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Mobile health clinic ailing

Fri., July 13, 2007

For the past 2 ½ years, Mobile Medical Clinic has provided health care to low-income and elderly patients in their own homes. Now, it’s the clinic that needs help.

The Spokane in-home health care provider is more than a business to its owner, Traci Pelchat. It is a calling born of necessity. Nearly all of her clients are on Medicaid, the state-federal health care program for low-income patients, or Medicare, the federal program for the elderly or disabled.

A nurse practitioner who has worked at several area hospitals, Pelchat has observed firsthand how emergency rooms are filled with people who have waited too long for primary care.

Mobile Medical, the only mobile primary care clinic in Eastern Washington, reaches out to about 1,200 patients for whom a trip to the doctor’s office is a nearly insurmountable obstacle – the aged, the immobile and the psychologically disabled.

“Oftentimes, our providers are the last option for these elderly and Medicaid patients,” Pelchat said.

Because of low federal reimbursements, many doctors offices limit the number of low-income patients they see to 10 percent or 20 percent, she said.

“The clinics that do take Medicaid-Medicare have to see so many people a day to make the reimbursements pay for overhead, they don’t have a lot of time to see each patient,” Pelchat said, adding that these patients often need extra support because of multiple physical or mental conditions.

Because Mobile Medical providers treat patients in their environments, they understand how patients live and whether they have people to look out for them, said Melody Bemis, a Mobile Medical nurse practitioner.

“Many of these people would go without treatment,” Bemis said during a visit to a Spokane Valley adult care home.

But despite the fact that Mobile Medical’s patient base has doubled since February 2006, when a story about the clinic appeared in The Spokesman-Review, Pelchat’s business is financially shaky – mostly because of delays in reimbursements for Medicaid and Medicare services.

It’s at least a three-week wait for reimbursement under the best circumstances, Pelchat said; make a mistake on the paperwork and “you’re talking about six to eight weeks.”

She added, “It’s the reason some doctors aren’t taking Medicaid and Medicare anymore.”

A spokesman for the Centers for Medicare and Medicaid Services in Seattle referred questions about reimbursements to its contractor, Noridian Administrative Services LLC. Calls to Noridian were not returned Wednesday or Thursday.

Most health care providers face the same delays in government reimbursements, as well as the low rate of Medicaid reimbursement in particular, as Pelchat does. However, many medical offices enjoy a much higher percentage of privately insured patients with quicker and higher payouts.

More than 90 percent of Mobile Medical’s patients are on Medicaid or Medicare.

“That money will come in,” Pelchat said.

“I just can’t afford to wait four weeks because a service number was wrong.”

To make ends meet, Pelchat has been working as a nurse in the emergency room of a Spokane-area hospital, as well as running her business.

“I have pretty much maxed-out both my lines of credit to fund this clinic,” she said.

So far, she has not missed a payroll for her seven employees, including three nurse practitioners. She also contracts with a doctor, who must review home health practices.

Were Mobile Medical to close its doors, it would be a hardship for not only its patients, but also would place an added burden on the emergency rooms of local hospitals, Pelchat said.

“I just watched Michael Moore’s ‘Sicko,’ and I can’t believe how much that movie describes the problem,” she said. “Most of these patients can’t find primary care providers to take them so as a result, they will just go to the ER.”

Earlier this month, the Ronald McDonald Care Mobile had to pull out of Spokane after two regional medical providers couldn’t find funding for it, leaving about 1,100 patients a year without its health services.

In addition, the People’s Clinic barely survived closure last month when Washington State University intervened with a $400,000 cash infusion for one year.

Pelchat does not know how much longer she can use her own capital to keep Mobile Medical running.

“I really want to continue to be part of the health care solution,” Pelchat said, “but at this point I don’t know how we can.”


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