MPCA News

Montana Community Health Centers (CHCs) Pitch In to Preserve Prenatal and Delivery Services

(L-R) Amanda Paulsen, Parker Paulsen (born 7/10/04), and Dr. Jana Peters, Lincoln County Community Health Center, Libby, MT

Maria Clemons, Executive Director of the Lincoln County Community Health Center says they almost lost prenatal and delivery services in Libby. "The two family practice doctors who provided the services felt that they could not continue to do so due to the escalating cost of malpractice insurance." she said. "We were in the process of recruiting another doctor and Dr. Tai, our Medical Director, thought it would be a good idea to sit down with the doctors from the private sector and discuss the situation as a community issue. We knew that we could put the private docs on contract and, if the contract was developed correctly, we could offer those services through them, and have them covered by the Federal Tort Claims Act."

The Federal Tort Claims Act, or FTCA, is a federal law which provides eligibility for malpractice liability protections to federally-funded Community Health Centers (CHCs), their officers, employees, and certain contractors. Basically, the federal government will represent the government's interest in any suit brought against the CHC. This allows the health center to use all of their grant funds to provide primary care services to their patients, as there is no need to set aside a large portion for malpractice insurance.

By hiring a family practice physician who also provided prenatal and delivery services, the CHC added another physician to the community who could help deliver the 90 or so babies per year. Jana Peter, MD, takes care of pregnant moms at the health center while the other physicians see the patients in their private practice. "It is just too far to drive to Kalispell (90 miles) or Spokane (120 miles) for pregnant women in labor. We had to do something to make sure they could have their babies here." said Clemons.

"It has worked out great," she continued. " All pregnant women who live in or come to Libby for care are now CHC patients and, therefore, have access to the sliding scale [discounts based on income]. It has resulted in expanded access and increased prenatal and postnatal care for all expectant moms because they come into the system earlier and stay longer. The patients have appointments with all three doctors throughout their pregnancy so they will have met the doctor who will deliver their baby."

The Lincoln County CHC worked with the Montana Primary Care Association and an attorney specializing in Community Health Center and FTCA issues to develop the contract. "We hammered it out," says Clemons, "It took some time, but everyone really wanted to make it work. And it does!."

Maria Clemons may be reached at 406-293-3755 or at maria@lcchc.org.

Meanwhile, in Cut Bank, John Maher, Executive Director of the Glacier County CHC tells a different, but equally compelling story.

The Glacier County CHC was funded in late 2003 and was scheduled to begin seeing patients in early 2004. As the director of a newly-funded CHC, Maher was in the process of recruiting medical providers to staff the clinic. He had interviewed several and was finalizing contracts when he was contacted by administrators from the local hospital/rural health clinic which was going through a period of financial difficulty.

The hospital was interested in keeping the doctors who were on its staff in town, but also, looking for ways to cut costs. They proposed that Maher consider hiring some of the doctors to staff the new CHC. Talks between the administrators from both entities and the doctors ensued. The end result was that the family practice doctors who were delivering babies went to work for the CHC. The hospital/rural health clinic continues to employ the other physicians.

"The babies are still delivered at the hospital," says Maher. "So the hospital kept that revenue. But the hospital does not have to pay the salary of or purchase malpractice insurance for the doctors we hired. Those doctors who now work for us are covered by FTCA. This decreased the hospital's overhead. It also helped to build our CHC practice. We went from 5 to 30 visits per day. All pre and postnatal care is provided at the Glacier Community Health Center. "It was a win-win-win," says Maher, "The hospital won by reducing their costs and keeping an important revenue stream. The doctors won because they can continue to practice as before, and the patients and community won because the doctors were able to stay here." When asked if the move was difficult for the patients, Maher responded, "No. Patients relate to providers, not facilities."

Montana Primary Care Association 1805 Euclid Avenue Helena, MT 59601 Phone: (406) 442-2750 Fax: (406) 449-2460