cahaba MEDICAL CARE 2017 ANNUAL REPORT TABLE OF CONTENTS// caring for the generations 3 Caring for the Generations WHO WE ARE of our entire country. In 2017, there were 15 FQHCs that served 319,327 patients in the state of Alabama. Cahaba Medical Care is a Community Health Center (FQHC), accredited as a Patient-centered Medical To qualify as an FQHC, an organization must meet and Home (PCMH) by the National Committee for Quality maintain certain criteria as mandated by the federal Letter from the Director Assurance (NCQA) and Joint Commission, with sites 4 in central Alabama serving Bibb, Perry, Chilton, Dallas, government, including but not limited to: Autauga, and Jefferson Counties. Our health centers provide comprehensive primary care services including • Serve an underserved area or population as defined treatment and management of chronic diseases, pediatric by HRSA. 8 Grants, Publications & Presentations care, women’s health services, dermatological services, • Provide services to everyone regardless of ability to sports medicine services, mental healthcare and more. pay. • Offer a discounted sliding fee schedule for charges Additionally, we have the technology and staff to perform based on income and family size. on-site procedures including x-ray, laboratory tests, • Provide comprehensive services including primary 10 Facts & Services ultrasound, echocardiograms, women’s health procedures, care and have on-site or an arrangement with another prenatal care with local delivery and so much more. We provider for dental, mental health and substance currently have 50 primary healthcare providers, three abuse services. social workers, and a team of nurses and medical assistants • Be a non-profit organization, and operate under the Expansion of Services whose job is to assist our patients in becoming healthier 14 governance of a community-led board of directors, individuals. 51% of whom are patients of the clinic. SERVING THE UNDERINSURED & UNINSURED Cahaba Medical Care provides high-quality health Cahaba Medical Care is also the ONLY Teaching Clinical Staff & Services Update 20 services regardless of a patient’s ability to pay. We offer Health Center in the state of Alabama. a discounted sliding fee schedule based on income and family size. While this has been the mission of the clinic since its founding, these services have only grown through WHAT IS A TEACHING HEALTH CENTER? our designation as a non-profit, Federally Qualified Health The Teaching Health Center program is an innovative 24 Community & Outreach way of funding residency education that allows training Center (FQHC). This designation carries with it grant funding (and accountability) that allows us to enhance our of primary care residents to occur in community-based services to those without insurance and to those facing ambulatory care clinics instead of in large hospitals. For hardship – whether medical, social, financial, or emotional. CMC, this means Bibb County is serving as the training 30 Residency Program ground for twelve resident physicians who are learning how to take care of all patients - regardless of insurance status, WHAT IS A FEDERALLY-QUALIFIED financial status, or physical status. Nationally, the Teaching HEALTH CENTER? Health Center program supports the education of more The purpose of an FQHC is to enhance the primary care than 700 residents, with a focus on training them to go and 38 Global Impact services in underserved communities, in particular for work in areas with a shortage in physicians and medical the underinsured and uninsured. FQHCs operate under professionals, thus beginning to address the medically the supervision of the Health Resources and Services underserved communities throughout the United States. Administration (HRSA) and play a crucial role in the health County, Alabama in September 2003, I was well-trained in many components needed CHIEF EXECUTIVE OFFICER //// for a successful career in rural medicine, but in other ways I was thoroughly unprepared. This was most striking when I saw firsthand DR. JOHN WAITS the collision of real live patients with the logical effects and unintended consequences of our public healthcare policies. For the past 14 years I have lived into healthcare. I saw government and worked as a physician in rural intrusion as tainting what could It is a well-worn adage that the only year Bibb County, Alabama. otherwise be the “pure” economics harder than internship is one’s first year of Growing up the son of a surgeon of healthcare. practice after training. This is nowhere more and a teacher in Tuscaloosa, true than in an “underserved” area, where Alabama, it would be hard for me As a pre-medical student at the the ratio of patients to available physicians to argue that I was not born into University of Alabama, I had the and/or healthcare providers is quite high. I will ignore for the purposes of this privilege. I would like to contend privilege of spending the summer This was certainly true for