TAHLEQUAH — A generation or two ago, when people got sick, they sought treatment from a family doctor, or for more serious injuries, the emergency room at the local hospital.

Today, a growing number of Americans seek care from community health centers or smaller emergent care facilities. Tahlequah residents have access to both: NEOHealth centers offers care at reduced rates based on income, and  UrgentCare takes walk-in patients at charges comparable to those of primary care physicians.

For people with insurance through a major carrier like Blue Cross and Blue Shield, treatment at a clinic like Urgent Care is more cost-effective than going to a hospital emergencyroom.

An average copayment for an Urgent Care visit runs about $40, compared to a $200 copayment at the Tahlequah City Hospital emergency room.

Affordability is a key element for many people. And under the Patient Protection and Affordable Care Act, clinics like NEOHealth and Urgent Care may experience rapid patient base growth, as the law provides for massive expansion to Medicare, Medicaid and preventive services.

NEOHealth was originally incorporated in 2001, and saw its first patient in April 2002. The center received its first grant funding in November 2002. The health centers – operating in Hulbert, Tahlequah, Westville and Muskogee – offer uninsured patients a sliding-scale fee, based on household size and income.

“Our lowest fee is $30,” said NEOHealth CEO Angel Westbrook. “NEOHealth operates three of its clinical sites – Hulbert, Westville and Muskogee – with grants from U.S. Health Resources and Services Administration’s federally-qualified health centers program, as well as billing insurance companies for services provided, and patient collections. NEOHealth’s Tahlequah clinical sites – Tahlequah Health Center and OB/GYN and associates – are not grant-funded but are revenue-generated clinics through billing insurance companies and patient collections. NEOHealth also operates a pharmacy in Hulbert, which is also revenue-generated and not grant-funded.”

John Kasprak, senior attorney for the Connecticut Office of Legislative Research, said PPACA includes several provisions that affect community health centers, including increased funding for health centers, insurance expansion, Medicare payment reform and workforce and training initiatives.

“Beginning in federal fiscal year 2011, the federal health care reform law [included] a total of $11 billion in new funding for health centers over a five-year period,” Kasprak wrote in a 2010 report. “Of this total, $9.5 billion will allow health centers to expand their total operational capacity to serve a significant number of new patients and to improve their medical, oral and behavioral health services. The remaining $1.5 billion will allow health centers to begin to meet their capital needs, by expanding and improving existing facilities, constructing new sites and upgrading health information technology systems.”

Westbrook said NEOHealth has directly benefited from PPACA, in the form of additional funding.

“We have been funded through PPACA to open a clinic in Muskogee, which is expected to be operational in October,” said Westbrook. “NEOHealth and other federally qualified health care centers in Oklahoma are closely watching the political policies. We will continue to seek out any additional funding opportunities that will benefit the communities in which NEOHealth provides services. We will make adjustments as necessary, and continue to provide the most quality affordable health care possible within our communities.”

To prepare for upcoming changes in training, billing and expansion, Westbrook said, NEOHealth works with the Oklahoma Primary Care Association, and believes they have an excellent resource in OKPCA Director of Public Policy Brent Wilborn.

The U.S. Supreme Court upheld PPACA as constitutional in August, but Republican presidential candidate Mitt Romney, and vice presidential candidate Paul Ryan, have vowed to repeal the law if they’re elected. The Oklahoma Legislature and Gov. Mary Fallin have adopted a “wait-and-see” attitude, and have declined to set up PPACA-required insurance exchanges until after the November elections.

“[The only drawbacks to PPACA we anticipate] is the uncertainty of its future,” said Westbrook. “[Overall] NEOHealth believes that all people should be able to have access to quality affordable health care, which has been NEOHealth’s mission for years.”

Unlike NEOHealth, Urgent Care is privately and locally owned, operating without any state or federal funds.

Urgent Care was established in Tahlequah in 2004, and expanded to Wagoner in 2008, to provide an option for patients who need medical treatment on short notice. Services are available to anyone, including those away from home or those unable to get a timely appointment with a primary care provider.

Dr. Tracey Childers, owner of Urgent Care, said continuity of care is key.

“We do our best to work with primary care providers for continuity of patient care,” said Childers. “Referrals to specialists are made when needed. Common services we provide include laceration repair, evaluation and treatment of minor injuries and illnesses. We perform sports, school and Department of Transportation physicals, and manage workers compensation cases for a large number of local employers.”

Under PPACA, about 200,000 Oklahomans who did not previously have health insurance will gain access through Medicare or Medicaid. Childers said Urgent Care has adopted innovative technology to help accommodate some of that growth.

“At Childers Medical Group [the umbrella company for Urgent Care and several other clinics], we strive to provide unparalleled quality health care services to the communities we serve,” said Childers. “One example of this commitment is our conversion to electronic medical records 10 years ago, ensuring quality patient care. This same passion exists in our eagerness to expand our staff and services as needed.”

Childers said while her personal commitment as a physician is to provide the same level of care for her patients as she would expect for her own family, she’s concerned about the sudden and exponential expansion of patients, with respect to the overall number of practicing health care providers.

“This will eventually affect the time a patient may have to wait to schedule an appointment or a doctor’s visit; only time will tell,” said Childers. “My prayer is that the medical community can meet and keep up with this demand of generating more health care providers.”

Childers said that for many years, the number of residency positions nationwide, particularly in the specialty fields, has continued to decrease.

“Changes are being made now to expand these residencies for specialization; however, several years may pass before these transitional benefits are realized,” said Childers. “For example, to become a family physician or an internal medicine physician, one must complete four years of college, four years of medical school and three years of residency, equaling 11 years to generate a [practicing physician].”

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What you said

The Daily Press polled online readers who do not receive care through W.W. Hastings Hospital, asking if they suddenly became ill and needed medical help, which would be their likely choice of treatment. Of 93 respondents, 29 percent, or 27 voters, said they would seek treatment at Tahlequah City Hospital’s emergency room. Twenty-five percent, or 23 respondents, said they would go to Urgent Care. Twenty percent, or 19 voters, said they would seek care at a hospital or care facility in another city. Twelve percent, or 11 respondents, said they are undecided. Eight percent, or seven respondents, said they would see their primary care provider, even it it meant waiting a few weeks for an appointment. Five percent, or five respondents, said they would go to NEOHealth. One percent, or one voter, indicated he would seek the advice of a specialist.



What’s next

The 10th in an ongoing series about the Patient Protection and Affordable Care Act will examine its effect on the prices and copayments of specific prescription drugs.



Learn more

To read the first eight reports in the Patient Protection and Affordable Care Act series, visit http://tinyurl.com/cabtssb, http://tinyurl.com/bn8xrmm,  http://tinyurl.com/chnx2m5, http://tinyurl.com/8ttvlns, http://tinyurl.com/blvqct7,  http://tinyurl.com/9ryk925, http://tinyurl.com/8hzo6fy.



Read it yourself

To read the entire text of the Patient Protection and Affordable Care Act, visit http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf.