Uninsured Patients And Staff Safety Strain The Budgets Of Charlotte Area Health Centers
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When Dr. Carlos Rish opened Centro Medico Latino in the early 2000s, he did so out of what he saw as a need to provide affordable care in Spanish to the growing Latino community in Charlotte.
“There was a need in Charlotte for a physician who had the facility to communicate not only verbally in Spanish, but also to understand the idiosyncrasies of the Latino community,” Rish said. “And I thought it would be a good place to do that for myself.”
The family practice grew from the first location in east Charlotte to three locations — one in south Charlotte and another in Monroe. But when the coronavirus pandemic hit in March, Rish was left wondering if he would be able to keep the doors to his private practice open.
With the stay-at-home order and people’s fears of leaving their homes, Rish saw the number of patients visiting his practice drop by 80%.
“We started wondering, ‘What are we going to do?’” Rish said. “We can't keep our doors open the way we would like to.”
He says that within two months, as patients started getting sick with COVID-19 or realized the pandemic wouldn’t end quickly, Centro Medico Latino began seeing a slow uptick in patients. But Rish had already endured the financial toll of seeing fewer patients.
Across North Carolina other private practices like Rish’s also saw their number of patients drop. A survey from the North Carolina Medical Group Management Association found that in April, 98% of respondents had a drop in their practice’s revenue and 50% saw their number of patients cut in half.
Centro Medico Latino managed to keep its doors open and all its staff employed through a Paycheck Protection Program loan. It also made up for lost revenue by spending around $400,000 they had saved for other projects, $50,000 of that went toward personal protective equipment. Rish said he started planning ahead and began ordering PPE in early spring as he saw the virus spread across the world. He hasn’t run out of supplies, but says the added costs of buying extra PPE is a significant expense for a practice like his own.
“For a family medical practice that deals mostly with people of lower incomes, and where our prices are very accessible so that these people can come and see us, $50,000 extra on PPE so far, in seven months, is a big chunk,” Rish said.
The American Medical Association surveyed its members and found that just like in Centro Medico Latino’s case, 64% saw their PPE spending increase.
As the pandemic went on, and people lost their jobs, millions of Americans lost their health insurance. Care Ring, a nonprofit clinic in Charlotte, noticed more people coming in without insurance, so they decided to briefly stop charging for services.
“To be a resource for them in a time of need, that was really important for us,” said Care Ring’s Chief Development Officer Kelly Musante. “So we knew that costs could no longer be a barrier to access to care.”
Care Ring provided free care for everyone for five months. Normally, payments for this care make up 10% of the budget. The remainder of their budget comes from grants and outside funding.
“We were financially impacted essentially overnight,” Musante said.
This wasn’t just an issue at Care Ring.
Before the pandemic, the National Association of Community Health Centers found 42% of patients at centers in North Carolina lacked health insurance. That was the case at C.W. Community Health Center in Charlotte. But CEO Debra Weeks says that number has since grown.
“It very quickly climbed to 67% uninsured and has climbed since then,” Weeks said.
Another financial hit from COVID-19 on health centers has been the initial drop in patients. The Kaiser Family Foundation reported that community health centers saw a 43% decline in patient visits in the first months of the pandemic.
On any given day, C.W. Williams Community Health Center would see 80 patients; that number went down to 20 when the pandemic hit. Weeks says they are now up to around 50 patients daily.
“I can’t imagine the words to make me revisit this time,” Weeks said. “As you know, it’s been an overwhelming year.”
Spending for the center has also gone up. She says this year they’ve not only had to spend extra on PPE, but because the center had to change how it provided services, it has also added expenses for other supplies like computers, sanitizing equipment and a negative-pressure room, which prevents airborne diseases, like COVID-19, from escaping and infecting others.
“We're buying supplies at a volume we never had to buy before,” Weeks said. “We have a need for equipment we never even imagined we would ever need.”
Adjusting to the pandemic has cost the center $500,000, but federal funding has helped it stay open and keep all of its employees. However, if cases continue to rise, and another shutdown is put in place, Weeks isn’t sure what will happen.
“I don't know if this time around I won't have to lay people off. I have to see. I don't know that this time around, you know, I may not be able to avoid a furlough,” Weeks said.
But Weeks says C.W. Williams Community Health Center has dealt with financial hardships in the past. She says they know how to survive and will continue to pivot to ensure their patients have access to affordable health care as the pandemic continues.
“We want to maintain our relationship with the community by not breaking our contract with them and continuing to provide them with good health information and service.”
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