City health centers struggle to keep up with patients' needs

In need of medical attention, but with no guarantee of getting it, people gather outside Health Center 10 on Cottman Avenue in Northeast Philadelphia. ALEJANDRO A. ALVAREZ / STAFF PHOTOGRAPHER
In need of medical attention, but with no guarantee of getting it, people gather outside Health Center 10 on Cottman Avenue in Northeast Philadelphia. ALEJANDRO A. ALVAREZ / STAFF PHOTOGRAPHER
Posted: June 29, 2012

AREEJ Alkhateep clutched her stomach as she, her husband and two children stood in a group of eight people shortly after 7 a.m. one recent morning, waiting for the doors to open at Health Center 10, a one-story green-brick and glass building on Cottman Avenue near Bustleton, in Northeast Philadelphia.

Alkhateep, 29, having come from Jordan just two months ago, spoke little English. Both she and her husband Eyad, 36, are unemployed and uninsured, and Alkhateep said that she couldn't afford to see a doctor for the pain she tolerated for two long weeks.

They are among an estimated 216,450 Philadelphians who lack health insurance, according to the Census Bureau. Experts say that some are too poor to pay for even basic health care.

That's taken a heavy toll on the city's health centers, including the busiest, Health Center 10, where only the sickest walk-in patients get to see a doctor the same day and where the waiting list for first-time adult patients is about eight months.

The long wait, experts say, reflects an increased demand for health care and an influx of immigrants to the area. The U.S. Supreme Court's decision on challenges to President Obama's health-care law is expected Thursday. If it overturns the law, the burden on Health Center 10 could grow even heavier.

"It's one of our most diverse health centers and it's a health center in one of the parts of the city that has one of the fastest growth rates, particularly in populations that are not insured or on Medicaid," said City Health Commissioner Donald Schwarz.

There are 39 health centers in the city that serve medically underserved and largely poor residents. Many of them are run by nonprofits and other organizations. Eight are run by the city.

Those eight get the lion's share of uninsured patients. There were 339,032 visits to the city's health centers in the fiscal year that ended June 30, 2011, including 57,973 at Health Center 10. Nearly half the city's health-center patients — who pay between $5 and $20, based on income — were uninsured. At Health Center 10, 60 percent are uninsured.

Health Center 10 is the city's only center in the Northeast, where, Schwarz says, an estimated 18,000 patients are without a primary-care provider, and about 40 percent of them have a chronic illness.

"We have a lot of people who need care in Philadelphia," Schwarz said. "That's what it means to have a waiting period for a new patient visiting Health Center 10 that's more than 200 days. That's not what we want."

Jason Mitchell, 30, of Northeast Philadelphia, was suffering from a cold a few weeks ago when he tried to schedule an appointment to see a doctor at Health Center 10. Mitchell, who works at a job that doesn't provide health insurance, said he was told that the next available opening was in February 2013.

"‘Wow! Are you serious?' " Mitchell said he responded. "?‘I'll be dead already.'?"

At the seven other city-run health centers, the wait time for new adult patients ranged from 23 to 99 days.

"The biggest risk of any long wait times is people simply give up and don't get any care," said David Grande, assistant professor of medicine at the University of Pennsylvania School of Medicine. "We want to make sure people see doctors on a regular [basis] and get basic treatment. … that only happens when people have and receive regular and long-term care."

"What needs to happen is an expansion of [health-care providers who will accept patients] regardless of ability to pay," said Natalie Levkovich, executive director of the Health Federation of Philadelphia. "Lots of providers don't accept Medicaid or have a cap. Therefore, people with public insurance or no insurance don't have many options."

The city was awarded an $80,000 planning grant in September by the Federal Health Resources and Services Administration to assess the need for another health-care center in the Northeast. The city wants to apply for federal funding toward a new health center there, Schwarz said.

Making tough decisions

The workload at Health Center 10, which employed six adult practitioners and two pediatricians last year, is overwhelming.

"We have been at capacity for about five years," said director Stuart Katz. "My ability to see more [rather than fewer] patients is governed by the size of the building and the staff I have."

The workload and relatively low pay — physicians max out at $109,820 — make it difficult to recruit and keep doctors and nurses, contributing to stagnant staffing levels at city-run health centers and long waits for patients, said Schwarz.

Rafaela Victoria, 37, rushed to the health center recently for the first time while suffering from extreme lower-back pain.

"I was crying," said Victoria, still in pain and leaning against the building one morning. "The pain was very hard."

Victoria said that she was told to go to a hospital emergency room after waiting for two hours. She made her way to Albert Einstein Medical Center. Formerly a travel agent, Victoria has been unemployed for a year and did not know how she would pay the bill.

In the fiscal year that ended June 30, city hospitals absorbed more than $235 million in uncompensated care, which includes charity care and debt, according to the Delaware Valley Healthcare Council's analysis of data from the Pennsylvania Health Care Cost Containment Council.

Much of that cost comes from emergency-room visits. Schwarz has said that emergency-room rates are low among patients who receive health care from city-run health centers.

But the demand for health care exceeds Health Center 10's ability to handle it. Northeast Philadelphia has been a growth center for the city's population over the past decade, especially for immigrants from Russia, Ukraine, Pakistan, India and Spanish-speaking countries, but the number of doctors has remained unchanged at Health Center 10 since 2008.

"We can't see them all — it's impossible," Katz said. Each center practices triage, deciding which patients are sick enough to see and which aren't.

Citywide, about 30 percent of all visits come from patients without an appointment. Some wind up getting referred to either a hospital emergency room or another health center with a shorter waiting time.

"My job as the administrator, I've got to balance," Katz said. "I have a responsibility to the public and to and for the staff. If I were just trying to get [the staff] to see 40 percent more patients, you risk burnout."

According to a study by health-economics experts at the University of Pennsylvania, there are roughly 300 primary health-care providers at 186 sites in the Northeast. But about 40 percent of those providers do not accept patients insured by Philadelphia's largest Medicaid HMO.

The reason? Experts say that providers are paid less for those insured under Medicaid compared to reimbursement from other insurance plans.

Meanwhile, some trek from other parts of the city just to receive treatment at Health Center 10, which patients say has good service and a caring staff.

Viola Scheurer, 67, of Port Richmond, said that a doctor at Temple University Hospital suggested that she visit the center 10 years ago after she was uninsured for a short time and in tears over a couple of bills. Now she has Medicare.

"They're just so helpful," Scheurer said. "Everybody in there is so sweet." n

Contact Jan Ransom at 215-854-5218 or Ransomj@phillynews.com, or follow on Twitter @Jan_Ransom. Read her blog, “PhillyClouphillycloutcom.

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