In South Jersey, New Options For Primary Care Are Slow To Take Hold

Apr 3, 2013
Originally published on April 3, 2013 8:19 am

Camden, N.J., has serious health problems, with too many people going to local emergency rooms unnecessarily. But progress is being made, albeit slowly.

John Pike, 53, is a Camden resident who used to be a frequent flier at the ER.

Pike has a smoker's cough, and when that cough or pain in his bad hip flared up, he'd go to the ER — maybe eight or nine times a year. But when he did, ER staffers didn't really remember him or his medical history.

"You get the feeling you are irritating them," he says. "It would be a simple problem. I'm wasting their time, where they could be dealing with a real emergency."

Once, he says, an ER nurse pulled him aside and said, "This is something your doctor can deal with."

"Not much I could say, because she was telling the truth," he says.

But Pike didn't have a primary care doctor until a community group called the Camden Coalition of Health Care Providers opened a doctor's office right inside Pike's apartment building.

Ken Gross, director of research and evaluation for the coalition, says the idea was to get "super users" like Pike to stop going to the hospital so frequently.

Gross says the group saw ER overuse in Camden as "a sign for us, from the data, that you don't have a source of primary care, or you have a loose relationship with primary care, or you can't get an appointment with your primary care because of your work hours."

Gross leads a team of health-data detectives at the coalition. For several years, they gathered hospital billing information from across Camden. Then they mapped the data block by block.

It turns out that Pike's building is marked as a bright-red "hot spot" on the map. Pike and his neighbors at the Northgate II building had racked up more than $1 million a year in hospital admissions and trips to the emergency room over about a decade.

These days, Pike rides an elevator to the doctor, just six floors down from his apartment. The space is bare bones, with just two exam rooms and a tiny file office, but Pike has his own doctor now — Dr. Madhumathi Gunasekaran.

"I feel comfortable with her. I can talk to her; she doesn't shove you off like some doctors," Pike says.

Dr. Jon Regis is a longtime member of the Camden coalition. His company, the Reliance Medical Group, operates 21 offices across New Jersey, including the practice at Northgate II. The subsidized housing there is home to many low-income seniors and people with disabilities. Many people who live in Northgate II now see Gunasekaran for checkups and other medical issues. But Regis says it took longer than he had hoped to win over residents — almost two years.

"We thought that since they were having such a difficult time, we could just open up the door and they would come down," he says. "That wasn't the case."

Regis says some residents told him they didn't want their neighbors to know they're going to the doctor. But Regis was persistent in trying to get residents to use Gunasekaran instead of the ER.

"We had to do a number of different things, like health fairs and meet-and-greets. We had to engender a sense of trust in the residents before they would come down to see us," he says. "I think that was somewhat surprising. But we're starting to get past that now."

About a year ago, only about 80 people got their primary care at the office. That number has grown to nearly 130, or about 19 percent of the building's residents. It was a slow start, but Regis says he is pleased with the progress.

Reliance uses revenue from private pay and private insurance patients at other office locations to help finance the clinic at Northgate II. This way, he says, "We don't have to turn anybody away, and we've been able to make this work."

This story is part of a partnership with NPR, WHYY and Kaiser Health News

Copyright 2013 WHYY, Inc.. To see more, visit http://www.whyy.org.

Transcript

DAVID GREENE, HOST:

Camden, New Jersey is a city that faces a number of problems. It has high rates of crime and unemployment. And it has serious community health issues, which are causing overcrowding in local emergency rooms.

WHYY's Taunya English looks at one group that's trying to change this by moving health care closer to the people who need it.

TAUNYA ENGLISH, BYLINE: Fifty-three-year-old John Pike used to be a frequent flier at the ER.

JOHN PIKE: You sit there and wait. And you can be there for like two, sometimes four hours, half or almost all day.

ENGLISH: Pike has a smoker's cough and when pain in his bum hip flared up, he'd go to the hospital eight, maybe nine times a year. But, ER staffers didn't really remember him or his medical history.

