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Case Statement – Community Health Center


The following is a case statement used in the Shasta Community Health Center (a FQHC) capital campaign that raised $4.4 million for a new building. It comes to the website courtesy of Shasta Community Health Center and Capital Quest, Inc. (www.capitalquest.com)

Challenge
Without building a new health center, Shasta County’s primary source of health care for the working poor and indigent, Shasta Community Health Center, will close.

Since its beginning in 1988, Shasta Community Health Center (SCHC) has leased part of the old county hospital building from Shasta County. In 1998, Shasta County made the strategic decision not to renew the lease, effective June, 2001, so that the building could be used for other county purposes.

This closure will create a crisis in the healthcare delivery system in Shasta County. SCHC patients (one in four residents in the county) would not receive timely care for illness, disease and preventive health services. Patients who do not need the intensive services of an Emergency Room would be forced to use these expensive facilities, creating delays for those who truly need emergency services. Patients would wait longer for primary health care, creating sicker patients, longer hospital stays and more tests and avoidable health services. Communicable diseases, especially among children, would not be diagnosed as early, posing community health risks.

Shasta Community Health Center is not a "free clinic." All medically uninsured patients pay based on a sliding fee basis, taking into account the family’s financial situation, however, no one is ever refused needed care solely because of the lack of financial resources.


Why The Community Should Care
Why should every person in Shasta County care whether the health center’s patients receive health services?

Almost half of SCHC’s adult patients have jobs and are considered "working poor." These patients, for the most part, have jobs, but do not receive health insurance from their employers and do not make enough to afford health care. Without Shasta Community Health Center, they would not be able to receive regular preventive and on-going health services.

This group of working families will increase even more as the affects of welfare reform are felt throughout the county. These families, who used receive some health care insurance as part of their public assistance benefits, are now working – yet, in most cases have no health insurance for themselves or their children. Regardless of whether and individual is on public assistance or part of the working uninsured, SCHC has been there to make medical care services available and affordable.

Fully 80% of SCHC's patients have lived in the county for at least five years, and more than half have lived here all their lives. SCHC's patients are friends and neighbors who are hard working members of our community, raising families in an increasingly expensive health care environment. While SCHC serves all who need it, less than 3% of the active patient base are transient or homeless.

Infants and children represent over 50% of the patients served by Shasta Community Health Center. All of the area schools depend on Shasta Community Health Center to work closely with them supporting children with serious learning and/or physical disabilities. Moreover, over 90% of all the medical and social "high-risk" newborns discharged by area hospitals are directly referred to Shasta Community Health Center for follow-up care and support. The only health care many of these children receive is through Shasta Community Health Center. In addition, Shasta Community Health Center has taken a leadership role in coordinating the enrolling of many hundreds of previously uninsured children of working families into the new federal/state funded program called Healthy Families. For many of these children, the program makes it affordable for them to access primary and preventive health, dental and vision care.

Emergency Rooms will be swamped by these 40,000 patients if SCHC is forced to close. The Emergency Room is the most expensive way to treat a patient and should be reserved for truly life-threatening illness. Because hospitals are required by law to treat anyone that shows up in the Emergency Room, the costs of treating the uninsured are passed on to all of the hospitals’ clients through higher bills.

Shasta County's hospitals cannot absorb this influx of patients and they are not staffed nor equipped to provide primary health care to thousands of people. Besides the cost issues, the hospitals simply cannot provide the follow-up care necessary to insure good health and preventive health care. In would be inordinately expensive, and impractical, for patients to be treated, and followed-up with, in the emergency room of local hospitals.

In addition to the increased costs, there would be added delays and waiting for any member of the community who faces a true medical emergency. Over-utilization of the emergency room system, and a lack of timely health care, will also create a ripple effect throughout the hospital system leading to increased waiting times for such hospital services as lab work, radiology and even in-patient care.

The fact remains that the most cost-effective way to provide basic, primary health care to those who don’t have health insurance, is through outpatient community health centers. In Shasta County, that means Shasta Community Health Center. Without SCHC, patients will not get regular health care. Without regular health care, patients are sicker, more costly to treat and the chance of a negative outcome is higher.

Perhaps most seriously, lack of regular health care creates a community health hazard. Who is sitting next to your child and grandchild in school? If that child has not seen a doctor in years, is it possible that your child’s school friend has a communicable, airborne childhood disease... or even something more serious?

