Vernonia Clinic Appeals to Oregon’s Congressional Delegation to Change Federal Grant Requirements

The clinic is designated as rural by Medicare but unable to qualify for a grant from the U.S. Health Resources and Services Administration because it’s not considered to be in a remote area.

It's more than 30 miles to the closest hospital. There’s no public transportation.

The Vernonia Health Center has even officially been designated a rural clinic by Medicare.

But that's not enough to qualify for the rural health grants from another federal agency -- the U.S. Health Resources and Services Administration -- to build back their health clinic after it reopened in February of last year.

“It was kind of frustrating to me that we would not be considered rural,” said Heather Lewis, facility program director of the Vernonia Health Center. “Everyone I talked to said you're a rural health clinic.”

After just of over a year’s work since reopening, Vernonia Health Center now has 1,200 patients coming in for care, which is roughly a quarter of what it was before Providence Health & Services left in 2010.

To bring back more clients, the clinic would like to be able to pursue its first rural health grant -- worth $50,000 to $100,000.

On top of their priority list is adding a medical assistant to their “skeleton” staff of a physician’s assistant, a medical assistant and a receptionist.

“We’re at a hump,” she added. “We aren’t making enough day-to-day income that we would be able to hire another practitioner or support staff, and without another practitioner or support staff we can’t expand our client base.”

If the clinic is unable to hire more staff, new patients would have to wait longer to book an appointment, and might end up calling 911 for services.

The grants might also provide a technology upgrade allowing follow-up appointments with specialists to happen remotely, Lewis said.

The rural grants are really the only possible source of funding, because Vernonia Health Center is too small to compete with an urban clinic serving more patients, when it comes to other public and private grants, Lewis said.

But the rural grants go only to counties that are more remote as well as clinics in census tracts that meet criteria based on a complicated methodology. 

Specifically, the U.S. Health Resources and Services Administration uses benchmarks called rural-urban commuting area codes that measure how many residents commute to other areas -- not necessarily the same as access to healthcare, Lewis and her supporters argue.

And Vernonia can’t meet that definition because its residents have to go outside the community to find work.

“Those communities who have a small economic base...have to travel to another community to work,” said Scott Ekblad, director of the Oregon Office of Rural Health, noting the commuters might get healthcare services closer to their jobs, but that leaves the elderly and the unemployed in a pinch.

The measure indicates rural commuting patterns, but “it doesn't indicate access to care,” Ekblad added.

Vernonia has the same rural-urban commuting code as cities such as Canby, which has a hospital.

Because 83% of Vernonia area residents work outside the area, the center can’t receive the rural grant money.

But the statistic ignores the real story, argues Lewis. Just 35% of Vernonia residents actually commute to work, when you factor out youth, the elderly, the disabled and the unemployed, according to Lewis’ calculation.

In addition, because of the way they do the analysis, Vernonia is lumped in with wealthier areas of their zip code that are outside the city proper and don’t contribute taxes to the city services. Nor does it factor in the patients who come from an area in Columbia County officially designated as rural even under the grants requirement.

“It’s not a good representative of the people we serve or what is happening in this community,” said Lewis.

“Really, the rural dollars were the only ones we could be competitive in applying for. But we were disqualified before we could even submit an application.”

After Providence left four years ago, Vernonia has been struggling to find a way to provide healthcare.

After one false start the center lined up the Public Health Foundation of Columbia County a year ago. Pacific University also has medical students rotating through the clinic.

But Lewis also is trying to help other clinics faced with the same predicament.  

“If it doesn't work for us to apply in a timely manner, I know that we are not the only clinic that will find itself in this position,” she said. “Our primary goal is just to bring awareness to this situation -- that this [methodology] should not be the only tool used or there should be an appeal process.”

When contacted by The Lund Report, officials with the Health Resources and Services Administration explained the policy has been in place since the 1990s, adding that there were no appeal processes.

“Presence or absence of a hospital would not affect eligibility,” Michelle Daniels, a spokesperson, noted when asked specifically about access to hospitals.

Daniels also wrote in an email to the Lund Report that there is a reason for the difference between federal agencies’ use of different definitions of “rural.”

“[The Centers for Medicare & Medicaid Services] is directed by statute to use the Census Bureau’s definition of rural for the Rural Health Clinic program which is based solely on population density,” she wrote, adding the laws for the agency’s grants “do not specify which definition must be used.”

But Vernonia Health Clinic isn’t taking no for an answer and is contacting Oregon’s Congressional delegation to help.

Tricia Tillman, director of Oregon Health Authority’s Office of Equity and Inclusion, has also weighed in, sending a letter of support and asking the agency to consider an appeals process or to change its methodology.

"We have seen inequities arise or be maintained when government does not account for the nuanced differences that exist between communities," she wrote. “We have come to recognize that there are many communities throughout Oregon with great need that are disconnected from an urbanized health care system but are not quite remote enough to warrant assistance through certain federal assistance programs."

Rachel can be reached at [email protected].

News source: