On 3/31, Erin Frazier, a nurse who works at the Harrisonburg Community Health Center, came to speak to our class about many primary services that are offered for low income individuals and vulnerable populations. I enjoyed her input about the benefits of health centers like the one in Harrisonburg and the importance of building relationships with patients in order to provide the best care possible. Have a gander below!
Our guest speaker today is Erin Frazier, who is a nurse with significant administrative responsibilities at the Harrisonburg Community Health Center. The health center is a FQHC (Federally Qualified Health Center), which is a nonprofit community health center aiming to provide primary health care to low income families and vulnerable populations. Examples of individuals of vulnerable populations that are seen at the health center include refugees from various different countries, undocumented immigrants and women who are victims of domestic violence. Because of the excellent primary care services that this facility provides to its vulnerable and low income patients, Erin states that many students have reached out in order to perform research here involving collection of data about patient outcomes and patient satisfaction.
The Harrisonburg Community Health Center operates based off of health center models that employ one main rule: the health center does not turn anyone away anyone, regardless of their inability to pay. In addition, patients can keep the doctor that he/she has built a relationship with, even in the midst of any insurance and/or other bureaucratic adjustments. Healthcare providers at this health center are essentially able to provide effective care to those who are in dire need of assistance with treating or maintaining illnesses or chronic diseases. Some of us in class were wondering about some of the ways that the health center is able to provide health care to its patients regardless of their ability to pay. One example concerns the ways in which they are reimbursed by Medicare and Medicaid. The health center receives more reimbursement money from these federal insurance programs than other healthcare facilities and this money is used to cover the costs for those patients who are unable to pay. Another example concerns how the health center is able to purchase different types of medications and vaccines. The health center is able to buy drugs from the pharmaceutical companies “at cost”, which allows them the ability to provides the patients with their medications for little to no cost. While other health facilities are sold pharmaceutical drugs for $20-$30, the health center is able to purchase the same drugs for about $2, allowing the extra money to be allocated towards another important resource.
The patient population at the health center is very diverse and many of them speak different languages. Erin emphasizes that healthcare providers at this health center will not interact or examine a patient who is unable to speak English unless there is someone present who is able to interpret. Many of these interpreters come from a variety of backgrounds (i.e. Iraq, Congo, Mexico) and are able to provide interpretations for those speaking Spanish, Kurdish, Swahili, Arabic and other languages. Further, all documents that are given to the patient are written in the same language that the patient speaks, so that they are able to easily read and reference these documents as necessary. “As a provider,” she states, “you are working in an environment that is different from the average hospital or clinic. The interpreter is present during the entire visit, even during physical examinations. Everything is repeated anywhere between 3-6 times to ensure that the patient is aware of any results and treatments plans before they return home. Sometimes things can become very chaotic, but we want to make sure the patient understands and is able to follow the plans that will keep them healthy”.
The health center utilizes a LCSW (licensed clinical social worker), who is an individual that is able to fill some gaps between a patient and the healthcare provider who is seeing a patient. The LCSW is often able to speak with the patient and unearth some of the social aspects in their lives that are affecting their health decisions. For example, Erin recalls a woman whose health was not improving after she had been prescribed medications to decrease her chronic diabetes. After a few visits to the clinic, a LCSW was called into the health center to understand why the patient was choosing to be non- compliant with her proposed treatment plan. The LCSW was able to find out that the patient recently escaped from a long history of domestic violence in West Virginia and moved to Harrisonburg to seek refuge. Additionally, she had recently witnessed her son commit suicide, which drained her emotionally of her will to live. Because the LCSW was able to listen to the patient and recognize the root of her problems, the patient was able to receive therapy that in turn, changed the overall outlook on her health in a positive manner as well.
Health centers like the one in Harrisonburg have many profound impacts in the community. Children who have Medicaid or Medicare are able to be seen throughout their development, which has been able to help with preventative measures. This will allow healthcare providers to help guide children with their health decisions at an early age, which will hopefully decrease the amount of individuals with chronic issues in the future. Many patients at this healthcare center are undocumented and due to the current political climate, has caused them to experience some chaos and frenzy. Many clients are stressed more than usual because they are frightened that they might be deported, however the Harrisonburg Community Health Center has been constantly assuring their patient that they will be able to continue receiving healthcare despite their documentation status. There are situations in which certain health problems fall outside of the health centers scope and patients must be referred to the emergency room. Because patients are unable to pay for many of the services at the hospital, they oftentimes will come to the clinic for emergent medical issues, such as myocardial infarctions and strokes. “We live in an environment where people would rather delay care because they cannot pay instead of going to an emergency room in an emergent situation, which is sad,” states Erin. Though hospitals like Sentara hospital can provide financial aid opportunities for patients, there are typically many obstacles and barriers in place for patients to receive this monetary assistance.
Erin believes that the health center is a creative and fun place to work, especially if healthcare providers are able to stop obsessing over operational details and focus on providing the best treatment as possible to their patients. The majority of these patients do not have the financial capability to afford expensive labs and imaging studies on a whim, therefore healthcare providers must be innovative in how they provide effective treatment for these patients. “The health center is a very patient centered environment and although the providers who work here are generally paid less than they normally would be paid at other healthcare facilities, our providers are passionate about the art of medicine, which involves interacting and physically examining the patients”, says Erin. Providers working at healthcare facilities that are not health centers are “you based”, which means that the more patients they see determines how much he/she is paid. However, in 2018, clinical quality data will primarily dictate how a provider is paid. “Providers have to ACTUALLY make patients better in order to receive compensation for their services. It will start with Medicaid and Medicare, eventually leading to private insurance practices after an observation period,” Erin states. This shift is because healthcare providers can have different motivations for why they are trying to help a patient and it is important to ensure that a provider is actually providing patients with treatments that are effective and beneficial towards treating illnesses. Overall, Erin emphasizes the importance of fostering relationships with the patients who come through their doors, because building relationships with the patient will provide more significant outcomes.