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By Deandra Williamson
Point Park News Service
For the past 30 years, the East Liberty Family Health Care Center, a federally qualified health center, has been a clinic that offered free medical care to those who could not afford it.
Due to the Affordable Health Care Act, by 2014 the income cutoff for medical assistance will increase and according to Executive Director Dr. Eileen Boyle, it is estimated that there will be up to 11 million more Medicaid enrollees in the United States by 2014.
As a result, the East Liberty Family Health Care Center expects an influx of thousands of patients in 2014 when the law becomes fully effective.
“Each state has the option to increase this threshold or forego certain federal dollars for medical assistance, so it will vary from state to state,” Dr. Boyle said during an interview.
According to Dr. Boyle, in the Massachusetts model that was used to create the Affordable Health Care Act, also known as Obamacare, it was discovered that when everyone had insurance it did not necessarily guarantee access to healthcare; there actually was more of a need for federally qualified health centers and community health centers.
Obamacare will hold the East Liberty Family Health Care Center and other federally qualified health centers accountable to carry out the national standards for quality and the cost effectiveness of care, with incentives aligned toward pay for performance, rather than pay for the amount of patients seen.
Most of the patients at the East Liberty Family Health Care Center are from the east end of Pittsburgh and approximately 70 percent of the patients are living below poverty level.
The Center is a religious based organization with a mission to provide quality, whole person, and community centered care to all, especially to the uninsured, underinsured and underserved.
“In the last year, 20 percent of our patients were uninsured and another 40 percent were on medical assistance,” Dr. Boyle said.
The Center serves a very needy population and provides healthcare to everyone regardless of their inability to pay because many people are uninsured and do not have access to healthcare. Even if they do have coverage, it is not always enough for their medical needs.
As a requirement by the Affordable Health Care Act, the East Liberty Family Health Care Center as well as all other federally qualified health centers and community health centers are required to certify as a patient centered medical home by 2014.
Such health centers are also required to implement an electronic health record.
The East Liberty Family Health Care Center is already certified as a level one patient centered medical home and implemented a new electronic health record in June 2012.
As a healthcare center, people are never turned away and Dr. Boyle explained that presently some people have barriers to healthcare because some may have insurance but it does not necessarily cover the care that the person needs.
“We deal with that all the time, where our patient comes in and I recommend something that I feel is medically necessary and their insurance company will say we’re not disputing whether it’s medically necessary, we’re just saying that we won’t pay for it,” Dr. Boyle said.
Under Obamacare no insurance company would be able to refuse to provide coverage or renew policies because of a person’s pre-existing condition. Also, the law will not allow insurance companies to charge higher rates due to gender or health status.
The Center has three locations, East Liberty, Lincoln-Lemington and Hosana House. It is a family practice, which cares for people from birth to death.
Gynecological and Obstetrical services are provided to pregnant women and there are several family practitioners who do prenatal care and deliveries at Magee Hospital. The staff also includes a pediatrician and a pediatric nurse practitioner.
Several outreach programs are offered to patients as part of the services provided at the East Liberty Family Health Care Center.
The Pediatric Outreach serves approximately 200 families with more than 600 children. The Pediatric Outreach Coordinator visits mothers in their homes to educate, encourage, support and help them manage the health and psycho social needs of their infants and children.
People who are struggling with drugs and alcohol addiction can get help through the Drug/Alcohol/HIV Outreach. Specialists offer addiction recovery support to addicts in and out of recovery and referrals are also made.
Community workers are sent to the streets of East Liberty every day to help the addicted to find recovery, treatment, community and hope.
Through Homebound Elderly Outreach, a team of homecare nurses and assistants go out to visit homebound elderly patients who would normally not be able to come to the office for care. The doctors would also go out and do home visits with these patients as well.
The Center also has benefits eligibility counselors who work with the uninsured to try and help them to apply for benefits or insurance that may help them get their healthcare.
“So we do a lot of outreach and try to help people where they’re at, rather than expecting them to come in or seek us,” Dr. Boyle said. “We try to go to where they are and meet their needs.”
The East Liberty Family Health Care Center also serves insured people and half of the budget is raised through patient revenues, which comes from insured patients who are billed for their services.
“Patients who do have insurance and come in for care and even self paid patients are asked to contribute something towards their care but it’s based on a sliding scale,” Dr. Boyle said.
The budget for this year is approximately $6.2 million.
Dr. Boyle added that any patient who lives below a certain part of the poverty level is offered a discount but they are still asked to contribute something towards their care.
The other half of the budget, $2 million, is raised through contributions from individuals, from churches, and also from foundations. This kind of funding is actively sought because there is a patient care fund for patients who do not have any kind of health insurance.
As a federally qualified health center, a federal grant of approximately $1 million is given and that money is intended to enable the East Liberty Family Health Care Center to provide healthcare to patients who would otherwise not have access.
The staff and practitioners at the Center are a part of the organization because of their call to serve those who are underserved.
“It’s really more than just a job it is a ministry to be able to meet the needs of people who may not have a lot of other options for care,” Dr. Boyle said.
The relationships with the patients are very important and Dr. Boyle, who has been working at the Center for 26 years, has patients that have followed her for her entire career.
“There may not be a cure of their diabetes or their hypertension but there is a trust and a lot of healing in that trusting relationship between the providers and the patients,” Dr. Boyle said.
Most of the patients at the East Liberty Family Health Care Center are pleased with the services they receive.
When Shimmie Mutombo moved to Pittsburgh from Africa, her husband became ill and he had no insurance. He became frustrated because he needed to take medical tests for STDs and HIV. Shimmie found out about the East Liberty Family Health Care Center and she took her husband there and they both loved the service they received.
Shimmie, who is now a receptionist at the Center, said that her husband only had to pay $15 fee to see the doctor.
Another satisfied and insured patient is Andrew Davis. He suffers from diabetes and said that he also loves the East Liberty Family Health Care Center.
Davis agreed that the service and the doctors are excellent.
“They stay on your case if you’ve been messing up and not eating right and they try to keep you as healthy as possible,” said Davis.
According to Dr. Boyle, there are some insurance providers that do not accept medical assistance as insurance, so there would still be a great need for healthcare centers like the East Liberty Family Health Care Center when Obamacare becomes fully effective.