Internist brings work to Dirne clinic

Hopes of providing one-stop services for Medicare clients in North Idaho moved closer to reality this week, when a Coeur d’Alene doctor merged her private practice with the Dirne Community Health Center.

Susan Melchiore, an internist who specializes in geriatrics, said creation of the SAGE Center Medicare Clinic realizes a dream of providing comprehensive medical, social and prevention services for up to 3,000 patients.

“I’ve been thinking for a long time about setting up a team approach to more comprehensive elder care,” said Melchiore. “When I came here 10 years ago, I thought the time was ripe then. Now, I think it’s overripe.”

Ideally, people eligible for Medicare – those aged 65 and older – should be able to receive not only complete medical care, but also help with social services, mental health and resources for staying alert and fit, she said.

“We want to focus toward the well elderly,” said Melchiore. “The goal is to keep people functional as long as possible.”

Melchiore began serious negotiations with clinic officials last fall, said Joel Hughes, Dirne Clinic administrator. In the arrangement, the doctor has moved her entire practice – staff, patients and records – to the clinic. The move boosts Dirne’s annual budget by about $500,000, bringing the expected total to more than $2.4 million for this year, Hughes said.

It’s a good addition for the clinic, which gains a full-time physician and two assistants who will focus on sorely needed services for an estimated 4,000 local Medicare patients without primary care, Hughes said. Limited federal reimbursement rates mean that few, if any, local doctors are accepting new Medicare clients.

“Every day, we get calls from people saying, ‘Will you take Medicare?’ ” he said.

The SAGE Center – or Successful Aging and Geriatric Evaluation – will accept only clients whose care is paid for either by Medicare or by private insurers, Hughes said. It will be separate from the Dirne Clinic, which provides care for people with limited or no insurance, but it will help support that work, he added.

“It spreads our costs and stabilizes us so that we can expand services to the uninsured,” he said.

Increasing Medicare service in Coeur d’Alene will allow people to receive care where they live instead of traveling to Spokane – or Sandpoint or Kellogg, said Lisa Johnson, spokeswoman for Kootenai Medical Center.

“We have all these retirees, and they move here and think they can find a doctor here, and they can’t,” she said.

Joining the clinic is a good move for Melchiore as well. The doctor will become an employee of the center, gaining access to administrative services that sapped time and energy from her private practice.

“I don’t like to do the books,” Melchiore said. “I’d much rather be with the patients.”

The change gives her more time to spend with patients like Juanita Anstine of Coeur d’Alene. For the first 60 years of her life, Anstine’s medical care was provided by Dr. Ted Fox. When Fox retired 10 years ago, Melchiore took over.

“She takes care of me,” said Anstine, 70, patting her doctor’s hand.

Melchiore offers the same advice to Anstine that she’d give to any senior citizen. Stay active, physically and mentally. Don’t simply accept pain and decline as the inevitable consequences of aging.

“So many people are putting up with symptoms or disease,” Melchiore said. “They don’t necessarily have to put up with that.”