Filling in the gap: Good Samaritan expands services to meet need
The Good Samaritan Clinic, the only free clinic in Haywood County, is struggling to meet the health care needs of its patients, largely because North Carolina didn’t expand Medicaid.
Ideally, the clinic’s patients, those who are uninsured and between ages 18 and 65, would now be covered under the Affordable Care Act that went into effect this year, but that has not been the case. Donda Bennett, executive director of GSC, said the clinic is needed now more than ever.
A majority of GSC’s patients fell into the gap created when the state legislators decided not to expand Medicaid, which would have covered an additional 500,000 people in North Carolina.
Once the ACA got under way, the clinic had a health care navigator onsite two days a week for several months. Only 60 of its patients became insured and were moved into other primary care practices. That is a small number considering the clinic has 4,600 patients.
“Essentially, if North Carolina had expanded Medicaid, most of our patients would have qualified for Medicaid and become insured. These same patients instead received letters of exemption,” Bennett said. “So they are exempt from paying the tax because they can not afford subsidized insurance based on their income level. The result is an overwhelming need for free clinics to continue.”
Because of the continued need in Haywood, the county commissioners approved funding in the 2013-14 budget for an added mid-level provider at the clinic. Chelsea Batten, a certified physician’s assistant, will spend half of her time at the clinic and half of her time at the Haywood County Health Department.
"This arrangement is unique and will help many people through an innovative approach. I am very appreciative that the county commissioners and county administration supported this effort to improve access to care in our county," said Carmine Rocco, health department director. "GSC continues to be a valuable partner serving the people of Haywood County."
“To have the commissioners and county leaders recognize this need is very exciting. The level of compassion for the uninsured speaks volumes,” Bennett said.
The public will have a chance to meet Batten and see the clinic from 4 to 6 p.m. July 8 during an open house event. Batten started her new position on June 19 for training and will start seeing patients on her own soon. While she got several offers after graduating, she said it felt like God was leading her to serve patients in rural areas.
“I came in here and felt like I could see myself here,” she said. “I had a connection to the staff and the clinic’s mission to all avenues of care.”
The addition of Batten will allow GSC to expand services by 50 percent. She joins current provider, Kristin Gruner, PA-C, and a support staff of four, along with more than 25 volunteers. Her role at GSC will be to provide primary care to uninsured patients and help increase access for patients who are currently on the waiting list to be seen.
“Chelsea is a bright young lady and eager to meet the challenges of working at both the Health Department and GSC,” Bennett said.
The clinic has 70 patients pre-qualified waiting to get in for new patient appointments whi will be seen by Batten. Bennett said the people on this waiting list were either accessing health care at the Urgent Care, emergency room or simply going without.
Carmine Rocco, director of the health department, approached the clinic last summer about this arrangement that would place a mid-level provider at the clinic part-time.
“At that time, we had over 400 names on our waiting list of patients wanting to establish primary care at GSC,” Bennett said. “Over the past year this number has grown to over 500 on our waiting list and we are consistently adding people to the list.”
Carmine Rocco, the director of the health department, was instrumental in communicating with the commissioners and getting this arrangement set up.
Bennett said access to health care is a major issue in Haywood County, making the role of GSC a vital part of the health care delivery system in the county. There are only five primary care practices in Haywood County. A majority of them are not accepting new patients because they too are struggling to fulfill the demand with small staffs.
“We have lost several primary care providers and only a very limited number of practices are taking new patients. Even less are taking Medicaid patients,” Bennett said.
If someone loses their job and can qualify for Medicaid, he or she can continue to receive care at GSC. But only 4 percent of clinic patients are insured with Medicaid, and the primary focus remains on the uninsured.
While GSC focuses on primary care and chronic disease, and the health department focuses on communicable disease control, environmental health and health education, it is important that the two agencies work closely together to improve health care. Rocco said the County Health Rankings national program places Haywood County at 48 out of 100 counties in Health Outcomes.
"We are improving but still have more improvement to achieve," he said. "This partnership will help better assure health care services are available to more people in need."
Funding and operations
Good Samaritan Clinic is a ministry with the mission “to glorify God through the provision of medical care, including spiritual and social support, to underserved adults in Haywood County.”
Because it is faith-based, the clinic doesn’t qualify for many grants and has to heavily rely on donations to operate. While the GSC board has looked into other options, ultimately, the staff doesn’t want to lose its ability to minister to patients who are open to it.
The GSC is considered a "hybrid" clinic because it serves the uninsured and patients who have Medicaid. To qualify, patients must be 200 percent or below the federal poverty level, uninsured, residents of Haywood County, or newly enrolled to Medicaid.
“About 70 percent of the clinic’s patients are employed but do not make enough money to afford health insurance and still meet living expenses,” Bennett said.
Most free clinics in the state of North Carolina operate like an urgent care — volunteer doctors and treating mostly acute illness. Since 2008, GSC has had a focus on managing patients with chronic diseases and becoming a primary medical home for patients.
“Because we focus on disease management, our staff must be highly skilled and the use of electronic medical records is a must,” Bennett said. “Our medical director, Dr. Jonathan White, is a hospitalist at MedWest Haywood and he is highly involved with our staff and providers to insure that we are giving outstanding care.”
Bennett said MedWest was an important part of the survival of the clinic since it started in 1999 and she looks forward to a continued symbiotic relationship as the hospital is transferred to Duke LifePoint.
“They currently provide lab work to our patients at no charge and work with us to make sure our patients are receiving the services they need,” she said.
If you would like to donate to Good Samaritan, visit www.gschaywood.org or mail a check to 34 Sims Circle, Waynesville, NC 28786