Walk-In Clinic Can Save Medical Expense for Uninsured without a Doctor

Faced with increasing pressure from the number of uninsured patients in Texas County that seek care through the Texas County Memorial Hospital emergency department, hospital officials have implemented a new primary care walk-in clinic in Houston.

Wes Murray, chief executive officer at TCMH, detailed operations of the clinic to hospital board members at their monthly meeting on Tuesday.

“We now have the staff in place to run a walk-in clinic five days a week,” Murray said.

The walk-in clinic operates out of the TCMH Medical Complex in Houston and Chip Lange, PA and Jeff Blue, PA see patients of all ages Monday through Friday from 10 a.m. to 6 p.m.

“Over fifty percent of the patients seeking treatment in our emergency department are not able to pay for the care they receive,” Murray said. “The walk-in clinic provides a convenient and low-cost way to see a healthcare provider for primary care needs.”

In September TCMH had $612,997.05 on the books as “bad debt” from patients that could not pay their hospital bills. Fifty-three percent or $324,888.43 of the bad debt was generated through the emergency department.

“Increasingly, the emergency department is the primary care clinic for patients that are not established with a local healthcare provider,” Murray said, noting that sometimes patients can’t get in to see their healthcare provider when they are ill and need to be seen within a few hours.

TCMH is required by state and federal law to provide healthcare for anyone that comes to the hospital emergency department or to anyone that calls an ambulance regardless of his or her ability to pay for services rendered.

According to Murray, the TCMH clinics will work established patients into the daily schedule when they are ill, but it’s not always possible to fit everyone in that seeks care at a TCMH clinic, even if the patient is an established patient.

The mid-level providers at the TCMH Medical Complex—Lange and Blue–are keeping an open and flexible schedule to see patients that want to walk in for immediate care without an appointment.

“The billing for the walk-in clinic will be like the billing at any of our hospital clinics,” Murray said. “It will be at a much lower cost because it does not utilize the acute care staff, physician and services of our hospital’s emergency department.”

TCMH continues to remain hopeful that Medicaid expansion will provide relief for many residents in Texas County that are not able to afford the expanded healthcare coverage through the affordable care act. However, Medicaid expansion will not occur without action by the Missouri state House of Representatives and Senate.

“We believe this walk-in clinic will help us continue to address the healthcare needs of the communities we serve through a significant number of open appointment times that are available daily as well as helping us trim costs that we are not being paid for,” Murray said.

The TCMH October financial report provided positive numbers. Outpatient revenues were up $70,448.00 over budgeted expectations for the month September. Inpatient revenues were up $10,995.00 over budgeted expectation for the month, too.

For the second straight month, TCMH had a positive bottom line. September’s bottom line totaled $99,656.07, bringing the negative year-to-date balance up to $543,956.14.

“We have made up some of the ground we lost earlier this year,” Linda Pamperien, chief financial officer at TCMH, explained.

Pamperien attributed the increase in inpatient and outpatient volumes to the additional healthcare providers seeing patients at TCMH clinics and doing procedures at the hospital.

Pamperien also complimented the hospital physicians on their efforts to manage the patients they have in the hospital.

“Our physicians are being extremely conscientious about managing the length of stay for their inpatients,” Pamperien said.

TCMH has been recognized by the Center for Medicare and Medicaid Services as providing high quality patient care at a lower cost per patient than the state and national averages. According to Pamperien, properly managing a patient’s length of stay helps the bottom line of the hospital and affects the federal quality data that is collected monthly.

Amanda Turpin, quality management director at TCMH, compiles the monthly quality date and TCMH and submits it to federal and state agencies. In mid-October, Turpin passed her board exam to become an internationally board certified healthcare quality professional.

Turpin is one of 11 nurses in the state of Missouri to attain the certification.

“We are very fortunate to have Amanda here working for us,” Murray said.

Also returning to the area is Heather Ragsdale Lobough. Lobough grew up in Bado and graduated from Houston High School. She is a certified registered nurse anesthetist, and she’s been working for the past few years at CoxHealth in Springfield.

Lobough has signed an employment contract with TCMH, and she will provide surgical anesthesia services at TCMH beginning November 10th.

“Heather is planning to move back to her family’s farm in Bado with her husband and daughter,” Murray said, adding that Lobough is looking forward to the return to Texas County.

Jenny Sawyer of Houston, a registered nurse at TCMH, took over the duties as infection control nurse manager in September. Sawyer has been a nurse at TCMH for nine years, and in that time has increased her education
and licensure to grow her nursing career. She’s currently pursuing a bachelor’s degree in nursing in addition to working full-time at TCMH.

Sawyer made a brief presentation to the hospital board regarding Ebola preparedness at TCMH.

“From the beginning, we have adopted the most aggressive approach,” Sawyer said.

Sawyer began working with hospital departments to put Ebola protocols in place in early October. Currently, roundtable drills and personal protective equipment testing is being done at the hospital.

“We have the federal guidelines in place,” Sawyer said. “I feel like we are ahead of the curve of many other hospitals our size.”

Joleen Senter Durham, director physician recruiting at TCMH, reported that site visits with two family medicine and obstetrics physicians were planned.

“Both of these physicians are looking at the TCMH Mountain Grove Clinic opportunity,” Durham said. “They are seeking a small town family medicine practice where they can practice obstetrics and deliver at TCMH.”

In addition to hospital and clinic tours, the physicians will bring their families and spend time in the area looking at the communities in Texas County.

Present at the meeting were Murray; Pamperien; Sawyer; Durham; Doretta Todd-Willis, chief nursing officer; Dr. Schaun Flaim, chief of staff; Dr. Jonathan Beers, vice chief of staff; Dr. John Duff; and board embers Janet Wiseman; Mark Hampton; Dr. Jim Perry, OD, and Russell Gaither.

Board member, Omanez Fockler, was not present at the meeting.

The next meeting of the TCMH board of trustees is Tues., Nov. 25th at 12 p.m. in the hospital board room.