TennCare cuts threaten clinics' well-being. - The Knoxville News-Sentinel (Knoxville, TN)

Byline: Kristi L. Nelson

Jun. 13--On some mornings, they start lining up before sunrise.

Folks are always waiting in line when the doors of Volunteer Ministry Center's People's Clinic open, said Ginny Weatherstone, VMC executive director. Sometimes there are too many for the volunteer practitioners to see in one day.

As TennCare cuts raise the number of uninsured, Weatherstone fears those clinic lines may swell into waiting lists weeks long -- or worse, force the acute-care clinic to permanently turn people away.

'We are going to be turned into a primary-care facility whether we want to or not,' she said, 'and we're not set up -- or funded -- to provide more care.'

VMC, which operates several programs for Knox County's homeless, opened the clinic, 410 W. Jackson Ave., in 2003. Its mission is to take care of immediate medical and mental needs, then act as a 'bridge' to move people to TennCare or other assistance by referring them to the Knox County Health Department and other providers, Weatherstone said.

In the clinic, furnished almost solely with donated equipment, certified nurse practitioners Mary Kollar, Peggy Pierce and Judy Whedbee and their nursing students see patients Tuesdays and Thursdays.

Supervised by Dr. Daniel Ely, the nurses treat everything from sprains, rashes and parasites to diabetes, hypertension and other chronic health problems. Because many homeless clients take shelter in old buildings, brown recluse spider bites have been common, Kollar said.

Nurses pull prescriptions from a 'pharmacy closet' stocked with samples donated by doctors and drug companies. The clinic also tries to provide some over-the-counter staples like Tylenol, cold medicine and sunscreen. If necessary, VCM will buy medicine for a client, which is a budgetary hardship, Kollar said.

Lab work is done in-house or prorated by the University of Tennessee Medical Center, and some local specialists see the clinic's referrals free for specific needs.

The clinic also operates a free Saturday morning behavioral health clinic, which offers both counseling and medication, and a free Friday morning dental clinic, unique in the area for also providing dentures, plus a monthly Spanish-language clinic that serves local Hispanics, largely seasonal workers.

When possible, after taking care of acute medical needs, VMC helps eligible clients apply for TennCare. Some refuse; common reasons are distrust of bureaucracy or lack of identification, Weatherstone said. The clinic doesn't require patients to have ID.

Weatherstone has spent years worrying about VMC's clients. Now she's getting worried about a new group of potential clients: people 'one step above' being homeless, working but poor, who are about to lose TennCare.

Kris Cook, 33, works at VMC and lives in its Jackson Apartments, one-room efficiencies for formerly homeless men. Cook got on TennCare four months ago, after moving to the state to find treatment for his epilepsy. TennCare picks up Cook's doctor visits and two anti-seizure prescriptions. The medical care, he said, 'is a lot better than what I got in Illinois.'

Last week, Cook received a letter that said he'll be dropped from TennCare. He doesn't know how he'll buy his medications, which top $200 a month, if he's not eligible for government assistance.

Other area clinics are 'expecting to be inundated' with former TennCare patients, said Nina Bowling, development director for InterFaith Health Clinic, which sees uninsured patients on a sliding scale. More than 90 percent of the 6,300 patients InterFaith saw last year needed at least one prescription, Bowling said.

'Using us will give people a primary health-care 'home' to manage chronic illness,' Bowling said. 'You can't manage chronic illness out of an emergency room,' where people will go, at greater expense, if InterFaith and other clinics are full.

New patients have to wait 21/2 months for an appointment, Bowling said; Interfaith has the space, but not the money, to increase its patient load. Funded half by community and local hospital support, half by grants and patient fees, InterFaith will apply to get some of the estimated $100 million the state says it will set aside for 'safety-net' providers, Bowling said.

Cherokee Health Systems, which operates 20 primary-care and behavioral-health clinics in 11 East Tennessee counties, also will apply for state safety-net grants, said its CEO, Dennis Freeman. Cherokee gets some federal funding, but more than 90 percent of the nonprofit's income is from patient fees and insurance payments. Like other providers, it will lose reimbursement on TennCare patients who become uninsured patients.

'Our projection is that somewhere around 8,000 people that we saw last year might lose TennCare,' Freeman said. Adding that to the 7,000 uninsured clients Cherokee saw last year will more than double the number of uninsured clients by next year, he predicts.

Freeman hopes attention on people losing TennCare will prompt state leaders to find a permanent solution for providing health care to the uninsured. He said Gov. Phil Bredesen assured safety-net task force members that the state would continue to fund the safety net after the initial $100 million is distributed.

TennCare clients made about 40 percent of the 18,000-odd office visits to Blount Memorial Hospital's Good Samaritan Clinic last year. The sliding-scale clinic has been bracing for the loss of some clients' TennCare coverage, said hospital spokeswoman Gina Stafford. Last year, Good Samaritan closed its financially burdensome dental clinic, and this year it closed to new adult patients except hospital/health department referrals. The clinic also will apply for state safety net money, Stafford said.

Weatherstone worries that the People's Clinic and other providers won't form a large enough net to catch all the people about to fall from TennCare rolls. To serve more patients, she needs volunteers, medications and money, and she's not sure the state's planned safety-net budget is sufficient for all the clinics that will be clamoring for funds. Still, VMC will apply, she said.

'I hope the money comes before the people do,' Weatherstone said.

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