Community health centers fear extinction just as need rises

By Frederick Melo, St. Paul Pioneer Press

Karina Forrest-Perkins, CEO of the People’s Center Clinics and Services in the Cedar-Riverside neighborhood of Minneapolis, prides herself on serving 10,000 low-income or uninsured patients annually, including many refugees and members of other vulnerable groups.

These days, it’s her clinic that’s vulnerable. She’s temporarily let go 27 of 58 workers because of the coronavirus pandemic. Dental services have been shuttered except for dire emergencies. Getting her immigrant patients to switch to telephone or online “tele-health” visits has taken weeks. Many don’t have iPads, iPhones or Internet access.

To make matters worse, until just a few days ago, the Minnesota Department of Human Services did not allow billing for telephone consultations.

“We went from seeing 100 patients a day to seeing 20,” said Forrest-Perkins, who said patient numbers have finally begun to climb again. “We went two-to-three weeks unable to bill. That was a $500,000 loss.”

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Serving health needs of the poor

Across Minnesota, it’s a familiar story for the state’s 17 federally-backed community health centers, organizations that specialize in serving the poor. About 30 percent of their clients are uninsured, and 50 percent are on Medicaid, the St. Paul Pioneer Press reported.

With 6 million jobless claims across America last week alone, and patients deferring even essential care as a result of the pandemic, they’re bracing for a perfect storm of increased demand at a time when it’s uncertain if they’ll be able to keep the lights on.

“As we furlough our staff, we’re going to need to quickly ramp up to address these millions of Americans who no longer have insurance,” said Dr. Ritesh Patel, CEO of Open Cities Health Center on St. Paul’s University Avenue.

Summer Johnson, development director with Open Cities, said the large East African population at the Skyline Tower low-income high-rise on nearby St. Anthony Avenue will need special attention once COVID-19 peaks. Social distancing in refugee communities appears uneven at best.

“They’re living with small hallways, crowded elevators, cramped community spaces,” said Johnson, noting the center’s attempts at health outreach within Skyline has been difficult. “We haven’t been really able to get that buy-in from that population. There’s 2,000 people living there.”

Like other medical centers, Open Cities may be overwhelmed by patients when infection rates peak.

“Will they go to Open Cities, which we are not prepared for?” she said. “Or will they go to the hospital ERs, which the ERs are not ready for?”

Waves on horizon?

Jonathan Watson is thinking in waves.

As the chief executive officer of the Minnesota Association of Community Health Centers, he’s seeing some of the state’s community health centers bordering on the brink of shutting down after losing 60 percent or more of patient revenue nearly overnight.

To make matters worse, the revenue drop is happening even as community health centers prepare for a potential surge in COVID-19 cases. These centers cater to the poor, the uninsured and underinsured patients on high deductible plans, a community particularly vulnerable to the virus because of underlying conditions, work or living situations.

Financially, “we don’t have the shock absorber that private centers have to weather storms like this,” Watson said.

Sooner or later, the non-COVID diabetic patient will need to come in for a face-to-face evaluation. So will the patient in a mental health crisis, or the patient who needs chemotherapy.

And chances are, many patients who put off urgent care for as long as they could during the pandemic will need deeper, more complicated services.

That’s wave two.

“A lot of people who come in for routine visits, they have chronic conditions like lupus, or diabetes, that need regular monitoring by a physician,” Forrest-Perkins said. “Should they become infected with COVID-19 or the flu, they are at the highest risk for loss of life.”

Then comes wave three. With record-breaking jobless claims, Americans everywhere are losing health insurance through their employers. Where will they go when they need services?

“To me, that translates to a lot of uninsured who may defer services,” said Watson, who isn’t trying to discourage patients from seeking care if they need it. Just the opposite, he said.

“We hope the uninsured will come to community health centers. That’s our whole model.”

Re-emergence of coronavirus

Watson, a former budget and policy analyst for the Wisconsin Department of Health and Family Services and Wisconsin’s Medicaid managed care expansion, said health systems also need to brace for what could be a fourth wave — the possible re-emergence of COVID-19 in late 2020 or 2021.

Even if patients who are admitted in the next few weeks are out of the hospital by late May or June or July, the history of viruses such as the influenza pandemic of 1918 indicates a possible resurgence in the fall. Some experts have predicted as many as 18 months of hot spots around the country.

So far, state and federal lawmakers have included some funding for community health centers in relief and stimulus bills, but it’s mostly served as an emergency stop-gap. For instance, the first federal stimulus package included $100 million for the nation’s 1,400 health centers, or $60,000 per health center.

It’s a help, but Open Cities’ Johnson said the pandemic could be an “extinction-level event” for many health centers everywhere.

“We’re unable to see a good chunk of what makes up our business — high-risk chronic patients that need these services,” she said. “Our revenue is down 61 percent, and our encounters are down 41 percent.”

Those needing care should call ahead

Watson encourages anyone who thinks they might need care to call ahead, and keep in mind that most hospitals and health centers have segregated respiratory patients from those needing important check-ups and other services.

Medical settings are increasingly safe places for urgent care during the pandemic.

Right now, health centers need patients, but they’re facing a crisis in both supply and demand.

“The supply is constrained by executive orders, in terms of non-essential care being shut down,” Watson said. “In terms of a demand issue, you have patients saying, ‘the last place I want to go is to a hospital and be exposed to the virus.’“