Rural Health Center designation is option for clinic

By Stephen Clearheart Johnson
North Forty News

The Red Feather Medical Clinic, operated by Janice Weixelman, D.O., has taken steps to become a certified Rural Health Center, which could benefit the clinic and the community in several ways.

"It is a detailed, tedious process with a 2-inch manual for conformity and many meetings in Denver and inspections here," said Michael Sledge, a volunteer assisting the clinic. "I expect us to succeed, although the process takes up to a full year."

Some 43 Colorado communities already benefit from the federal program administered by the states. The program strives to improve care available to rural residents, partly with programs aimed to attract qualified medical personnel to serve in areas where salaries or earnings are usually low.

Certification could bring forgiveness of medical school loans up to $50,000 per year for physicians who commit to serving three years in an underserved area.

As an RHC, the clinic would receive a higher reimbursement rate from Medicare, up to double for some procedures. This would help pay for expanded hours and for attracting more health professionals. It could also offer some reduction in insurance costs. Weixelman currently pays more in malpractice insurance than she pays herself, she said.

Many of the full-time residents of Red Feather Lakes are older retirees covered by Medicaid and Medicare. Weixelman noted that many medical practices limit their Medicare intake to not more than 15 percent of volume to remain profitable. Currently the Red Feather clinic's client base is 30 percent Medicare.

As an RHC, the clinic could offer low-income patients fees on a sliding scale, with some federal reimbursement. And the clinic could serve uninsured patients in the Colorado Indigent Care Program.

It could also acquire better equipment through tax-deductible donations or loan and grant programs such as the Colorado Rural Outreach Program. Weixelman would like to add an echocardiograph to supplement her EKG equipment in diagnosing heart conditions. Grants for computer systems capable of electronically transferring patient records would be a great aid, she added.

The clinic has already met several of the requirements for gaining designation. A feasibility study funded by the Health District of Northern Larimer County has already determined that the area is medically underserved.

The Health District, according to Lin Wilder, is currently studying whether there is enough need and demand to support a full-time clinic, an item which the feasibility study concluded was doubtful.

Still, the clinic is staffed and open sufficient hours to meet RHC criteria as a result of Weixelman's personal commitment.

The clinic already meets a requirement list of diagnostic and therapeutic services commonly furnished in a physician's office. Other requirements include certain facilities and conformance to procedural and policy conditions. Most importantly, there is a requirement for record-keeping and billing practices that conform to complicated federal standards.

Currently, the clinic outsources the billing and medical coding, at a cost of 35 percent of billed income. Obtaining equipment and staff trained to perform this function in-house could be quite costly. Medicare claims must be filed electronically and conform to a rigid coding protocol.

Working with Medicare also has some drawbacks. Weixelman noted that payments are often delayed 90 days and that some services, such as flu shots, must be provided at fees that are well below actual cost.

One issue facing Weixelman is whether to remain a private practice or to create a nonprofit corporation or community foundation to serve as an umbrella. Tom and Judy Viola, active volunteers and grant writers, are urging her to apply for nonprofit status.

A clinic does not have to be nonprofit to become an RHC, but Tom Viola noted there are many more grants available to nonprofits.