Former Family Medicine Center on Willow Ave. will apply to become a federally qualified health center (FQHC) to provide better care for underserved populations
By Reggie Ellis
VISALIA – Kaweah Delta’s new year’s resolution was to provide better care for its most vulnerable populations – those who are new to the area and without a primary physician, covered by Medi-Cal or uninsured. And just two days into the new year, Kaweah Delta opened its new Sequoia Health and Wellness Center (SHWC) in the former Family Medicine Center, located just north of Kaweah Delta Medical Center at 202 W. Willow Ave., Suite 502, in Visalia. A grand opening and ribbon cutting for the center will be held from 5 to 7 p.m. on Tuesday, Jan. 14.
The Sequoia Health and Wellness Center (SHWC) is part of the nonprofit arm of Kaweah Delta of the same name. Under its new structure, SHWC will continue to provide a variety of health care services (primary care, women’s health, prenatal care, pediatrics, etc.) to people no matter who they are, where they live and regardless of income, insurance or ability to pay. However, unlike Kaweah Delta’s other primary and specialty clinics, the center will be applying to become a Federally Qualified Health Center (FQHC). As an FQHC, the facility would have access to benefits that current Kaweah Delta clinics do not, such as the ability to employ physicians, sponsor visas for foreign graduates, offer federal loan forgiveness for physicians, receive federal and state grants and receive a higher rate of reimbursement for residents insured by Medi-Cal and Medicare.
Ryan Gates, PharmD, Sequoia Health and Wellness Center’s Chief Executive Officer, who also serves as Director of Population Health Management at Kaweah Delta, said the move will enable SHWC to access State and Federal programs and funding sources that will help it expand and improve care for patients and attract more physicians and providers to Tulare County. SHWC has already added new positions to expand its services as a result of its effort to become a FQHC. Those positions include a community outreach specialist, psychologist and social worker, health promotion instructor, referral specialist and a clinical pharmacist. In the future, Gates said additional services could include chiropractic and dental care.
“This is an exciting moment. From the very beginning we’ve known this is the right thing to do for our patients, our physicians and our community,” said Ryan Gates, PharmD, Sequoia Health and Wellness Center’s Chief Executive Officer, who also serves as Director of Population Health Management at Kaweah Delta. “Our community wants and deserves outstanding health outcomes and needs greater access to physicians. Alongside our community partners, Sequoia Health and Wellness Centers will play an important role in helping us achieve both.”
Last April, Kaweah Delta applied for the former Family Medicine Clinic as well as its Urgent Care on Court Street to be FQHC “new access points” with the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services which oversees health care to medically underserved and vulnerable populations. Gates said Kaweah Delta’s application was not among the five awarded in California.
Now, Kaweah Delta plans to apply for the former Family Medicine Clinic to be a “look alike” FQHC. The designation would provide Kaweah Delta with many of the benefits of being an FQHC, such as the ability to employ physicians directly and student loan forgiveness and foreign visa programs, but would not come with the $655,000 grant to operate annually nor cost-based reimbursements, where centers can be reimbursed for the entire appointment instead of a flat fee that may not cover the cost of providing care to patients.
By not losing money on nearly three-quarters of the patients coming to these two clinics, CEO Gary Herbst told the Sun-Gazette last spring that one of the major hurdles for Kaweah Delta is its inability to employ doctors. California is one of five states prohibiting hospitals from employing doctors. The ban against the corporate practice of medicine (CPM) dates back to the 1930s when there was a growing concern over hospital administrators overriding physician decisions about patient care based on cost. The idea was that keeping doctors independent of hospitals would result in better patient practices. The California Supreme Court in 1932 determined that it is impossible to separate the regulated practice of care from the business practice because “either one may extend into the domain of the other,” according to a report by Health and Human Services. The report also cites a 1938 decision that letting a corporation hire and control physicians would lead to “divided loyalty and impaired confidence” between the interests of the corporation and the patient’s needs. The only exception to the rule in California are hospitals operated by the University of California, such as UCLA and UC San Francisco.
Now that the Sequoia Health and Wellness Center is operational, Gates said the nonprofit entity SHWC will submit its application to be an FQHC look alike on Jan. 17. HRSA will then plan an onsite visit in the late spring and provide SHWC 90 days to correct any issues it may have as a nonprofit clinic. The earliest SHWC could obtain an FQHC designation would be in July. Once approved, the nonprofit would then apply with the Calfornia Department of Health Care Services for the higher rate of reimbursement, which is often 33% higher than typical reimbursements for Medicare patients at public and private clinics.
Through the FQHC co-applicant model available to public entities, Kaweah Delta Health Care District will continue to own and operate the center, but it will be governed by SHWC’s 11-member Board of Directors, of which at least 51 percent are patients of the Center. Kaweah Delta would also not be the first public hospital district to journey into FQHCs. In 2013, Hi-Desert Medical Center applied to create a nonprofit arm to operate federally funded clinics and was awarded FQHC status.
Kaweah Delta is a publicly-owned community health care organization that provides comprehensive health services to the greater Visalia region and Tulare County. With over 5,000 dedicated medical professionals and employees, Kaweah Delta is committed to meeting the community’s health needs through state-of-the-art medicine, high-quality preventive services and specialized health centers and clinics. For more information, visit www.kaweahdelta.org.