North Country tries to grow with demand

Flagstaff, AZ – Community health centers have long filled in the gaps of the health care system. North Country Community Health Center serves people with or without insurance at eleven clinics throughout northern Arizona. They offer primary care -- things like children's vaccinations, check ups, and prenatal visits. Their clinics are bursting at the seams now. And if Congress passes a health care reform bill they could become even busier. Arizona Public Radio's Laurel Morales reports.

SADLER: The knee is stable that's the important thing. Do you have an ace bandage at home?

Scott Sadler, a physicians assistant at North Country, sees a patient who complains of a popping knee. Sadler has worked at community health centers like North Country his entire career.

SADLER: We do health care reform almost every day here because we have to get people where they need to be even when they're insured or uninsured and that's very hard.

At North Country no one is turned away.

SADLER: You walk in the door whether you have insurance or anything at all you're going to get taken care of. That's very important. People are realizing that even with insurance whatever health care reform is going to do it's still going to have holes and gaps. It does now.

Sadler's patient is on the Arizona Health Care Cost Containment System or AHCCCS. That's Arizona's Medicaid.

At North Country about 30 percent of the patients are on AHCCCS. Another 15 percent are on Medicare, and about 20 percent pay on a sliding scale. Private practices can't afford to take so many patients on public health insurance. The reimbursements are lower and the paperwork is time consuming. North Country, a non profit, can serve the poor because many of their patients have private insurance and it receives a small amount of federal funding. But financially they're just squeaking by.

SFX: patients checking in

In the sunny lobby Chief Medical Officer Andrew Saal shows where patients check in. The staff first must determine who will cover the bill.

SAAL: One of the problems with AHCCCS is it's really hard to get on and there's very few case workers because of the budget cuts.

Saal walks into a waiting room with few empty chairs. As flu season approaches North Country is bustling with activity.

SFX: woman speaking Spanish, child whining

Community health centers are popular on both sides of the health care debate. They provide affordable services at a relatively low cost. But they're only part of the solution.

What happens if someone needs to see a specialist? North Country Medical director Eric Henley recalls a woman who recently came in with a knee fracture.

HENLEY: We got ortho to take her. As soon as they saw her X-ray though they said you gotta go through the ER. They don't want to take people who are completely uninsured without them putting some money up front. But if you come thru the ER they can't turn you away they have to do what's medically appropriate within reason. Now that's crazy right. What could be more expensive than the ER when you don't actually need to go to the ER?

When medical students decide what they want to practice, many choose to be specialists rather than primary care doctors. They prefer the regular hours and the higher pay.

But if Congress passes a public option North Country CEO Ann Roggenbuck says northern Arizona will need more primary care providers to meet the new demand.

ROGGENBUCK: Coverage doesn't equal access. Just because we cover everybody and figure out a way to pay for it doesn't mean patients will be able to access care because the systems are so bottlenecked and there's such a scarcity of primary care providers out there.

Initially wait times may go up. But North Country is anticipating the demand by partnering with a medical school in Mesa to essentially grow their own doctors. The students spend a year in large lecture halls in the valley, then they work alongside physicians in rural community health centers like North Country.

SAAL: Preferentially we try and get them to consider underserved populations. Who's going to work with these people? So the hometown program means We try to recruit people from the small towns like Flagstaff, and Holbrook, and the reservation try to get them closer to home. Then we try to do all those rotations through their hometowns whenever possible.

And he says with more people covered by the public option North Country would receive more money.

SAAL: Right now we're already serving them on the sliding scale if they were to have insurance that would mean we would continue to serve them and we might potentially have slightly more money. Last year we operated at a very slim margin but with that you can see we now have 11 clinics and we service almost 40,000 people.

Eventually they may even have enough money to build a 12th community health center on the west side of Flagstaff.

For Arizona Public Radio I'm Laurel Morales in Flagstaff.