What was your reaction to the story in last week's Bonanza regarding the impending closing of the Incline Village Family Health Center (Searching for healthy solutions: Impending health clinic closure worries low-income locals)? I suspect many people didn't even read it – after all, if you're not a "low-income local" it doesn't affect you, does it? Or does it?
In 1995 Dr. Rick Tietz started a clinic at the hospital to serve patients who needed health care but did not need the Emergency Department. Ultimately Dr. Tietz brought the clinic under the auspices of the Childrens Cabinet, providing primary care at nominal fees for those who could not otherwise afford health care. Eventually, to make a long story short, the County got involved bringing with it Title 10 funds to underwrite the clinic's operations. In 2007, after some years of the clinic moving around and often operating under battlefield conditions, Nevada Health Centers took over the operation, making it the 22nd or 23rd clinic under their operation.
Nevada Health Centers is a federally funded Community Health Center Program that has operated medical and dental centers in Nevada for 29 years. Since taking over the Incline clinic in 2007, NHC has expanded rapidly, at one point to 31 clinics (they now have 29), and seems to have overextended itself financially. One solution to this overexpansion is to close the Incline clinic. In the Bonanza story NHC CEO Thomas Chase cited finances as the reason for the closure, noting that the clinic ran at a deficit of $120,000 during the past fiscal year, with $160,000 in expenditures to only $40,000 in revenue.
OK, maybe I'm naïve, but it seems to me that a clinic that is set up to serve low-income folks isn't going to make much in income, charging $10 for an adult visit and $5 for a child. NHC knew this when it took on the clinic, and at that time we can reasonably assume the management of NHC was taking on getting funding for the clinic – indeed, for all its clinics. Now new management seems to expect the clinic to carry itself, which doesn't happen with this type of operation.
Now here's where it affects you and me. Low-income folks are, inevitably going to need health care services for themselves and their children. So without the clinic, where will they go? To the ER at the hospital. As you know, ER services are expensive, regardless of how minor the treatment may be. The ER will not, as a matter of policy, refuse services to anyone, without regard to ability to pay. I have no doubt that the folks who now go to the clinic would pay if they could – I'm told they pay the clinic's fees willingly and gladly – but they simply can't pay the ER's prices, so the hospital absorbs the costs and, inevitably passes the losses on in higher fees to those who can pay – you and me. In addition, these non-emergency cases in the ER impose an added burden of triage on the ER staff and can delay or interfere with services to genuine emergency cases.
Who are these clinic patrons? A few were interviewed in last week's article; they are working people – some are seasonal employees, some employed in service jobs in the community. They are mothers, fathers, school children, grand parents. I'm told almost 600 families will be affected by the clinic's closing – that's around 2000 people who will, by default, become ER patients or will suffer from a lack of health care. Here. In our town.
I, for one, say this cannot be allowed to stand. NHC should step up to its responsibility to the community, and we as a community should demand that they do so. The hospital has extended its hand to help in any way it can, and we as a community should do no less. Every religion and moral code has in its principles some version of "as you treat the least among you, so you treat Me;" We need to keep this in mind – our community is what it is not only because of the wealthy and retired among us but also because of the working folks who keep it all running. They take care of the rest of us in many ways – it's time to repay that.