Summary
Shasta Community Health Center provides primary health care services to 40,000 patients in Shasta County – fully one in four of the county's residents. Over 80% of the working poor and indigent in the community receive their primary health care from Shasta Community Health Center.

Shasta Community Health Center works closely with physicians in the community. Many of these physicians treat SCHC patients on a reduced or no fee basis as part of their commitment to the community.

There are currently 10 staff physicians, 6 nurse practitioners/physician assistants practicing at Shasta Community Health Center. Additionally, there are 34 medical specialists providing specialty care to this under-served population. Through a unique partnership, medical specialists in the community offer their specialty at the clinic a few hours or days each month.



Shasta Community Health Center provides primary health care through three specific medical practices:

Family Practice
Providing a wide-range of health services, these family physicians, physician assistants, and nurse practitioners provide quality health care to over 25,000 adults and children each year. Additionally, the Family Practice Residency Program allows first, second and third year family practice residents the opportunity to work hands-on with patients, under the supervision of a specially-trained physician. These six resident physicians see 7,000 patients each year.

Pediatrics
Specializing in childhood illness and injury, these pediatric physicians, physician assistants, and nurse practitioners provide quality health care to 13,000 infants and children each year.

Medical Specialty Program
Often patients of Shasta Community Health Center require health care that requires a medical specialist. Because of this, SCHC has created a partnership with 34 medical specialists in the community that provide 18 different medical specialties at the clinic. Shasta County, like many rural communities, face an acute shortage of medical specialists. Through this program, SCHC addresses an unmet need.

The specialties provided at SCHC are:
Ear, Nose and Throat
Endocrinology
Gastroenterology
General Surgery
Gynecology
Neurology
Neurosurgery
Orthopedics
Pediatric Cardiology
Pediatric Neurosurgery
Pediatric Orthopedics
Plastic Surgery
Podiatry
Proctology
Pulmonary
Rheumatology
Urology
Vascular Surgery

Sadly, patients must often wait as much as two years to see a medical specialist. Presently, one of the greatest barriers to additional specialty care is the lack of space in the current facility. Each of the specialists can access only two examination rooms, instead of the more efficient three exam room set-up seen in most physician offices. Moreover, other specialists throughout the community have offered to assist in this program, but SCHC has had to turn down their assistance because of limited space.

A new facility will alleviate these problems. Shasta Community Health Center has a plan to bring more primary care practitioners (physicians, nurse practitioners, and physician assistants) and medical specialists to the community, but there is no room at the present health center for additional practitioners.

Reasonable access to quality health care in Shasta County can only be solved by a new facility, specifically designed to create an efficient delivery system. As the population of uninsured continues to grow, many with low-paying, limited-benefit jobs, the crisis in healthcare in Shasta County will also continue to grow. With a new facility, SCHC is ideally poised to help the growing number of working, uninsured residents of Shasta County.

The Capital Campaign
In 1999, the Shasta Community Health Center Board of Directors determined, after a professional feasibility study, to launch a $4,000,000 capital campaign to build a permanent health center. This new facility will insure that the working poor (one in four people in Shasta County) can receive timely, high-quality care.

Shasta County has also agreed to make available 6.5 acres of land it owns along Radio Lane for the site of the new clinic.

The funds raised will pay for construction of the new clinic and the necessary equipment to provide health services to those that need it. The campaign will focus on receiving gifts from foundations, corporations, small businesses, physicians and individuals. A full copy of the feasibility report is available upon request.

The New Facility
After a review of available buildings, the Board of Directors of Shasta Community Health Center determined that there is no building that could be adapted to the health center’s unique needs for a reasonable cost. There are no suitable 35,000 square foot buildings available for purchase or lease in SCHC’s service area.

Through the generosity of Shasta County, 6.5 acres of land along Radio Lane is available at virtually no cost to the health center. With this gift of land, Shasta Community Health Center’s board of directors has determined that building a 35,000 square foot facility is the most economically feasible plan.

The new health center will be able to serve more patients more efficiently. The larger health center will allow for an additional 10 medical specialists, 2-3 family practice providers, 1-2 general internists, and 1-2 pediatric providers. The new health center will be able to accommodate 10,000 additional active patients.

Perhaps most importantly, the new health center will enable each physician to have three examination rooms, meaning that more patients can be seen more efficiently by each physician.

