CHCs and Imaging: Precursors of the PPACA Model

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Community health centers (CHCs), established by the federal government as part of a 1975 legislation package, have spent 37 years trying to solve one of the primary problems tackled by the Patient Protection and Affordable Care Act (PPACA): keeping underserved or uninsured patients out of emergency departments through the provision of affordable preventive care. Today, more than 8,000 CHCs across the country provide health care to over 20 million patients. Donna Rosenlieb, RT, a registered diagnostic medical sonographer who serves as radiology supervisor for the Community Health Center of Central Wyoming (CHCCW), says, “Our mission is to be the stopgap for the underinsured and uninsured—to keep them out of the emergency departments. Without us, there would be nowhere else for them to go.” CHCCW is based in the 55,000-person city of Casper, and it reaches patients from both Casper and the surrounding areas (the state’s population is just under 570,000). The clinic offers diagnostic radiography and ultrasound to its patients, but for economic reasons, it has no on-site radiologist. “Having a radiologist on-site just isn’t financially justifiable, but the ability to offer diagnostic imaging to our patients is really invaluable,” Rosenlieb says. Imaging the Underserved Rosenlieb gives the example of a female patient with a high-risk pregnancy who was evaluated via ultrasound at CHCCW before being referred to a specialist in Denver, Colorado. “Those women would just show up on the labor deck if we weren’t here,” she notes. “Through our ultrasound, we are able to get the patients up to a higher level of care, if they need it. Imaging, under a CHC model, is very important, and we consider ourselves lucky to be able to offer it.” CHCCW works with Virtual Radiologic (vRad), transmitting images electronically for interpretation by the nationwide practice’s subspecialty radiologists. “vRad has played an extremely important role in making sure we get those images read in a timely manner,” Rosenlieb says. “Our providers have access to their radiologists if they have questions about reports. It’s been a very good relationship. It’s been nice having those brains out there to pick—to make sure I get the patients what they need.” CHCCW also helps CHCs with basic radiography in Dubois and Riverton, Wyoming, and vRad performs interpretations for those locations as well. “Technology, the ability of rural clinics to have radiography, and the specialists at vRad give people living in Wyoming’s vast open spaces access to quality care,” Rosenlieb says. When the individual mandate of the PPACA kicks in, Rosenlieb anticipates an increase in volume for the clinic, which prices its services using a four-segment sliding scale based on proof of income. “There’s a population out there that still isn’t coming in, in spite of the sliding scale,” she says. “On top of that, people have a tendency to stay with a provider they already like, and we are already set up with Medicare and Medicaid as primary income sources, so we’re likely to see an influx of patients.” Preparing for the Future Rosenlieb, with 30 years of experience in imaging, says that working for a CHC has given her a fresh perspective on the specialty’s importance to the continuum of care. “I have a new, keen sense of how imaging plays into family medicine, women’s health care, and quick care,” she says. “I’m getting a different perspective on family medicine and on how important the relationship is between family medicine and imaging. I see how imaging plays into how these physicians care for their patients—and how critical it is.” Accordingly, Rosenlieb hopes that CHCCW will be able to expand its imaging offerings as time goes on (particularly in the category of preventive services, such as mammography), and she is grateful that its current model will enable it to accommodate any additional volume. “We’ll be able to handle any excess,” she says. “vRad is going to have our back, and ‘Bring it on’ is our attitude.” As a worker on the frontline of providing preventive care to the uninsured, Rosenlieb is optimistic about the future of health care—and about the role that imaging can play in improving quality (while reducing costs). “These are people who would just wind up in the emergency department with very complicated conditions,” she says. “As a CHC, we are helping to ease the burden on the taxpayer, which is something that is poorly understood by a lot of people. When uninsured patients go to the emergency department for basic care, that cost is put onto those of us who have insurance—and it translates into higher costs for everyone.” CHCs already provide the service that the PPACA is hoping to expand, Rosenlieb says, and they are expected to play a critical role in intervening before patients get to the emergency department. “CHCs are expected to be central in spearheading the process under health-care reform,” she says. “If we can intervene in patients’ lives and get them on a healthy process, that’s critical.” She concludes by returning to the example of pregnant patients. “Our obstetric patients get their prenatal ultrasounds here, meaning they are tracked and cared for, instead of showing up in the hospital as train wrecks,” she says. “When you follow the patients and see the results of the imaging they have received, you understand how important this service is. I have more satisfaction working here than from anything else I’ve ever done.” Cat Vasko is editor of Medical Imaging Review and associate editor of Radiology Business Journal.