Eastern Iowa Health Center expands to keep up with huge demand

CEDAR RAPIDS — In a few days time, the Eastern Iowa Health Center briefly will close its doors so staff can pack up their belongings and move to a temporary location at 600 Seventh St. SE.

The primary care clinic is moving so it can renovate and expand its facility at 1201 Third Ave. SE. That's because in the past year it's seen a huge increase in patient load and developed a milelong waiting list.

When the $1.9 million project is finished and the clinic reopens in four to five months, it will be compliant with the Americans With Disabilities Act, have much needed improvements and have more exam rooms. Joe Lock, chief executive officer of EIHC, and other administrators who don't work with patients will be off-site and their offices turned into exam rooms.

This is a necessary move, Lock said, because patient encounters — or an interaction between a patient and health care providers — jumped 63 percent from 2014 to 2015 — increasing from 24,273 to 39,594. In addition, the number of homeless patients served soared 176 percent in that same time frame, rising from 377 to 1,319, according to health clinic data.

Lock said he's stumped as to why patients numbers have increased so much, but attributed the majority of the growth to the passage of the Affordable Care Act and the expansion of Medicaid.

The EIHC is a Federally Qualified Health Center — a special designation given by the Centers for Medicare and Medicaid Services to clinics that work with an underserved population. The designation means they are eligible for higher reimbursement rates from CMS.

There are 14 in Iowa and about 1,300 across the country.

It provides primary care and OB-GYN services to low-income Linn County residents, Lock said, in addition to disease management for diabetes, cholesterol and hypertension.

'The one thing we do best is keep people out of the emergency room,' Lock said.

Finding a medical home

There's another reason for EIHC's patient growth, Lock said — a shift in patients from the free clinic over to EIHC. Eastern Iowa Health Center is seeing about 150 to 200 patients referred to it from the Community Health Free Clinic every month, he said

The Community Health Free Clinic has provided free medical and dental services to those without health insurance since 2002.

The clinic's primary purpose is to offer patients urgent care services, said Chief Executive Officer Darlene Schmidt, but in recent years patients began using the clinic more as a primary care doctor's office.

'But we're not set up for that,' she said.

Especially because so many patients have one or more chronic diseases that need to be effectively managed, she said.

After the ACA's passage, Schmidt hired a team of insurance navigators to help patients sign up for either private or government-sponsored insurance plans.

'We sign people up every day,' she said. 'From July (2015) to January (2016), we helped 874 people obtain insurance.'

The next step was to find these patients a medical home, a team-based approach to health care that provides patients with coordinated and comprehensive care. That often meant referring them to Eastern Iowa Health Center.

'A medical home is so important,' Schmidt said, explaining if a patient has diabetes he or she need education and to have their feet and eyes regularly checked. 'We try to do those things, but there's only so much we can do. We still have lines of 200 people to see. We don't have 30 minutes to look at their feet.'

But EIHC has a long waiting list — upward of 450 people — so the free clinic continues to care for the patients until they're able to get an appointment, Schmidt said.

Clinic numbers show that visits are steadily falling — about 13,627 people came to the free clinic in 2012 while only 7,473 did in 2014.

'We're seeing a decline, which is a good thing,' she said. 'The goal of every free clinic is to not need to have a free clinic.'

Planning for the future

Lock believes every one deserves outstanding, quality health care regardless of socioeconomic status. And he's working to ensure that Eastern Iowa Health Center is able to keep up with demand.

EIHC has hired two additional OB-GYNs — bringing the total up to five — but offering competitive salaries on a tight budget can be a challenge, he said. However, those services are desperately needed, Lock said, explaining there are about 784 pregnant patients at the clinic.

'In the OB world, we're providing care to women without insurance or who are on Medicaid,' said Diane Sorensen, the clinic's social worker. 'We see a lot of women who are here on a Visa or green card and maybe don't qualify for Medicaid yet.'

Giving these women the medical care they need will help reduce the number of premature deliveries, she added. Sorensen also works with the women and other patients to find community resources, including transportation with in the Medicaid system, baby items and food banks.

EIHC also has hired a health coach, Melissa Curry, to work with patients to better manage diabetes and other chronic health conditions. Curry said a large portion of patients are overweight and about 650 have Type I or Type II diabetes.

She works on achievable life style changes and weight loss through diet and exercise, she said, in addition to getting them involved with other community resources such as the YMCA's Diabetes Prevention Program.

And looking to the future, the clinic has applied for a federal grant that would allow it to provide dental services — something Lock and Sorensen said is very needed for the Medicaid populations. Dentists can be hesitant to work with the Medicaid population, Lock said, because reimbursement rates are low and the population can have a high no-show rate as they're often dealing with other barriers such as lack of transportation.

EIHC surveyed several hundred of their female patients to get an idea on the kinds of services they're having trouble accessing, and about a quarter said dental, Sorensen said.

'We'd like to be able to have a 'warm handoff,'' Lock explained. 'To say to a mom, 'Oh, you've got your kid in here for a well-child check, how about we check and see if a dentist is available to look at his gums.''