PLUMMER, Idaho – Like most people, Shelly Sweet doesn’t want to wait when she needs her doctor. At the Coeur d’Alene Tribe’s Benewah Medical Center, she doesn’t have to.
The clinic finds time for Sweet with her doctor the same day she calls. The Emida woman usually arrives to an empty waiting room and is ushered into an exam room within minutes.
It’s not that Sweet is a tyrant requiring special care or that the medical center has so few patients that it can get her in at a moment’s notice. No one waits for service at Benewah Medical Center.
“It’s same-day service,” said Debra Hanks, medical center director. “One doctor swore it would never work. Now that doctor would never go back to the way it was.”
Benewah Medical Center celebrates its 15th anniversary today with the same ground-breaking spirit with which it began. In 1990, the Coeur d’Alene Tribe creatively combined funding sources to enable it to provide affordable medical care to tribe members and non-Indians, a cutting edge concept. Now, the tribe is leading the charge to reduce society’s need for medical services through an emphasis on prevention and wellness.
“They certainly had the first wellness center in this area. They recognized early, and did something about trying to get community members to recognize, they have some self-responsibility in improving,” said Doni Wilder, director of the Indian Health Service division in Portland. “Everyone wants to emulate them, but I’m not sure anyone has that wellness piece yet.”
Tribes nationwide operate health centers now patterned after the successful Benewah clinic. Community health clinics have sprouted from Bonners Ferry to Coeur d’Alene, motivated by Benewah Medical Center’s populist magnetism. More than 8,000 patients visit the Plummer clinic in a year.
“A national model for Indian and rural health care” is the Indian Health Service description of the clinic 34 miles south of Coeur d’Alene. A pile of awards support that assertion, including, most recently, the prestigious Johnson & Johnson Community Health Leadership Award.
“Progressive and unique, the Benewah Medical and Wellness Center is an outstanding model of a community working collectively to reach the common goal of building a healthier society,” the Johns Hopkins Bloomberg School of Public Health, which issues the award, announced in its invitation to the May awards ceremony. The award included $50,000, which the center is directing toward prevention of cardiovascular disease and depression.
“It’s a vision of our elders we’ve completed,” said Leta Campbell, a Coeur d’Alene Tribal Council member who manages the center’s medical records department. “As I travel around the country, other tribes ask ‘What did you do right?’ I feel privileged to be here.”
The tribe was pushed to act in 1987 when health care for its people sporadically operated out of a half-condemned building, and the Indian Health Service often turned tribal members over to collection agencies for nonpayment of medical bills. Non-Indians on the Coeur d’Alene Indian Reservation had it no better. Health care was at least 45 minutes away if they could afford it. Many lacked insurance.
With money from federal grants, Benewah County and the city of Plummer, the tribe built and opened the $2 million, nonprofit health-care center three years later. Fourteen health care workers served 800 patients that first year. Two years later, the tribe added a dental clinic.
Under a century-old treaty, the Indian Health Service covers care at the center for members of any federated Indian tribe. From other patients, the center accepts Medicare, Medicaid and private insurance, which help the center’s tight budget. A federal grant helps cover the cost of care for uninsured patients.
By 1998, center doctors were treating 8,000 patients a year, and half were non-Indian. The clinic had nearly tripled in size to add exam rooms, a dental wing and more space for the pharmacy, counseling, health education programs and offices.
The staff had grown to 80, including four doctors, and the tribe was shifting its emphasis from triage to prevention. That year it opened a $5 million health club a block from the medical center, and they promoted it as a wellness center.
“There’s a big push in HHS (Health and Human Services) to get people moving and thinking about nutrition,” Wilder said. “The Coeur d’Alenes have been doing this. They’re definitely a role model.”
The wellness center includes a physical therapy training room, a five-lane swimming pool complete with bleachers and starting blocks for swim meets, a 94-degree therapy pool, a dance studio with a mirrored wall, a full gym with first-class floors, and dozens of weights, treadmills, exercise machines and spinning bikes. The tribe pays annual dues for tribal members. Rates vary for others, ranging from $19 to $41 per month. The center has more than 3,000 members.
Prevention is a necessary strategy, Hanks said.
“The uninsured rate is astronomical. Our funding is fixed. We’ll be challenged financially, and to continue services will be tough,” she said. “So we’re seeing what we can do in prevention and wellness, changing lifestyles and behaviors.”
Hanks, a former CEO at Spokane’s St. Luke’s Rehabilitation Institute, took over as center director in 1999. Patient complaints about long waits prompted her to involve the center in a yearlong analysis project. Every action taken at the center was scrutinized, exposing duplication and obvious improvement potential. Hanks wanted patients to move through the center quickly without sacrificing quality of care.
A year ago, the center started offering patients access to doctors the same day they called. Staff was retrained and the center closed a full day to practice. Now, staff members wear headsets and save time and energy by staying in communication.
“We radio for lab tests and lab techs come right to exam rooms,” Hanks said. “It increased productivity and patient satisfaction. I don’t have anyone calling me anymore with complaints.”
Last year, Hanks invited a doctor and author to teach the center staff that courtesy comes before efficiency.
“Our satisfaction rate is always high, at least 92 percent,” she said. “Our challenge is how to keep improving, but there are always ways. We want everyone exceptionally satisfied.”
Shelly Sweet fits that category. She’s come to Benewah Medical Center for care nearly since it opened. Her diabetes was diagnosed at the center.
“It’s like a big family here,” Sweet said. “A lot of people feel loyalty here. They don’t need money up front. They even know my voice on the phone. They take really good care of me.”
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