Grant makes a healthy difference

The number of people without health insurance in North Idaho is higher than ever, but fewer of those people have to forgo medical care.

A federal grant has let Coeur d’Alene’s Dirne Community Health Clinic, formerly a volunteer-run near-free clinic, quadruple its monthly patient load from about 300 to 1,200. Nearly three-quarters of those patients are uninsured. The rest are on Medicaid or Medicare and couldn’t find a doctor accepting new patients with their coverage. Or they have health insurance with high deductibles.

“We had about 4,500 Medicaid patients who couldn’t get a doctor,” says Michelle Britton, director of the state Department of Health and Welfare’s regional office in Coeur d’Alene. “Now they’re with Dirne and with other practitioners who agreed to take more. We have a medical home for every Medicaid patient in Kootenai County.”

The U.S. Department of Health and Human Services awarded Dirne $565,750 last December to offer medical care full-time to the area’s underserved population. The department awarded Boundary County $900,000 two years ago for the same reason. Boundary opened a new community clinic.

Since Dirne began operating in March as a federally funded community clinic, patient visits to Kootenai Medical Center’s emergency room have leveled off, says Roger Evans, the hospital’s emergency room director. It’s too soon to have enough evidence to credit Dirne, he says, particularly since a full-cost clinic opened during non-business hours at about the same time.

But Evans knows from experience that many uninsured people showed up in the costly emergency department for minor ailments because they knew the hospital wouldn’t turn them away even though they couldn’t pay. Now, Dirne handles most of the demand.

“We’re very happy Dirne has taken the direction it has,” Evans says.

While the number of emergency room visits is stable, the hospital’s amount of charity care is rising, most likely due to Dirne. Some of those people going to Dirne need more care than a doctor can offer in an exam room, says clinic medical director Dr. Leanne Rousseau. Dirne refers them to KMC for hospitalization.

“We are noticing a difference,” says Carmen Brochu, KMC’s vice president of patient care. “Charity care dollars have gone up this year.”

The federal grant changed the personality of the Dirne Clinic as effectively as a topnotch psychotherapist.

“It’s a big change,” Rousseau says. “People liked Dirne. It was so simple. You see patients, give them medicine, they get better. But there were limitations.”

The clinic that opened in 1989 to help people with no medical insurance didn’t offer surgery, biopsies, pediatric or women’s care, follow-up for chronic diseases or broken-bone repair. Doctors, nurses and support workers volunteered their time. When emergencies called scheduled doctors away the two nights each week the clinic was open, patients without critical problems were asked to leave.

“It was overwhelming because the need is so great,” says Lidwin Dirne of Coeur d’Alene, who belongs to a group of lay Catholic women.

She raised the idea for a clinic for the poor in the 1980s, insisting that health care is a basic human right. After the clinic opened, it saw about 100 patients each week.

The clinic survived on donations and compassion. It accepted no state or federal money or Medicaid or Medicare to avoid a morass of regulations and red tape. But the nonprofit clinic’s board of directors finally decided last year that it couldn’t meet the growing need for health care in North Idaho without more help.

Don Merica, 45, is pleased with the new federally funded clinic. He waited outside Dirne a year ago for more than an hour in 20 degree weather to see a doctor. Before the grant, Dirne operated on a first-come, first-served basis, so patients began lining up outside its door an hour or more before it opened for the evening.

Merica had no insurance and his upper back bothered him. Parts of him occasionally went numb. Eventually he was diagnosed with multiple sclerosis.

“Now I make an appointment,” Merica says, smiling as Rousseau takes his daughter, 9-month-old Madison, from him as he climbs onto an exam table. “I see Dr. Rousseau every time. I’m so impressed with her. I’ve already sent other people here.”

Patients pay for services based on their income. Most pay $15 per visit, which is reduced to $10 if they pay the same day they see the doctor. The clinic offers the same services as any medical office. It also offers mental health counseling and discounted prescription drugs. Dental services are on next year’s expansion schedule. Thirty-five health care workers are on staff.

Since March, the Dirne Clinic has expanded into two buildings at 1111 Ironwood Drive while it searches for one location that meets all its needs. Such a building will cost about $300,000, which the clinic will have to raise. It already needs to raise more money just to continue operating as it is. The federal grant covers the costs for 500 uninsured patients per month. In September, the clinic saw 783 uninsured patients rather than turn away anyone.

“It costs us about $100 per patient,” Rousseau says. “We realized we need to market to people with insurance. And if the community helps us, we can see more.”

The clinic needs more Medicare patients because Medicare reimbursements would help cover costs. Britton, the president of Dirne’s board as well as Health and Welfare’s regional director, believes Medicare recipients have as much trouble finding doctors to take them as people with Medicaid do. The clinic could fill Medicare recipients’ need for doctors, and patients on Medicare could help the clinic’s need for money.

Rousseau also hopes to convince some larger employers who don’t offer health insurance to their employees to make sizable donations to Dirne, where their workers most likely go for medical care.

Lidwin Dirne is pleased the clinic she sparked reaches so many people now. But she worries that the nature of big business will squelch the spirit of compassion so dominant in the old clinic.

“I’m still on the board, like a little watchdog,” she says. “I’m trying to make sure that the original spirit of service will be there. The first and most important thing is to treat every person with dignity whether they can pay or not. I’m not sure that spirit is still there, but I think it is.”