PIKE: I don't know. You get to feeling you're irritating them 'cause it would be simple problems. I'm wasting their time where they could be dealing with a real emergency.

ENGLISH: Once, an ER nurse pulled Pike aside, and told him, this is something your doctor can deal with.

What'd you say to that?

PIKE: Not much I could say 'cause she was telling the truth.

ENGLISH: Pike didn't have a primary care doctor, but then things changed when a community group called the Camden Coalition for Health Care Providers decided to open a doctor's office right inside Pike's apartment building.

Researcher Ken Gross says the idea was to get super users like Pike to stop going to the hospital so much.

KEN GROSS: That's a sign for us, from the data, that you may not have a source of primary care, or it's a loose relationship with primary care or you can't get an appointment with your primary care because of your work hours.

ENGLISH: Gross leads a team of health-data detectives at the coalition. Several years ago the analysts tried something new. They gathered hospital-billing information from across the city. Then, they mapped the data block by block.

Turns out, John Pike's building is a bright-red hot spot on the map. Neighbors at his Northgate II building rack up more than a million dollars a year in hospital admissions and trips to the ER.

(SOUNDBITE OF ELEVATOR DING)

ENGLISH: These days, Pike rides the elevator to the doctor - six floors down.

(SOUNDBITE OF ELEVATOR MOVING)

PIKE: The space is bare bones - just two exam rooms and a tiny file office, but Pike has his own doctor now.

DR. MADHUMATHI GUNASEKARAN: I'm Madhumathi Gunasekaran, and I'm a primary care physician, and they call me Dr. G. I believe strongly in prevention is better than cure.

Is it a new pain or is it the same like something new? Can you show with your fingers where exactly it hurts?

PIKE: Right here.

GUNASEKARAN: Right there? And no history of kidney stones?

ENGLISH: Dr. G. recommended an at-home device to help Pike manage his medication, and she nags him to quit smoking.

PIKE: I feel comfortable with her, I can talk to her, she doesn't - what do you call - shove you off like some doctors.

DR. JON REGIS: If you have a doc that's not willing to listening to you, not willing to look you in the eye, he's always writing, and trying to get you out of the room, he doesn't have the anointing to do what he's doing, then you need to find another doc.

ENGLISH: Dr. Jon Regis is a longtime member of the Camden coalition. His company, the Reliance Medical Group, operates 21 offices across New Jersey and the practice at Northgate II. The high rise is subsidized housing and home to low-income seniors and people with disabilities. Many there now see Dr. G. for check-ups.

REGIS: But it took a while, almost two years, for that to happen. We thought that since they were having such a difficult time, we could just open up the door and they would come down, that just not the case.

ENGLISH: Location was supposed to be the big selling point, but Regis says some residents told him: they don't want their neighbors to know they're going to the doctor.

REGIS: They had to see that we were serious. And we had to do a number of different things - health fairs, meet and greets. We had to engender a sense of trust in the residents before they would come down and see us. I think that was somewhat surprising. But we're starting to get past that now.

ENGLISH: At first, only about 80 people got their primary care at the office. That number has grown to nearly 130 or about 19 percent of the building's residents. It was a slow start, but now Regis is pleased.

REGIS: We've been able to say open, but health care is a business. Although it's a special business, it is a business. And one and one is two no matter where you are.

ENGLISH: A hospital emergency room can charge $500 - or more - to care for sniffles or a stomach ache. Regis says Medicaid and Medicare pay him a lot less. Reliance uses money from private-pay and private-insurance patients at other office locations to balance the books at Northgate II.

REGIS: So we don't have to turn anybody away, and we've been able to make this thing work.

ENGLISH: It's a different kind of home remedy; one that experts hope will push people to use the system in less expensive ways.

For NPR News, I'm Taunya English in Camden, New Jersey.

GREENE: And that story from Camden is part of a partnership with NPR, WHYY, and Kaiser Health News.

(SOUNDBITE OF MUSIC)

GREENE: It's MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.