June 19, 2018
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Group continues push for federally funded Knox County health clinic

By Stephen Betts, BDN Staff

ROCKLAND, Maine — Proponents of a federally funded health clinic for low-income residents say the need for one still exists in Knox County, although one of them acknowledged that changes made by local physician practices have helped patients.

A long-awaited report concludes that more information is needed before a decision can be made on whether a federally subsidized health clinic would be feasible in Knox County.

The need for the clinic has been diminished somewhat, according to the report, by local physician practices affiliated with Pen Bay Medical Center taking new patients and the expansion of hours of those practices.

The report by Shrum Associates was commissioned by Penquis, which received an $80,000 federal grant in 2011 to assist in the planning and development of a federally qualified health center on the mainland in Knox County. The center would be an around-the-clock clinic aimed at serving the needs of low-income Knox County residents.

There is already one such clinic in Knox County on Vinalhaven.

Penquis obtained the planning grant after a large study released earlier in 2011 by three of the state’s largest health care organizations — including Pen Bay’s parent corporation, MaineHealth — found the need for a center to improve access to health care.

The report released last week found that more information was needed.

“We believe additional analysis is required in order to establish a clearer view of how financially viable a federally qualified health center in Knox County might be, and how the possible clinic locations and service area might be best defined to contribute most robustly to that vitality,” the Shrum report concluded.

The report notes that Pen Bay has taken steps since the report was commissioned that have increased access to health care.

A year ago nearly all of the physician practices under the umbrella of Pen Bay were closed to new patients. The new hospital chief executive officer, however, found that those physicians were working well below capacity and have since opened them to new patients, according to the report.

Pen Bay also had practices open at 7:30 a.m. and added weekend hours. The hospital reported a 25 percent reduction in children visiting the emergency room during the past six months after the schedule changes at the physician practices.

Dr. Paul Klainer, however, said despite those changes there is still an absolute need for the clinic.

He said that when Pen Bay became part of the MaineHealth corporation it tightened the income level for people to be eligible for free or reduced care from 200 percent of the poverty level to 170 percent. This has resulted in fewer people qualifying, he said. The federal poverty level for Fiscal Year 2013 is $11,170 for an individual and $23,050 for a family of four.

In addition, dental care and mental health care are not covered adequately under existing programs, the doctor said.

Klainer is the volunteer medical director of the current Knox County clinic, but that has only limited hours (6 p.m. to 9 p.m. on Wednesdays). It also has days on which dentists volunteer their services for low-income patients with no insurance.

“We’re a Band-Aid, but we need a solution,” Klainer said.

He said there are challenges in moving forward with a clinic that would be open 24 hours a day, seven days a week, but he felt it could be achieved. The current clinic is provided space in the Bok building in Rockland owned by Pen Bay Health. Klainer said Pen Bay has cooperated with the organizers looking at creating a clinic. He said that the clinic envisioned by the steering committee would also need a brick-and-mortar location.

The report notes, however, that Pen Bay’s chief executive officer was concerned about the potential impact of a federally funded clinic on Pen Bay’s private practices and that additional analysis was needed.

Klainer said the steering committee received exciting news this week that the federal government has agreed to accept applications for new sites for federal clinics.

The financial viability of a health clinic in Knox County would be uncertain, according to the report. Of the 11 federal health clinics in Maine, only three are profitable, according to the report.

In Knox County, only 48 percent of residents have private insurance. Another 19 percent rely on MaineCare, which serves low-income residents, another 19 percent receive Medicare, which serves older residents, 2 percent receive military health care, and 12 percent have no insurance.

The report also noted that another major uncertainty about the success of a health clinic is the impact of the federal Affordable Care Act. The act will provide tangible and measurable relief to Maine families, according to the Kaiser Family Foundation.

The study commissioned by Penquis notes that the best options include linking with an existing federal health clinic. For Knox County to have its own clinic would require a special designation from the governor of the need for such an operation based on a high percentage of residents being underserved for health care. That effort would be uncertain and could take up to two years, the report notes.

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