me. reflection, the rural American equivalent of that, internally, I never took my of 1993 in Washington D.C. as #firstworldproblems like not having a Publix privilege for granted. However, an intern for a think-tank of the Even more profound than the work was the and having a much smaller Wal-Mart stocked reflecting on a childhood in the religious right. I was tasked to be philosophical and cognitive dissonance that with less nutritious options than the Wal- 1980s and collegiate years in the the intern / assistant to a leading occurred as early as my first week of seeing Mart in the neighboring cities; the lack of “I was well- 1990s, from the “Richter-scale-9” bioethicist and healthcare policy patients. I remember calling my father, and diverse after-school activities; the perceived year of 2017, I just don’t know expert in an effort to oppose observing, with emotional exhaustion, “there lower quality school systems, etc., because trained in many anymore. What I can say is that the Healthcare Reform being wasn’t a single patient that I saw today who at the end of the day, it is a 30-120-minute components it motivated me to work harder promulgated by the Clinton would have any benefit from a Medical inconvenience for middle and upper class Savings Account (“MSA”: the ubiquitous needed for and to prove myself worthy of my administration. At the time, I fully families to access these resources in nearby advantages. For “[w]hoever can be agreed with the logic not only of conservative financial tool of healthcare cities. Not in every case, but in most. The a successful trusted with very little can also be the promise of a free-market driven reform). contributory impact of these exact issues, career in rural trusted with much” (Luke 16:10, healthcare system, but of the ethics What I meant was that there was an however, on the inability to either recruit New International Version). of anti-entitlement, meaning the entire cohort of my neighbors who were or retain physicians and other professionals, medicine, but assurance that the healthcare unemployed, without a vehicle, and living healthcare or otherwise, is - or should be - in other ways I From this vantage point grew a system had mechanisms in place with food insecurity. What benefit were they a topic of active discussion amongst County going to reap from putting away, tax-free, was thoroughly bias - ubiquitous in white Alabama to keep individuals from taking Commissions, rural economic development and now ubiquitous in the advantage of healthcare providers, ~$2000+ from their non-existent paychecks, forums, Chambers of Commerce, and unprepared.” conservative, red-state ethos that insurers, and systems. to pay for healthcare? Mayors’ offices. informs so much of our policy - Somewhat embarrassing in retrospect, this toward personal responsibility. Despite an exceptional medical thought had not occurred to me in a decade What cannot be ignored in this discussion, school education at the University of thinking about healthcare reform. More however, is Medicaid. In high school, I was turned on of Alabama Birmingham, and telling is the fact that it was not taught to me Medicaid is a public insurance program that to the centre-right magazine, The a great internship / residency / from the many people I worked with as a is a Federal-state partnership. It provides a Economist. I wrote my senior fellowship at the In His Image “caveat” to the usefulness of the policy. Federal “match” to state legislature budgets paper on “Health Care Economics Family Medicine Residency in and state Medicaid offices, but in turn requires and Reform”, advocating for Tulsa, Oklahoma, I received little With this background that landed me “on certain core services, including healthcare for health savings accounts, as well as formal education or training in the the front lines” in an underserved rural area, children in poverty, pregnant women, those the reintroduction of more free- public policy aspects of healthcare. what does the rural healthcare crisis look like with disabilities, and the impoverished elderly market forces and less government Therefore, when I landed in Bibb from the vantage point of a patient living in in long-term care. a rural area? 4 CAHABAMEDICALCARE.COM 5 Notably absent in states such as Alabama hyperlipidemia, and diabetes and are delaying visits were performed each year, allowing for Fourteen years of practice has granted me a that have not “expanded” Medicaid - either thorough and effective care, thereby worsening diagnoses and treatment of chronic diseases, wealth of stories about rural healthcare, too voluntarily, in previous “expansion” programs, the state epidemic of myocardial infarction cancer screenings, and so many new patient- many to share here. They include how the or via the ACA expansion of 2009 - is the (heart attacks), congestive heart failure, and provider relationships. FQHC program allowed creation of Alabama’s dearth of coverage for so many who do not fall strokes.