Joe Castel never pictured himself driving to Skid Row to visit his doctor. But the 49-year-old Pasadena resident is a contract employee with the government agency FEMA and that job does not provide health insurance.
So when his friend, the CEO of the John Wesley Community Health Institute (JWCH), invited him to visit the clinic, Castel accepted.
Still, the rough neighborhood where the clinic is based gave him pause, especially on his first trip down there. Castel’s doctor had him run around the block to get his heart rate up to check his heart murmur.
“I was literally jumping over people laying on the street ,” Castel said. “I mean, people shooting up, I was running past them. Doing drug deals, I was running past them. Pushing their carts, I was running past them. You know, they were like hurdles laying on the ground.”
Although the neighborhood feels troubled, on the inside, the superstore-sized clinic is stocked with clean exam rooms, a pharmacy and a seven-chair dental wing. It also offers psychology, radiology, vision and even housing services.
Castel, who has since joined the clinic board as a consumer representative, is not the only one looking to community health centers for care. Clinics like this one are booming, in California and across the country. They are expanding and renovating with billions in federal dollars provided by the stimulus legislation and the Affordable Care Act.
This clinic is part of a Federally Qualified Health Center (FQHC), a type of clinic targeted in President Obama’s health reform measure as a key component in building medical capacity for the millions of Americans expected to gain health insurance under the legislation. In Los Angeles alone, one million people are projected to land federally subsidized coverage starting in 2014, and many are likely to go to clinics for their care.
In California, there are about 120 FQHCs, representing over 1,100 “delivery sites” and serving upwards of 2.9 million patients. Nationwide, there are more than 1,100 FQHCs providing care to about 20 million patients at 8,000 delivery sites.
The clinics use the federal money to build more centers, add more exam rooms, expand services and switch over to electronic health records. As a result, many of these clinics are no longer operating on shoestring budgets.
Just last May, the JWCH Institute received a $2.7 million federal grant to renovate and expand its Norwalk clinic, about 15 miles southeast of Skid Row.
“There’s also a special reimbursement that we get for each patient that has Medicare or Medi-Cal that exceeds what a doctor in private care would get,” said Dr. Paul Gregerson, medical director for the JWCH Institute.
This higher reimbursement allows clinics to build a team-based approach, or patient-centered medical home, emphasized under the Affordable Care Act. Under this model, patients see teams of caregivers from chronic disease specialists to social workers to nutritionists to clinical pharmacists.
“All these people … will be able to see the patient and we’ll be able to afford them because the overall visits when they do see the doctor will be reimbursed at a higher rate of pay,” Gregerson said. An added benefit, he said, is that the team approach allows primary care doctors to see more patients.
With all this federal money, community clinics are growing quickly, but this rapid growth is creating some anxiety.
“It’s creating a lot of tension because the growth has just been so fast,” said Melissa Schoen, an independent consultant for community health centers and foundations. “I think clinics are really struggling with this, the increase in demand they’ve been seeing and now getting ready for health reform and more and more patients potentially coming to them.”
Lauren M. Whaley is a reporter at the CHCF Center for Health Reporting, based at the USC Annenberg School for Communication and Journalism. The center, which provides in-depth reporting on California health issues, is funded by the nonpartisan California HealthCare Foundation.