24–35; Huang ES et al. Health Serv Res 2007;42:2174–2193; Hicks LS et al. Health Aff (Millwood) 2006;25:1712–1723; NACHC. Community Health Centers: The Local Prescription for Bett er Quality and Lower Costs. www.nachc.com/client/A%20Local%20Prescription%20Final%20brief%203%2022%2011.pdf. Published March 2011; Ku et al. Strengthening Primary Care to Bend the Cost Curve: The Expansion of Community Health Centers Through Health Reform: Policy Research Brief No. 19. Geiger Gibson/RCHN Community Health Foundation Research Collaborative. 2010; Hawkins D et al. J Ambul Care Manage 2011;34(1):90–99; Centers for Medicare & Medicaid Services. Fact Sheet: Federally Qualifi ed Health Center. www.cms.hhs.gov/center/fqhc.asp. Published April 2009; All Web sites accessed April 2011.

Missouri Primary Care Association3325 Emerald LaneJeff erson City, MO 65109(573) 636-4222Fax (573) 636-4585www.mo-pca.org

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2011 Calendar of Events

MPCA is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. MPCA designates this activity for 13 continuing education credits.

MAY National Physical Fitness and Sports Monthwww.fi tness.gov

JUNEHome Safety Monthwww.homesafetycouncil.org

Men’s Health Monthwww.menshealthmonth.org

JULYUV Safety Monthwww.aao.org/aaoesite/eyemd/uv.cfm