JEFFERSON — The way in which medically under-served populations are cared for in Jefferson and Dodge counties might be about to change, as three safety-net health-care providers in the region consider merging.
According to Tina Crave, president and CEO of the Greater Watertown Community Health Foundation, the boards of the Community Dental Clinic of Fort Atkinson, the Rock River Free Clinic in Jefferson and the Watertown Area Cares Clinic of Watertown are taking steps to align their operations into what will be called Rock River Community Clinic Inc.
They are preparing to make the transition to an integrated, community-based delivery model called a Federally Qualified Health Center. If approved by each of the clinic boards later this month, the future FQHC will become one of 18 Wisconsin community health centers providing care to medically underserved populations at more than 140 locations across the state.
The three local health-care entities, Crave said, are working collaboratively to increase access to primary health and dental care, and improve the health of uninsured and underinsured residents of Jefferson and Dodge counties.
“This transition will ensure the long-term sustainability of services to meet three shared goals — to improve the quality and coordination of health-care services, increase community member access to health-care services and improve health outcomes for low-income residents,” Crave said.
According to those involved in the transition, recent months have seen the boards of each of the clinics exploring options for ensuring long-term sustainability of services. Crave said transitioning to FQHC status will allow the clinics to receive reimbursement for services to Medicare and WI Medicaid recipients. She said this will ensure the long-term financial stability of services and will allow access to a federal 340B Drug Discount Program to provide patients with affordable prescriptions. It will access tuition reimbursement and National Healthcare Service Corps programs to recruit and retain health-care providers.
Crave also noted it will mean the clinics can receive liability protection through the Federal Tort Claims Act and retain local governance, ensuring decisions about health care in the community are made by area residents.
Crave said that once the transition is complete, the clinics will operate as one business entity, providing care at multiple sites across Jefferson County. Consolidation will allow the clinics to provide enhanced coordination of care, while achieving operational economies of scale.
“If approved by each of the boards, the clinics will consolidate into one business entity on Jan. 1, 2020,” Crave said. “One governance board, which will include representation from each of the three clinics, will be established in January. This board will outline plans and centralize resources to meet the requirements to formally achieve FQHC status.”
Crave said key milestones to be accomplished in 2020 include establishment of a shared mission, vision and organizational identity, and creation of centralized support functions, including human resources, accounting, facilities, purchasing and risk management. She said there will be establishment of a leadership structure, and shared policies and procedures, along with implementation of a shared electronic medical record with interfaces to allow for seamless access to information in the clinics and local hospitals.
Other goals for 2020 include establishment of processes to proactively manage population health, care coordination and clinical outcomes, creation of a process to bill and collect Medicare and Medicaid revenue, and formulation of a plan for expanding access to mental health services.
“Patients, staff and volunteers from each of the clinics will be engaged as the board develops integration plans and timelines,” Crave said, adding regional health-care partners will support the transition to FQHC status through a newly developed Rock River Coordinated Health Care Network. Network partners include Fort HealthCare, Watertown Regional Medical Center, Jefferson County, Watertown Public Health, Rainbow Hospice Care and the Greater Watertown Community Health Foundation.
“These network providers have a long history of working together to improve community health,” Crave said. “In fact, all three of these clinics were all established as a direct result of collaborative needs assessments and planning conducted by these organizations.”
Crave said the new health entity in the region will be building on a strong foundation. Overall in 2018, the clinics served 6,872 patients with approximately 9,500 total visits.
“The three clinics were created by community volunteers and have thrived, thanks to the generosity of community volunteers and donors,” she said. “Community support for the three clinics makes it possible to provide care for patients who are uninsured. Moving forward, the clinics will continue to provide care to the uninsured without reimbursement. Continuing support from our communities helps to meet the needs of our neighbors who can’t afford insurance.”
Lori Maas is the executive director of the Rock River Free Clinic, located in Jefferson. It was established in 2003. She said she is optimistic the merger will be approved — and about the possibilities a consolidation would create.
“Presently, the three entities work together, sharing many of the same clientele/population, and refer patients back and forth,” she said. “But now we will be one entity and have the ability to share information more quickly. This will allow for better service to our patients. We are also excited about the plan to add mental health programs to the network.”
