New Clinic Serves Medicaid Patients Only
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.”
Christen McCurdy can be reached at email@example.com.