As Florida reels from the medical and economic impact of coronavirus, community health centers across the state are preparing for an influx of new patients on two fronts.
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“I heard someone describe the community health centers as being the Tuskegee Airmen of the health care system,” said Dr. Temple Robinson, CEO of Bond Community Health Center in Tallahassee. “Providing cover, if you will, to the emergency rooms and the hospitals.”
Robinson said community health centers — a safety net for people who are uninsured and underinsured — are not only expecting to identify and treat patients with coronavirus who can be cared for outside of overburdened hospitals, but they are also planning for a longer-term need for services among Floridians who now find themselves unemployed.
Robinson spoke with WLRN about how community health centers are responding to the pandemic and what they need today from lawmakers. Below is a lightly edited transcript of that conversation:
WLRN: We had more than 74,000 Floridians apply for unemployment benefits last week. The American Hotel And Lodging Association estimates we've lost around 400,000 hospitality jobs just related to our hotel industry in Florida. How are Florida's health centers preparing for all these people who are now unemployed, possibly newly uninsured, and more vulnerable than ever as coronavirus is spreading in our communities?
Dr. Temple Robinson: We are very concerned about the influx of newly unemployed people who will not be able to afford COBRA insurance, who may not fall into any other kind of funding category to help them get health insurance. And they are going to be at our door and we'll have them open.
We're working very hard not to lay off staff ourselves because we also have a business to run. We're hoping that we will not have to lay off any staff. We're looking to get the supplies that we need from sources, very unusual sources, if you will. We have medical centers ordering supplies from Amazon. We're flexing the hours of service based on when people need to see us. We have people such as dental hygienists — who can't work now because we're not doing any services that require a lot of PPE [personal protective equipment] or any elective services — now working as front desk or helping on the medical floor.
Are you going to be eligible to receive any of the money that is earmarked for health care in the federal rescue package?
Yes, we will receive some of the stimulus money. But despite this, the stimulus money, the influx of new uninsured patients is going to require additional funding. We are very fortunate that we were included in the package, but we're going to need much more money than this because we anticipate probably doubling our census—the number of patients that we care for. And these people will be uninsured. So you're talking about access to affordable pharmaceuticals, discount laboratories, medical services, dental services.
And when this COVID crisis is over, we would like to now retain these folk as our patients. They would need to come to us because a lot of them would not go back to the same work that they had.
You potentially have a population of people who haven't interacted with community health centers before. What can they expect?
A lot of people think of a community health center and they think it's some type of clinic. It's a vaccination, immunization clinic, or a VD clinic, or an HIV clinic.
But when they walk into a community health center, they will realize this is comprehensive care. You have primary care providers such as family medicine, internal medicine, OBGYN, pediatricians, then you have dental departments under the same roof. You have mental health and behavioral health services. … People who have never accessed a community health center will be pleasantly surprised that it is all-inclusive and comprehensive.
And the other services are things such as case management if you are laid off and you need someone to help you negotiate your rent, or legal aid, or keeping the lights on, or child care services. New people now are going to have to figure out things they've never dreamed of before.
And to clarify, you do take insurance, right?
Yes. But for insured patients, we couldn't take take care of the uninsured patients. A lot of people think that community health centers are fully federally funded. That is not the case. The federal government supports us and we benefit from that support, but most community health centers, federal funding only covers anywhere from 12 to 20 percent of their operating budget. So without the insured patients, we could not do what we do.
You're in Tallahassee. In your line of work you pay attention to how policy affects your patients. What do you think state lawmakers need to be doing right now?
Well, I think state lawmakers of course need to work with the federal government, but also have to look internally. Each state is unique. Each county is unique. And each health care system and their particular needs are unique. So to get quick data — what do you need? when do you need it? how much do you need? — and get the supplies out to the various health care centers quickly. This is what it's going to take.
What is the state of your personal protective equipment right now that you keep in your own clinics?
I have enough to last until Tuesday.
And under normal circumstances, how far in advance do you have your supplies?
We try to have at least a month-and-a-half of what we call ‘PAR levels.' So when we get down to a month-and-a-half of what we think we need, we order more. So we're down to now, we have enough to last until Tuesday.
And the staff has been very creative and the community has been supportive. So we've had people like Ace Hardware that have donated cases of Clorox. We've had the school board that has sent over paper towels and hand sanitizer since the schools are closed. So this is how we're essentially scrapping for supplies.
And then in the health center world, we have something called the PCA, which is the Primary Care Association. And they look after all of the health centers within a state. And they are out beating the bushes and trying to see what trucks are coming across the state line. It's almost like the mafia looking to see if they can hijack a truck that has some beer in it, if you will [laugh]. We're being very creative to make this work.
I heard a doctor in New Orleans, which has the highest coronavirus case fatality rate the country right now, say we're one week behind and we need to be planning three weeks ahead—
— Yes. I'm very frightened about — I shouldn't use the word frightened, but I am going to use that word — I am more concerned about the unknown than I am what I'm facing right now. We're really behind. And I'm really concerned about what the next week, week-and-a-half is going to be like.
Anything else you want patients to know right now?
We have a health center in every county. And while you're staying safe at home with your concerns about the coronavirus, do not let your chronic illnesses — if you have them — go neglected. Contact your provider. They will set up a telephone conference with you, or telehealth conference, or walk you through how to talk to you on your iPhone, and make sure that you keep your chronic illnesses in check while you are secluded at home.
The health centers are open.
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