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Access to health care in the Plateau, a rural mountainous region of Western North Carolina, may be significantly improved by the beginning of 2021, with the opening of a new community health center.
The facility would serve the Plateau communities of Cashiers, Highlands, Sapphire, Lake Glenville and Lake Toxaway, potentially changing the face of medical care in parts of Jackson, Macon and Transylvania counties.
The new facility is being planned through a partnership involving Blue Ridge Community Health Services, Mountain Area Health Education Center and the Highland Cashiers Health Foundation.
The Plateau region has struggled for decades to recruit a sufficient number of medical professionals to serve its tens of thousands of residents, according to those who live there. The pressures of the COVID-19 pandemic have only heightened those concerns in a region with an aging population that is more susceptible to serious illness.
“This is a special project approved by the board of the foundation to handle the primary-care physician shortage on the Plateau,” Dr. Walter Clark, a retired podiatrist and chair of the Highlands Cashiers Health Foundation, told Carolina Public Press.
“If people from Swain or Graham or Clay or Transylvania need to come up here, it’s going to be open to them,” Clark said. “We want to serve as many people as we possibly can in Western North Carolina, from our zone over to Cherokee.”
Funds from the nonprofit health care foundation “will cover this operation for at least five years” as a result of having some “very benevolent donors,” Clark said.
The area foundation was one of six health-care-focused nonprofits established as part of last year’s sale of the nonprofit Mission Health system to for-profit HCA Healthcare.
Blue Ridge Health, a federally qualified health center that generally sees a larger percentage of uninsured patients in its clinics than do other primary care offices, is eligible for federal grants but also maintains operations with payments from Medicare and Medicaid as well as from patients with commercial insurance, said Richard Hudspeth, CEO of Blue Ridge Health.
The new practice will provide medical services to all, regardless of ability to pay.
Working with MAHEC, Blue Ridge Health will extend its footprint to a ninth county. The federally qualified provider already operates in Buncombe, Haywood, Henderson, Polk, Rutherford, Swain and Transylvania counties and has an existing office in Jackson County in Sylva. It also operates 11 school-based health centers.
In the communities that it currently serves, Blue Ridge provides primary care, dental, pharmacy, behavioral health and nutritional services.
Hudspeth said primary care will be the first priority of the new practice and that the recruiting of physicians is underway.
“Recruitment of physicians in general can take quite some time,” Hudspeth said. “To have someone give up a job somewhere else and to come to you is really a six- to 12-month process.”
But, Clark and Hudspeth said, it is possible the new center could be open by the end of this year.
Additional services like behavioral health can be added going forward based on demonstrated need, the two said.
While Blue Ridge will manage day-to-day operations, MAHEC will engage in an on-site rural teaching program with the hope that graduates will remain in the area.
The Asheville-based nonprofit is one of nine health education centers in North Carolina that recruits, trains and retains medical professionals to serve in resource-starved rural areas. It carries out its work in conjunction with UNC Health Sciences, an academic health center.
As of June 2019, 582 physicians and dentists had graduated from MAHEC, and more than 60% of family medicine graduates stay in the region, the training organization said.
A dire need in region
Together, MAHEC and Blue Ridge hope to narrow the gap that exists between the daily medical needs of both residents and transient workers and the region’s limited pool of doctors.
Those needs and their root causes run deep. According to MAHEC, 1 in 4 children in Western North Carolina live in poverty, 1 in 6 adults are uninsured, and 1 in 5 are over age 65.
MAHEC-trained personnel already work in 16 counties, all deemed primary care health professional shortage areas. Many of their patients continue to suffer from cardiovascular disease, behavioral health disorders and substance use, all of which remain higher than the state average.
In addition, the region is now contending with the continued spread of COVID-19, with 158 cases and one death attributed to it in Macon County, 16 cases and one death in Transylvania County, and 55 cases and one death in Jackson County, all as of Wednesday.
No site has yet been announced for the new community health center. “Blue Ridge is the one that’s got to make the final determination on that,” Clark said.
But a committee has been established to examine options for the use of 8 acres of land owned by the foundation that are adjacent to U.S. 64 in Cashiers, he said.
Clinic part of answer to health access struggles
Announcement of the health center is the latest good news delivered to area residents who for the past year have made concerted efforts to ensure sufficient medical care. Ongoing calls for at least one full-time physician culminated in a contentious public hearing in January hosted by Gibbins Advisors, the independent monitor hired to hold HCA accountable for fulfilling the service promises it made when it acquired Mission Health.
At that hearing, it was announced that Dr. Todd Detar, then a medical director at Roper St. Francis Express Care in Summerville, S.C., would join Mission Health’s primary care office in Cashiers. Detar’s first day at the practice was May 27, and the office is once again open all day, Monday through Friday.
Clark told Carolina Public Press the discussions that his foundation initiated with Blue Ridge Health and MAHEC arose “because of the uproar of the people in Highlands and Cashiers.”
Physicians under pressure during pandemic
The opening of a new practice is a bright spot within an increasingly troubled profession in the region. There is a shortage of at least 140 primary care physicians in Western North Carolina, according to MAHEC, and given the financial pressures being experienced by providers during the coronavirus pandemic, that shortage may worsen.
Two recent surveys conducted jointly by the N.C. Academy of Family Physicians and the N.C. Pediatric Society underscore the tenuous link between population needs and the availability of primary care, especially in rural areas.
The survey of nearly 500 doctors, conducted April 30-May 4, showed that the financial pressures being experienced by community-based physicians had intensified.
The vast majority of respondents identified themselves as being affiliated with a hospital or health-system-owned practice or a physician-owned practice. About one-third of all respondents said they worked in a rural setting.
“Financial pressure continues to increase on practices, with 87% now reporting they are under significant or extreme financial pressure, increasing to 92% for physician-owned practices,” an executive summary of the survey says.
Further, “The percentage of practices considering permanent closure or selling to a larger entity has grown exponentially since late March, with about 1 in 10 considering such action.”
Nearly two-thirds of respondents reported at least a 40% drop in patient volume during North Carolina’s stay-at-home mandate as they grappled with overhead costs such as mortgages or rental payments, equipment, payroll, malpractice coverage and other expenses.
Even when including telehealth, 11% of rural practices reported a drop in patient visits of 60% or more. To remain afloat during the lockdown, 37% of the practices reduced salaries, 42% furloughed employees, and 74% cut office hours.
Loans were seen as “minimally helpful,” with some physicians expressing concern over their ability to repay short-term assistance from the Medicare Accelerated and Advance Payment Program.
Greg Griggs, executive vice president and CEO at the family physicians academy, said members of the General Assembly have been asked to consider some type of state funding for independent primary care practices.
“There is a serious chance that the state will lose primary care capacity if immediate assistance is not provided,” Griggs said.
In Cashiers, Clark, who practiced medicine for 38 years, also expressed concern over the pressures being placed on community health providers and the inability or reluctance of patients to visit their physicians during a prolonged pandemic.
“They’re not going to the doctor. Their blood sugar’s up, their blood pressure’s up. It scares me to death that we’re going to lose people not from COVID-19 — we’re going to lose them because they don’t go to see their doctor.”