New Clinic Serves Medicaid Patients Only

Pendleton Primary Care may be the only clinic of its kind in the state
The Lund Report

 

June 27, 2013 – While Oregon Health Plan patients often report difficulty finding providers who will treat them due to low reimbursement rates, a physician in Umatilla County has bucked the trend – opening a clinic that serves Medicaid patients exclusively.

The Pendleton Primary Care Clinic opened its doors in February and so far is open three days a week, staffed by Dr. Bruce Carlson, along with a nurse practitioner, receptionist and medical assistant. The clinic is situated in Pendleton, on the east side of the county, because despite being roughly equal in population to Hermiston – each town has about 16,000 people – the number of family providers in Pendleton is half that in Hermiston, Carlson said.

According to state Medicaid enrollment data, 12,356 of Umatilla County's 75,000 residents – or 16 percent – are enrolled in the Oregon Health Plan, though the number of OHP enrollees makes up just 84.2 percent of those in the county who are eligible.

Carlson also happens to be president of the Pendleton Independent Providers Association, and the only primary care provider on its board, so when the association started to discuss the possibility of opening a clinic to help Medicaid patients access primary care services – and ensure access to care in Pendleton in particular – he stepped up.

“It's limited to Medicaid patients only to kind of take the pressure off and ensure access,” Carlson said. “We're gonna see if this thing works. With access at a reasonable cost, people don't have to go to the emergency room as much. That's one of the reasons people use the emergency room. They can't get in any place.”

Right now, wait times to get an appointment at Pendleton Primary Care are relatively short, and Carlson said his schedule is rarely full. The clinic is also beginning to schedule some time to allow walk-in patients, he said.

While the clinic has yet to meet capacity, Carlson anticipates the number of visitors will swell in January, when the Medicaid expansion kicks in, enabling 5,000 more residents of Umatilla County to join the Oregon Health Plan.

So far, Carlson said, most of the patients he sees say they have had some access to medical care in the recent past, but many are new to the area or have complex health problems requiring more attention from a primary care provider.

Carlson said the clinic is paid OHP's capitation rate, and has applied to become a certified rural health clinic, which will allow supplemental reimbursement by the state.

It's unclear whether any similar clinics exist elsewhere in the state. Carlson said he'd heard rumors of other such clinics but hadn't been able to confirm them.

Patty Wentz, a spokesperson for the Oregon Health Authority, was unable to verify whether any other Medicaid-only clinics exist in the state in time for The Lund Report's deadline.

The clinic also receives some financial assistance from Moda Health (formerly ODS Health Plans), however the insurer did not respond to a request for comment about its relationship with the clinic. According to Carlson, Moda has provided a “very minimal grant” to help the clinic buy simple items to help patients monitor their health.

“Scales and blood pressure cuffs is where we are,” Carlson said. Referring to Gov. John Kitzhaber's example of allowing certain patients to buy air conditioners with OHP's global budget funding, Carlson added, “Scales are a lot cheaper than air conditioners.”

Image for this story by Erica Feliciano (CC BY-NC-ND 2.0) via Flickr.

Christen McCurdy can be reached at christen@thelundreport.org.

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Comments

July 3, 2013 Dear Ms McCurdy, I just read your “Lund Report”, “New Clinic Serves Medicaid Patients Only” dated June 27, 2013 and am stunned that you printed it. You have certainly sufficiently slapped a lot of hard working caring people in the face. Does it strike anyone else that the person granted a great deal of money to administer Medicaid benefits in our county, suddenly opens a rural health clinic? His clinic joins Saint Anthony’s We Care Clinic and the Center for Women and Family who received their Rural Clinic status in 2009, just to name a couple. I have first hand knowledge that Dr. Carlson through his position as administrator of the Umatilla County EO CCO reassigned over half of the patients previously assigned to The Center for Women and Family to his clinic. When patients called Dr. Carlson’s office to find out why they had been reassigned they were told that Cesareo Texidor, PA was no longer practicing. With ethics like these I question Dr. Carlson’s ability to administrate Umatilla’s CCO let alone a health clinic. I think it is time that the state of Oregon as well as the federal government take a look at who is administrating their “test” program in Umatilla. It seems like some accountability is needed. Every state looking at this experimental program will look and say, “This is a good opportunity to line our pockets with government money”. This could be a good program for states, but let’s get it right from the being. Sincerely, Jane Airth PO Box 1085 Pendleton, OR 97801 702-235-7078