Ebola Update

could-it-be-ebolaNew travel constraints have been imposed on people entering the U.S. from three countries at the center of West Africa’s Ebola epidemic.  The Centers for Disease Control and Prevention (CDC) says starting next week travelers from those countries will be directed to check in with health officials every day and report their temperatures and any Ebola symptoms for 21 days.  Although only two people have been diagnosed with the illness,  media coverage about the Ebola Virus Disease continues to raise fears among the public.

Community Health Centers are fielding phone calls from worried patients and staff.  They are also practicing readiness, reviewing screening protocols and procedures, and taking inventory of their personal protective equipment (PPE).  Whitney Young Health , a Community Health Center in upstate New York recently told the local newspaper the Times Union in an article  that it has “held four infection control meetings. and created an internal process for handling a patient with a travel history to West Africa.”  Dr. Kallanna Manjunath said, “We need to be prepared, both for patients’ sake and, equally important, for our staff.”

The Health Resources and Services Administration  (HRSA) has also posted a Ebola resource page on their web site and is directing health centers questions/concerns about Ebola to the CDC and/or their state and local health departments, and to leverage State/Regional Primary Care Associations (SRPCAs) on concerns that have not yet been addressed at the federal level.  SRPCAs are already sending out important CDC alerts to their health centers and gathering information. One concern is whether health centers have equitable access to personal protective equipment (PPE), and that staff have sufficient training in putting on and removing PPE, if that becomes necessary. CDC has posted a new guidance that instructs healthcare workers on this topic.

Health center specific concerns about Ebola and other communicable diseases will be the focus today of NACHC’s Chief Medical Officer, Dr. Ronald Yee and health center experts from the field. They will lead an important NACHC TeleForum about the role of health centers in the Ebola outbreak today at 12:00 Noon – 1:00 p.m ET.  To join the conversation  health centers must call in must call in by directly dialing 1-877-229-8493 and entering PIN: 15035. The call will be recorded and accessible to those unable to attend. You can find the recordings and source documents at www.nachc.org (just click on “Clinical Issues”).  The recording will be available approximately two business days after the event.

Stay tuned as we keep you posted on these fast moving developments.

Ebola and Community Health Centers

facts-about-ebolaThe Centers for Disease Control and Prevention (CDC) is trying to ensure that providers are prepared in case more cases of the Ebola virus are detected. A second healthcare worker at the Texas Presbyterian Hospital has now tested positive for the virus after coming into contact with a patient who died from Ebola. CDC and its partners are taking precautions to prevent the spread of Ebola within the United States. Among the resources coming out from CDC is a resource/checklist for Outpatient/ Ambulatory Care Settings. Representatives from the Department of Health and Human Services are also hosting a conference call on Monday, October 20th at 1 pm, ET for hospital executives, hospital emergency management directors, and safety officers to describe how to prepare healthcare systems to protect health and safety should an Ebola patient be present at the facility. We will post the call information as soon as its available.

In the meantime NACHC is also urging health centers to work directly with local public health departments to ensure an effective and coordinated response. NACHC is advising health centers to ramp up their front desk/scheduling operations to ensure appropriate screening of patients. If a patient is concerned that they are exhibiting symptoms of Ebola, the protocol for telephone screening should first and foremost rule out whether the patient has traveled to any of the countries affected by the Ebola Virus Disease. If appropriate, the patient should be referred to a facility that is equipped and prepared to handle such cases without presenting to the health center and possibly exposing others. Call ahead of time to alert the facility that a suspected case will be presenting, so that they can prepare for their arrival.

NACHC’s Chief Medical Officer Ron Yee, MD, also offers some cautionary advice: “While we are greatly concerned about the protection of our communities, patients and staff from the Ebola virus, taking the appropriate measures, we need to make sure that we are also protecting our populations from influenza and addressing enterovirus cases. These conditions will affect a great number of individuals and are also very important, from a public health standpoint. We should not let the fear of Ebola distract us from the important work of prevention. While taking the proper steps to address Ebola, make sure you and your loved ones get vaccinated, wash your hands frequently, and cover your coughs. These are things everyone can do now to stay healthy.”

Finally, don’t forget to include communications in your response planning. The primary goal is to educate and to allay fears about Ebola and emphasize to the community and patients that staff are trained and prepared to deal with public health threats.

Ebola What is Happening Now


As has been widely reported, the Centers for Disease Control and Prevention (CDC) has confirmed the first case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from Liberia. Even a single case of Ebola diagnosed in the United States understandably raises concerns, but medical and public health professionals across the country are ready to respond.  NACHC is closely monitoring the situation and tracking information alerts from the CDC.

“With the report of the first Ebola virus case in the U.S., our patients are asking for information,” said Don Weaver, MD, Associate Medical Officer for NACHC.  “The best resource to stay informed on this and other emerging health threats and public health emergencies is the CDC’s Clinician Outreach and Communication Activity (COCA) Program.  If you are not already on COCA’s partner list, you can sign up by sending an email to coca@cdc.gov with ‘Listserv Subscribe Request’ in the subject line.”

