$5M in grants sought for medical mall

SCHENECTADY COUNTY — A group of local medical providers, governmental agencies and human service organizations is hoping to obtain $5 million in state grants to reconfigure primary care services in Schenectady County by establishing a medical mall at St. Clare’s Hospital.

But at least one member of the group, Hometown Health, believes the task force is moving in the wrong direction.

The Schenectady Primary Care Restructuring Committee will submit an application — through Ellis Hospital — to the state Department of Health by May 1. The state has set aside $7.5 million for medical institutions in the Capital Region to improve delivery of primary care services.

State Department of Health spokeswoman Claudia Hutton said the grants are part of $100 million to be awarded statewide this summer. “They cover the cost of developing new offices and renovating existing space,” she said.

If Ellis receives the full $5 million award, it would transform St. Clare’s on McClellan Street into a regional primary care center, capable of serving thousands of people annually in a one-stop setting, said William P. Spolyar, committee chairman and director of the Schenectady Free Health Clinic. “We are trying to develop a home base for people to receive their primary health care,” he said.

The committee also plans to develop over the next six to 12 months a long-term strategy for primary care in the community, Spolyar said. The strategy will consider ways to increase the number of primary care physicians in the county and reduce the number of people with little or no insurance, estimated at approximately 20,000.

“There is a shortage of primary care physicians in the country now and it is not an overstatement to say that three to five years from now people will have problems finding primary care physicians,” Spolyar said. “Also, health insurance will become more expensive and less people will have access to it.”

The grants are the state’s latest effort to make health care more efficient, cost-effective and affordable. The process began with recommendations more than a year ago from the New York State Commission on Healthcare Facilities in the 21st Century, also known as the Berger Commission, to close nine hospitals and eliminate nearly 3,000 nursing home beds. The recommendations became state law in January 2007.

BERGER OUTGROWTH

In Schenectady County, the commission recommended that Ellis and St. Clare’s consolidate services and that Bellevue Woman’s Hospital close. In the wake of this hospital reconfiguration, local officials created the task force to examine ways to improve the county’s primary care system.

Ellis Hospital CEO James Connolly said “Enhancing the health care delivery system for the entire community involves more than reconfiguring acute care. We are presented with the opportunity and the responsibility to improve the continuum of care — including primary care — with an effort that goes beyond the walls of a hospital, clinic or physician’s office.” Ellis is a member of the task force, which consists of more than 30 medical providers, human service agencies, the county’s medical society and government groups, and will submit the grant to the state.

The proposed regional primary care center at St. Clare’s would incorporate the hospital’s family practice and dental residency programs as well as its newly established pediatric program as part of the strategy, Spolyar said. In addition, insurance providers would be available there to sign up people for an applicable medical insurance program, such as Child Health Plus or Medicaid.

Ellis would own the center, but other medical providers in the community would be allowed to lease space to offer their services, Spolyar said. The free clinic, Schenectady County Public Health, which offers a number of clinics, private providers and Hometown Health are among those under consideration as tenants.

Also under consideration is a plan to develop a network of primary care providers who would go into the community to service people with little or no insurance, Spolyar said. “This would involve reorganizing what exists. We want to make a medical system where you bring the care to people, rather than people come to the care.”

HOMETOWN HEALTH

Hometown Health, a federal qualified community health center in Schenectady, believes the task force’s primary care model is flawed and could end up costing more money to operate than it will generate.

Hometown has offered to take over all primary care services in the county and use its federal designation to obtain a higher reimbursement rate for each patient visit than the proposed medical mall could earn. It receives $116 per patient visit while an urgent care center receives $40 for the same patient, said Joe Gambino, spokesmen for Hometown Health.

“If you are going to give this medical mall its best chance of being self-sustaining, is it going to be better sustained at a reimbursement of $116 or $40?” Gambino asked.

Hutton said the state’s tentative budget would increase the reimbursement rate to $74 per visit after two years.

Gambino said Hometown would have to remain under its own governance, that is outside of Ellis’ control, to maintain its federal qualification. “This proposal would make Ellis do what Ellis does best, which is acute care. Primary care would be taken out of their hands,” he said.

Several medical providers have said privately they are opposed to Hometown Health taking over primary care services in the county.

The task force has asked local providers for letters of support for its medical mall proposal. Gambino said Hometown will not offer its support until “we have a more clear picture. We want to participate, but what role we should play in it is unclear. The state has already said the safety net providers need to be involved in this project.”

Gambino called the task force’s medical mall proposal an ambitious project. “The questions that have to be asked are how much will this medical mall cost, where is the money coming from and how do you know it will sustain itself?” he said.

If the medical mall is up and running and Hometown Health is still here, then there would be two primary care practices in operation in the county, Gambino said. “They would be doing what we are doing without the enhanced rate. If they are doing the same thing we are doing and doing it for three times less, it will be hard to sustain.”