Salud limits number of patients

By Cherry Sokoloski
North Forty News

"We're at capacity. We're reeling as an organization." That's the grim assessment of an executive from Salud Family Clinics, which operates a clinic in north Fort Collins.

The local Salud clinic began limiting new uninsured patients a few months ago, as a result of budget cuts and increased demand.

"No one group can take care of all the uninsured in Larimer County; the demand is too high," stated Dr. Virgilio Licona, associate medical director of Salud. "It's a community issue, not a Salud issue."

Fort Collins Salud is not closed to all new patients; in fact, the clinic saw an average of 13 new patients each day in January. People who meet certain criteria are still being accepted at the clinic, but many are being turned away.

The change is a disturbing one for the clinic staff, according to assistant medical director Dr. Doug Whitman.

"The staff feels frustrated that they can't serve everybody in the community," he said. "It's very difficult to say no to community members who need our services the most."

Community health centers such as Salud act as "safety net" providers, serving primarily a low-income population. At the nine Salud clinics in Colorado, 51 percent of patients are uninsured. In 2008, Licona said, the state's 15 community health centers, including Salud facilities, cared for 420,000 Coloradans.

Salud is dealing with double trouble in the current economy: decreased revenue and increased demand. In the last year, the Salud clinics statewide have suffered $2.5 million in budget cuts from the state, Licona said. At the same time, "demand is up incredibly," he said, as more and more people lose their jobs and consequently their health insurance.

In 2009, patient numbers at the local Salud clinic were up by 10 percent. As a result of the state cuts, however, the clinic's budget dropped by 12 percent.

The Salud clinics also rely on annual grants from the federal government, which are designated for care of the uninsured. This year, that grant makes up 23 percent of Salud's budget.

Salud's patient roles have been steadily increasing since the organization took over the Fort Collins clinic in 2002 from Poudre Valley Health System. The clinic saw 12,000 individual patients in 2009 and had 40,000 patient visits. Compared with 2003, that's a 25 percent increase in patients and a 50 percent increase in visits.

Some patients accepted

People who are still being accepted as new patients at Salud, with or without insurance, include the following:

• All pediatric patients
• All pregnant women
• Any immediate family members of patients already registered with Salud
• Any woman referred by the Women's Resource Center
• All homeless patients
• All farm workers

New patients with insurance, including Medicare, Medicaid or private insurance, are also being accepted. In addition, Salud sees some high-risk follow-up patients discharged from the hospital, on a case-by-case basis.

Besides mounting demand and reduced funding, the Fort Collins clinic also suffers from a shortage of medical staff, resulting in long hours and stress for those who remain. Currently, Salud has four family physicians, three pediatricians, one physician's assistant and one nurse practitioner.

Just one year ago, the local clinic had three additional physicians. Licona is now recruiting for an additional physician and a PA or nurse practitioner. It's a challenge, he said, to find "young physicians that have the same spirit" needed to serve in a community clinic.

"Patients have multiple medical problems, plus socio-economic problems," he noted. "It's extremely rewarding work, but it's not for everyone."

Whitman said that with the addition of new employees, the staff hopes to serve more patients. However, he noted, an increase in patient load might require expansion of the Salud facilities. Last year, in an attempt to serve more patients in limited space, Salud started offering evening clinics on Monday, Tuesday and Wednesday.

National problem cited

Licona sees Salud's challenges as an extension of the nation's overall healthcare woes.

"Our health system fundamentally is extremely flawed, because we have not made sure everyone has access to insurance," he commented. "How long can we continue to spend more than any other industrialized country, and still be the only industrialized country that doesn't cover its populace? There are too many people on the outside looking in, and we don't have a way for them to be seen properly."

For those who cannot be accepted by Salud under the current rules, what are the options? There aren't many, according to Kim Walkenhorst of the Larimer County Health Department. The Family Medicine Center, a residency program, accepts uninsured patients, as does Urgent Care at Harmony and Timberline, owned by Poudre Valley Hospital. The Health District for Northern Larimer County registers new patients once each month for its dental clinic. Patients must live within the health district, and they are charged on a sliding scale. Private clinics generally see some uninsured patients, but Licona pointed out that doctors are also affected by the current economy, making it more difficult to take on the uninsured.

"At the end of the day," stated Licona, "you have the emergency room. There you have people who get very sick because they can't access primary care, and they end up in a very expensive arena."

Despite the overwhelming current situation, Licona is optimistic for the future of the U.S. health-care system. "I think we will win long-term," he said. With health care currently consuming 17 percent of America's gross domestic product, he predicted that financial necessity will make the country "move forward."