The Near West Side T. McCafferty Health Center is a Jewel in the Health Care System for the poor, uninsured and underinsured
By Hugo Urizar
(Cleveland, OH - May 29, 2009). The City of Cleveland Department of Public Health issued a Request For Proposal (RFP) on April 13, 2009 to independent health providers to operate and manage the city’s three public health centers, Thomas F. McCafferty, J. Glen Smith and Miles-Broadway.
The proposal went to the Cleveland Clinic, MetroHealth, University Hospitals, St. Vincent Charity Hospital, Neighborhood Family Practice, Care Alliance and Northeast Ohio Neighborhood Health Services (N.E.O.N).
According to the RFP, “The goal of the City of Cleveland is to provide uninsured and underinsured Cleveland residents with access to a full scope of high quality primary care services through the expansion of services at the city’s health centers. This initiative is designed to incorporate the city’s health centers into Cleveland’s health care safety net as fully-functioning primary health care providers with expanded hours to meet the growing number of uninsured and underinsured Clevelanders.”
The people who understand the delivery of health services to the inner-city poor, uninsured, underinsured, and to the linguistically and culturally different segment of the population believe that the McCafferty/MetroHealth Center is doing a superb job in delivering those services. Some of them go as far as calling it, “The Health Care Jewel in the Near West Side of Cleveland.” And here is why:
In 2008, the Thomas F. McCafferty/MetroHealth Center provided services to more than 41,325 people.
Two Pediatricians and one Pediatric Nurse Practitioner with a combined experience of more than 70 years attended to 8,672 visits in 2008.
A bilingual staff has been providing a continuity of Comprehensive Primary Care Services to persons of all ages since 1970, supported by bilingual social workers (LSW and LISW) for family assessments and complex issues; all of this and keeping same day or next day appointments almost always available.
The center also provides the services of a Legal Aide Society lawyer particularly focused on obtaining rightful education services for children failing in school or with developmental delays. Additional legal services are also available regarding immigration, domestic violence, and many other issues.
One of the two OB/GYN physicians at the McCafferty/Metro Clinic is bilingual, and together they have provided services to more than 5,833 patients in 2008 through the Well Woman/Preventive Care Program. The patients in need of surgeries are sent directly to MetroHealth. Among the services provided by the Gynecological & Obstetric Care Department are: IUD placement, walk-in pregnancy testing, colposcopy (for abnormal pap smears), endometrial biopsies, low risk prenatal care done by bilingual family practice physicians, higher risk evaluations by OB/GYN specialists and direct referrals to High Risk OB Clinic Facilities, screening of all pregnant teens and women for social and medical risks including domestic violence, drug use, and housing needs. Working with a Licensed Independent Social Worker, community volunteers provide each newborn with blankets, car seats, lotions, and clothing. In addition, the Center has various contraceptive methods available to low income women free of charge through a targeted program.
The Family Practice is staffed with six bilingual Spanish/English physicians who treated 17,749 patients in 2008, including 1000 walk-in visits. They have been providing Intergenerational Primary Care for 18 years. Additional services include: Low risk prenatal care, on-site blood drawing, EKGs, walk-in pregnancy testing, diabetes checks, blood pressure screenings; HIV testing and anti-retroviral treatment; and acute and chronic disease management. Medication access programs are available in addition to MetroHealth pharmacy services, which provide affordable medications to patients in the MetroHealth Community Discount Program at much reduced prices. Urgent visits are available daily. Five of the six physicians also work at MetroHealth hospital; all offering seamless transition services from the doctor’s office to the hospital and rehabilitation, to nursing home and home care, supported by a bilingual Licensed Social Worker specializing in geriatrics.
The Pride Clinic provided services to more than 348 patients in 2008 through its Med Peds/Family Practice Primary Care providers. The Clinic, which is focused on gay, lesbian, transgender, and bisexual persons and their families, also provides care in Spanish.
Internal Medicine Sub-Specialists at the Pulmonary Department of the McCafferty/Metro Health Center were able to provide services to more than 483 patients during 2008. Services ranged from smoking cessation to evaluation of chronically ill persons with respiratory diseases - such as chronic obstructive pulmonary disease, asthma, and sleep apnea. Pulmonary function testing is done on site. Follow-up specialty care is available at the MetroHealth main campus.
There were 114 visits in 2008 at the Center that required the services of an Internal Medicine Sub-Specialist in Cardiology. The Center provided a bilingual Spanish/English specialist, testing and follow ups at the main campus. Other services included: Evaluation of cardiovascular diseases of person’s referred by Family Practice and OB/GYN physicians, EKGs done on site, referral for additional testing at main campus by the same bilingual cardiologist, who is also a specialist in arrhythmias.
