How Field Clinics Reduce One Hospital's ED Strain

Amidst fields of cotton, cabbage, and other northeastern North Carolina crops, volunteer nurses and others set up camp to provide services to the area's migrant and seasonal farm workers. They arrive in the evening, just as the workers are coming out of the fields, with care tables and coolers of ice water and snacks, standing ready to monitor blood pressure and glucose levels, run TB skin tests, or perform rapid HIV screenings.

According to an HHS report released this week, uninsured families can only afford to pay in full for about 12% of hospital stays, resulting in tens of billions of dollars worth of uncompensated care each year.

Elizabeth City, NC-based Albemarle Health is no exception: According to its 2010 annual report, it provided nearly $27.5 million in unreimbursed community care.

Rural hospitals and health systems throughout the country face this same challenge, and the best solutions are unique and based on the specific needs of the regions that they serve.

"We're constantly assessing what's going on in the community and figuring out, 'How can we address it?'" Nancy Easterday, RN, MBA, executive director of safety net clinics at Albemarle Health, said in an interview. "Northeast North Carolina is very rural, very agricultural, has limited access to four-lane highways. We're either covered by farmland or swampland, and that definitely affects our programs and services."

Albemarle Health serves people across a 1,947 square-mile swath of one of the country's poorest regions. While a portion of the community is made up of migrant and seasonal workers, others are uninsured permanent residents without access to primary care. Supported by grants and donated healthcare services, Albemarle Health and its Albemarle Hospital Foundation is trying to confront those issues and improve the health of its community—as well as its own bottom line.

Problem: Migrant and seasonal farm workers across nearly 2,000 square miles.

Solution: Although there are programs serving migrant and seasonal farm workers throughout the country, Easterday says theirs is unique in North Carolina. Beginning last year, Albemarle Health started delivering healthcare directly to the workers, setting up field clinics about once a week during the growing season, which runs about May-November. She says whereas other programs provide workers with transportation to health clinics, Albemarle's large geographical area makes doing that impractical.

Since workers don't typically get out of the fields until 6 or 7 pm, "if we were giving them a ride to the clinic, it would be 8 or 9 o'clock, and that's just really difficult," she says. Instead, Albemarle staff perform health screenings in the field and provide needed follow-up care, such as giving free medication or even facilitating surgery, like they did for one worker with an abdominal hernia. "We were able to get him into a local surgeon right away," Easterday says.

Problem: Uninsured and low-income population

Solution: Albemarle Project Access was introduced in September 2010 in an effort to increase access to primary care and specialty services. The program uses physicians who actually volunteer their services to care for patients. Some physicians pledge a number of visits, others a dollar amount. During the first six months of the program, physicians—many of whom are not employed within the Albemarle system—provided $90,000 of donated services. In addition to reducing the strain on the Albemarle ED, the program also links patients with other resources; for example, it might help patients realize their eligibility for and enroll in Medicaid or disability benefits.

One patient who repeatedly visited the ED with dental issues was able to received donated treatment from an oral surgeon. Another was able to receive treatment for colon cancer, which otherwise would have likely gone undetected for a long time. Easterday says the program should reduce at least some of the strain from patients arriving at the ED with minor medical problems. "It can't fix the entire issue," she says. "But it certainly makes a difference."

Healthcare leaders: we'd love to hear from you. What are some of the ways you are confronting the unique care challenges that face your organization?