The new health center will house three clinical areas and ancillary services, including:

Primary Care. This clinical area will house all of the primary care services including the Family Practice and Family Practice Residency Program. Included in this area will be all of the Family Practice practitioners (physicians, nurse practitioners and physician assistants), including the unique Family Practice Residency program, where first, second and third year medical students will treat patients under the direct supervision of teaching physicians.

The Family Practice Clinical Area will allow 3 additional family practice providers to be hired and would include room to increase the number of residents from 6 to 12 residents.

Specialty Care – Current space limits prevent an expansion of Shasta Community Health Center’s unique Medical Specialty Program. Even though several physician specialists in the county have indicated an interest and willingness to bring their services to the health center, there is no room for these specialists to see patients.

The new health center will have its own specific clinical area for these specialists, including three exam rooms for each specialist on-duty. These additional exam rooms will allow specialists to see more patients in the same timeframe, which, more than anything, will dramatically reduce the up to two-year wait to see a specialist.

Pediatrics – Over half of the patients seen by medical professionals at Shasta Community Health Center are under the age of 18, and 35% are under the age of ten. Yet these children must often wait weeks to see a physician and, because of the contagious nature of many of their illnesses, the community as a whole is at risk.

Providing care to children in their formative years is particularly important. Care received during the early years prevents more serious health problems in later years. Without early childhood medical care, child development is affected.

The new health center will include a Pediatric Clinical Area, which will enable SCHC to add 2 pediatric health care providers as well as provide each physician with three exam rooms, thereby increasing the number of patients each physician can see in a single shift.

Ancillary Health Services. The health center may also house several Ancillary Health Services including a full-service lab, pharmacy, isolation room, patient teaching areas, chronic disease education areas and administrative support. A networked computer system will allow all dictation and patient records to be available electronically.

What About Operating Support After the Clinic is Built?
  • Over 80% of the operating revenue of SCHC comes from stable federal and state sources.
  • The remaining 20% comes sliding fee scale payments and from state, local or private grants.
  • Pro-forma budgets indicate that SCHC’s operating revenues can support the operations of this size clinic.
Building Costs
The total cost for the new 35,000 square foot Shasta Community Health Center is estimated at $4,000,000.

History
Shasta Community Health Center was founded in 1988 by a partnership that included the Shasta Trinity Medical Society, Redding Medical Center, Mercy Medical Center and the County of Shasta after the closing of Shasta General Hospital.

Over 54,000 individuals within Shasta Community Health Center’s service area are low-income, and 20,000 of these live below the federal poverty level ($17,010 household income for a family of four). 40% of the targeted families in the service area are uninsured.

Like many mainly rural counties, Shasta County has a large population of what is best termed the "working poor." These are individuals that have full or part-time employment, but do not usually have any health insurance and, because of what they are paid, cannot realistically afford to pay for health care. About 45% of the adult patients seen at Shasta Community Health Center have some form of employment.

SCHC is the only large-scale primary care provider offering sliding fee discounts for the low-income, uninsured, working residents.

Since 1988, SCHC has provided 500,000 patient visits, and in 1998 alone, provided over 70,000 patient visits.

Benefits of a Successful Campaign:
  • A new health center will allow space for two to three additional Family Practice physicians. This will dramatically reduce the waiting list and waiting time for appointments. Each Family Practice physician will be able to care for 2,000 patients each year.
  • A new health center will allow for the addition of one to two general internists to help care for the growing elderly population served by SCHC. Each internist can care for 1,500 patients each year.
  • A new health center will also allow an additional Pediatric physician, which is desperately needed. This Pediatric Physician will be able to care for 2,000 children each year.
  • A new health center will allow for the Family Residency program to be expanded, allowing more low-income families access to medical residents working under the supervision of SCHC staff physicians.
  • The unique medical specialty program, whereby local medical specialists work part-time for the health center to provide specialized medical services, can be increased to accommodate all of the specialists who want to participate, but must currently be turned away for a lack of space.
  • New diagnostic equipment, including such basic services as an ultrasound, mammogram, fetal ultrasound, general x-ray, health central laboratory, and pharmacy, can be made available in one convenient location.
  • 120 full-time jobs will be saved. Economic models show that these jobs and the operating expenses of the health center supports over 300 other jobs in the community.


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