CDC has also posted interim guidance on evaluating patients for the Ebola virus, including a checklist on evaluating returned travelers to the U.S.  They have also created an Ebola readiness self assessment to assist local and state officials in planning a response.  If these tools do not address questions you have, CDC experts will answer questions about #‎Ebola‬ today during a Twitter chat from 4:00 to 5:00 pm ET. Follow @CDCgov on Twitter, and use the hashtag ‪#‎CDCchat‬ to participate in the chat.

Because of the high profile Ebola now has in the media, health centers might also receive queries from the media. A few message points to consider:

  • Community Health Centers have always been on the front lines as a responder to public health threats and have the tools, experience, and networks on the ground to effectively respond and protect their communities.
  • Community Health Centers are prepared to identify and triage possible cases of the Ebola virus by following their existing policies and procedures for infectious disease control and proper handling of laboratory samples.
  • Community Health Centers traditionally have very effective partnerships with their public health departments and can help coordinate planning, information alerts and outreach with CDC, state and local public health officials, and area hospitals.
  • Community Health Centers are effective responders because they know and understand the immediate health needs of the surrounding community and the patient populations they serve.

Please stay tuned to this blog to stay updated on developments.


Demand for Care and the Funding Cliff

We’ve been writing a lot about the demand for primary care lately.  One thing we haven’t mentioned the segment of the population who gained access to insurance with bronze exchange plans that may come with out-of-pocket costs.  As reported earlier in Modern Healthcare , some people who purchased these plans  have struggled to pay for care at Community Health Centers.  That, in turn, puts further strain on health centers’ financial health.  Yes, it’s about dedication not dollars at health centers, but when the demand for primary care continues to climb it’s important to have a sound financial footing to continue to meet the need.

As California Healthline noted in a follow up article to the Modern Healthcare story, “CHCs receive federal funding and are not allowed to refuse care to patients if they are unable to pay. About 20% of the 7.3 million individuals who purchased coverage through the Affordable Care Act’s insurance exchanged enrolled in bronze plans, which tend to have low premiums but higher out-of-pocket costs, including coinsurance, copayments and deductibles of up to $5,500 per person. In addition, individuals enrolled in bronze plans do not qualify for federal cost-sharing subsidies, which are available to those with silver plans.”

We’ve also noted in a previous post on this blog  estimates are that the demand for primary care is expected to climb by as much as 14 percent as the newly insured gain access to care.

The good news is that there is a broad coalition of Members of Congress who are now paying attention to the looming problem of the funding cliff.  Bipartisan lawmakers in the House and Senate have sent letters to the Congressional leadership calling for action on the funding cliff [see press release].  In the House, 250 members signed on to the letter, addressed to Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA), while in the Senate, 66 Senators added their name to the letter addressed to Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY).

Stay tuned for more developments on this story.

Choosing Primary Care as a Career

primarycareThe bias against primary care is featured in this month’s The Atlantic with a thoughtful essay penned by medical student Mara Gordon, titled, “Why I am Becoming a Primary Care Doctor.”  Gordon describes how few of her medical school classmates at the University of Pennsylvania are following her into the primary care field, opting instead for more lucrative specialty practices.  “At medical schools, general medicine is often considered unchallenging and quaint, even though primary care doctors are what our nation needs most from its medical schools.” Gordon cites predictions by the U.S. Department of Health and Human Services that there could be a primary care  shortage as great as 20,000 doctors by the year 2020.

Gordon makes her most powerful case in confronting head-on the conventional — and inaccurate — prejudices about primary care:

“But there’s something deeper at play, a widespread and nagging perception that primary care doctors just aren’t as smart as their specialist counterparts. A 2013 essay in the Annals of Internal Medicine asked the question most of my colleagues are too polite to verbalize: If you’re smart enough to do well in medical school, why would you go into primary care?”

Gordon offers up a powerful counterpoint.  “I’m eager to work across disciplines to help keep patients healthy, rather than reacting when they get sick,” she writes.  “I want to get to know my patients over time. There will be painfully rushed office visits in my future. There will be red tape and frustrations. But like many of my smart peers headed into this field, I also feel motivated by the challenges of designing new systems that meet the needs of patients, not the needs of insurance companies.”

With those words in mind consider that primary care will be the focus of the National Health Service Corps (NHSC) next month.  The program will celebrate its fourth annual Corps Community Day (CCD) on Thursday, October 9, 2014.  NHSC sites, clinicians, Ambassadors, alumni, and partners (including many health professions schools) across the nation will host activities and events to raise awareness about the vital role of the primary care workforce and highlight the impact the NHSC  has in boosting access to primary care in rural and underserved communities.

Corps Community Day events will be held during National Primary Care Week, October 6-10, and throughout the month of October. This year’s Corps Community Day theme is “Partnering to Make Primary Care Career Choices Possible,” and the Corps is working to secure activities/events across the U.S. and its territories.  If your health center has NHSC scholars, loan repayors, and/or alums and would like assistance with a CCD event, contact: Tracy McClintock, MBA, Senior Management Analyst at the Bureau of Health Workforce, Health Resources and Services Administration (HRSA).