The Clinic Today

St. Thomas Community Health Center is among the largest and most comprehensive Primary Care facilities serving both insured and uninsured patients in the New Orleans area. St. Thomas CHC has a full time staff of Internal Medicine and Pediatric physicians as well as Nurse Practitioners. Currently, our hours of operation are from 8:00 a.m. until 5:00 p.m. on weekdays, with evening appointments for mammography, and group and specialty clinics on Saturdays. The clinic offers a full range of prevention and primary care services. We also house the CDC-supported Louisiana Breast and Cervical Cancer Early Detection program which offers both screening and diagnostic mammography, culposcopy and surgical consultations. Specialty consultations in Rheumatology, Pulmonary, Cardiology, (including non invasive cardiac testing), Optometry, and Nephrology are available. We accept selected medical students and individuals from the resident training programs at Louisiana State University and Ochsner Clinic Foundation who wish to gain experience in community clinic medicine. We have four full time Primary Care physicians, (3 Internal Medicine specialists and one Pediatrician), and with specialty consultants from several academic centers. We have specialty consultants from LSU School of Medicine in Rheumatology and Pulmonology, and for Cardiology consultations we have Cardiologists from 2 major community Cardiology programs.

Ongoing Challenges

After Hurricane Katrina, a significant number of physicians left the community, leaving many patients without their usual medical home. Thousands of people lost the jobs that had provided health insurance. Today, the major "safety net" health provider, the Medical Center of Louisiana at New Orleans (MCLNO), has re-opened but offers limited primary care and subspecialty care.

Since the re-opening of St Thomas clinic in October, 2005, the clinic has provided ongoing comprehensive primary care, but we have also more and more begun to function as a "safety net" clinic for patients without insurance who are referred from area emergency rooms, or who are unable to be seen in a timely fashion in any of the few other primary care sites. We are working hard to improve our efficiency to be able to provide more and more availability of care to these individuals, who have few other options. In this endeavor to improve our systems and operational efficiencies, we have received significant administrative support from the St Charles Community Health Center, and the Blue Cross Blue Shield Foundation of Louisiana.

At least partly because there are very limited sites for mammography, and many patients are self-referred for suspected abnormalities, the incidence of breast cancer detected has been much higher than usual per number of women screened. Arranging follow-up treatment for uninsured women with breast cancer is another of our major activities. We have been supported in this care by grants from the CDC and from foundations such as the Komen Foundation, the Cancer Research and Prevention Foundation, and others.

Most of the patients express feelings of grief and anxiety; many are referred to mental health providers. We believe health care will be affected for decades as the sequelae of Katrina unfold. We are in the process of remodeling space, and developing the best evidence-based practice models for dealing with the community mental health issues in a culturally sensitive way. Several academic centers and agencies with expertise in these areas are consulting with us. The Episcopal Dioceses of Louisiana, and of Southwest Florida have supported us generously as we develop this program.

Sustainability

Over the years, St Thomas has been an independent, not-for-profit clinic. The majority of patients have little or no insurance. Being independent has given the clinic the opportunity to be flexible and quickly responsive to community direction and needs. Independence has also meant ongoing challenges to financial security and sustainability. Revenue generation, grants, and donor contributions remain critical. Cost effectiveness and efficiencies are constantly reviewed.

There are several strategies that are promising for revenue generation. Installation of the electronic record with scheduling and billing will enhance reimbursement and efficiency of provider utilization. With many physicians gone, subspecialty care is quite limited in the city. The clinic is fortunate to have subspecialists in Cardiology, Pulmonary, Rheumatology, Gynecology and Optometry. All this care is offered without regard for ability to pay. However, we do seek all appropriate reimbursement where available, and our patients are expected to contribute what they can according to a sliding scale of charges based on Federal Poverty Guidelines. It is hoped that the revenue from insured patients will substantively help support the unfunded or underfunded services.

Grant writing activities remain a priority.

Federal grants, in the form of Social Service Block Grants, and recently announced Health and Human Services grants to our region will also help sustain our services at present. In the future, i.e. 5 years or so, there will be a better defined source of funding for the uninsured in Louisiana. It is the time from now until that funding is defined and established that St Thomas Community Health Center for which has to develop strategies.