Mental Health: Primary Care providers routinely diagnose and treat depression, anxiety, Attention Deficit Hyperactivity Disorder; and assess a wide range of disorders such as Post Traumatic Stress Disorder and psychoses. Crisis management coordinated by physicians, social workers, and security personnel is practiced and implemented as needed. Complicated and seriously troubled individuals are referred to MetroHealth Department of Psychiatry and to community agencies for psychiatric services and continued case management as needed. Other individuals and families are referred to community agencies and programs for counseling, parenting programs and educational services.
Financial Counseling: MetroHealth Community Discount Program provides comprehensive medical care at very affordable rates to the poorest people in the community. Bilingual counselors interviewed 7,496 persons/families in 2008 for this program.
One group that will suffer greatly from a change in management will be the large number of Hispanics that are not very proficient in the English language and who are using the clinic services on a regular basis.
The reason that many Hispanic community leaders worry about the recent request for bids issued by the City of Cleveland on providing health care at the McCafferty Clinic is that the clinic is actually providing services that no one else is likely to provide to a large number of people in the community, many of which are Hispanics, and most of whom are residents of the City of Cleveland.
Many people familiar with the quality and quantity of services provided by the McCafferty-MetroHealth Clinic think that a change in management at this point in time could disrupt services and unnecessarily break up a team of bilingual professionals that has been together for more than 18 years. "It took lots of effort and a considerable amount of time to put this team together,” said a staff person of the clinic. “This team enables the clinic to provide intergenerational care to extended families.”
Specifically, the clinic provides bilingual (English/Spanish) primary care and OB/GYN care, including 24 hour on-call coverage in Spanish. All six Family Physicians, an obstetrician, cardiologist, a med/peds provider, two highly trained social workers, seven receptionists, five nurses, a medical technical assistant, three financial counselors, the medical records manager, a security guard and a Legal Aide attorney are all Spanish speakers.
It is estimated that more than 50% of the patients at the clinic are Hispanic and 1/3 of them speak Spanish at their medical appointments. Out of this population, 25% use the MetroHealth Community Discount Program, which provides a doctor visit, lab, radiology, emergency, inpatient, and surgical care for almost free to persons at 100% of the poverty level or less; and this accounts for about 1/5 of all the clinic patients. Research shows that while other hospitals claim to provide discounts, it is often only a doctor visit discount, while other services are limited.
If the present structure in place at the McCafferty/MetroHealth is forced to move out and another entity moves in, it is not likely that they will have the same team composition to service the people who now find comfortable access to McCafferty, including free parking. If new service providers are not affiliated with a hospital, then comprehensive care from clinic to hospital to rehab center or nursing home will be lost.
The McCafferty Clinic team mentioned above will have to be divided because there is no facility large enough to hold them together. Again, patient care will be disrupted. Many of the 10,000+ people (out of 40,000+ visits a year) have serious chronic diseases and rely on the clinic to be available daily. Moving the clinic and reducing services will cause some on the discount system to lose their coverage; and some will become seriously ill with illnesses the clinic could have prevented or treated. The 100 walk-in patients the clinic services each month will most likely end up at MetroHealth Emergency Room. This is precisely what the City of Cleveland Request For Proposal is trying to avoid.
The City of Cleveland Department of Public Health Request For Proposal (RFP) also says that: “A critical component to the partnership is collaborating to upgrade and enhance each of the buildings.”
The City of Cleveland has three Health Centers. MetroHealth had a moderate sized practice at the Miles-Broadway clinic. In 2005 MetroHealth built a new and now busy clinic at E. 71st and Broadway. Metro has a small primary care and OB/GYN practice at the J. Glenn Smith clinic, but did not bid on providing vastly expanded services there as requested in the current proposal. Metro did bid on the McCafferty clinic because Metro provides most of the services requested by the RFP.
Most people agree that the McCafferty/MetroHealth partnership is doing an excellent job in servicing the health needs of a distressed community and that it is a good example of how governments - County Hospital and the City of Cleveland - can work together. Metro has not had a formal lease with McCafferty for years and pays no rent. In exchange, MetroHealth provides all the services mentioned in this article, and more.
MetroHealth does pay for some renovations to the McCafferty Health Center, but does not cover all of the building repairs that are needed.
When McCafferty patients were asked, they overwhelmingly prefer the excellent services they receive at the McCafferty Clinic.
The City of Cleveland Health Commissioner Karen Butler said that the city would not save any money on the new project. Instead, it would be “cost neutral.”
Most Hispanic Leaders interviewed for this article want “the jewel of the health care in the Near West Side of Cleveland to remain under the present partnership, McCafferty/MetroHealth.”