For now, Maas said, all respective physical facilities will remain where they are.
“My understanding is our primary physical facility will be in Whitewater, to better serve a large portion our patients, with satellite locations around Jefferson County,” she said.
At present, the Rock River Free Clinic has a paid staff consisting of a provider, nurse, front desk person and executive director. It also has volunteer doctors, nurses, front desk help, a marketing committee and general volunteers.
The clinic is funded, in part, by fundraising via private, club and church donations, patient donations, and the United Way of Jefferson and Walworth Counties and Tomorrow’s Hope. Jefferson County also contributes, along with miscellaneous grants.
“I believe our current funding will remain the same, with the added advantage of being able to see patients with Medicaid, which will allow us to also seek reimbursement from Medicaid,” Maas said. “Currently, we do not see patients with Medicaid.”
Maas said the clinic is comprised of “team players” with their patients’ best interests at heart.
“We are prepared to do what it takes to make sure our patients continue to receive the care they deserve,” Maas said. “Our hope is, with the FQHC, we will have the ability to offer doctors tuition reimbursement, which will allow us the opportunity to draw more medical professionals into our area to help serve our patients. We are optimistic about the future.”
Barb Morrison Gudgeon, one of two directors of the Community Dental Clinic in Fort Atkinson, said she is sure the plan for consolidation will be approved by the board, and she and her colleagues are strongly in favor of the merger.
“We will see an increase of Medicaid reimbursements, and building a stronger network of care for our low-income/Medicaid patients. We can’t see the negatives of this merger. Currently, we have been working together, sharing the same clientele/population, and referring patients. But now, we will be one joint collaboration,” she said.
She also said the clinic’s facilities will remain where they are.
Community Dental Clinic was started in 2007. In 2018, the clinic had 5,341 patients and this number is on target to increase this year. The clinic has more than 11,000 patients of record who are served by paid staff and dentists.
The clinic is funded by Medicaid payments, private pay patients, donations and grants.
“We will be able to seek a higher reimbursement rate from Medicaid,” Morrison Gudgeon said. “The current reimbursement rate is 17 cents on each $1 that the clinic can bill Medicaid.”
Gudgeon said she and her colleagues are excited about the potential for collaboration.
“This is a way for our clinics to each expand, being able to offer the best of our abilities to the shared population we are serving,” she said. “Having the ability to offer doctors tuition reimbursement — that, in itself, is an amazing benefit that none of us could offer in our current situation. We can’t wait to see what the future has in store for this exciting new venture. This is a ‘win’ for our area’s low-income/Medicaid population and the long-term stability of our clinics. This is an absolutely exciting journey to be embarking on and we have the best teammates around to join us on this journey.”
Watertown Area Cares Clinic Director Carol Quest said she believes the merger will be approved and noted the clinic will remain where it is, at 415 S. Eighth St. The facility opened its doors in May of 2008. Clinic visits in 2018 totaled 1,200, with the client roster at 699. Quest said 2019 numbers are consistent with those of 2018.
“We have many volunteer providers and one paid provider,” Quest said. “When we become a FQHC, we will be able to bill for some of the services. The clinic will continue to need the community for ongoing support.”
Jefferson County’s director of human services, Kathi Cauley, said her department also is excited about the pending merger.
“The FQHC brings a number of advantages, including a broad provider network that we will be part of for behavioral health services. In short, more people are typically able to access services, because FQHC’s attract providers due to advantages such as tuition reimbursement, student loan pay back options, and enhanced Medicaid options. We, in the Human Services Department, are excited to be part of bringing these opportunities to the people of Jefferson County.”
Gail Scott, director and health officer at the Jefferson County Health Department, agreed.
“I think this new merger is an exciting opportunity for Jefferson County and the surrounding area,” she said. “It will allow for more patients to be seen by quality providers who have a mission of serving those who would otherwise go without care. By forming a network and working together, we can enhance our ability to create a stronger and more resilient community. There are dedicated people working to assure that the clinic is sustainable, and able to offer medical and dental services for years to come.”