Health care systems that serve vulnerable communities regardless of patients’ ability to pay, including those who are uninsured, those who need translation services or those who might be lower income or experiencing homelessness, face unique challenges as coronavirus infections climb.

Michael Erikson, chief executive officer of Neighborcare Health, said the community health care system was dealing with medical calls “well above expected volumes.” Meantime, the demand for its dental services has declined.

Neighborcare — which serves about 75,000 patients each year, offers 16 clinic locations in the Puget Sound region and is a safety net provider — has suspended routine dental work, Erikson said.

“Dental practice creates a lot of aerosolized procedures, i.e., the drilling. If you are positive for COVID, that puts more potential virus in the atmosphere,” Erikson said of the disease caused by the new coronavirus, adding that halting routine dental work would also conserve personal protective equipment desperately needed in the state’s medical facilities.

Neighborcare will still provide urgent and emergency dental services, Erikson said.

Neighborcare also is embracing care by telephone and asking medical patients to delay some in-person visits until “it’s a safer time to access health care.”

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Most patients have access to a telephone, he said.

But shifting to telehealth presented some unique challenges for community health clinics. About 60% of Neighborcare patients use Apple Health, Washington state’s Medicaid program.

“Telephone-based visits have historically been nominally reimbursed,” Erikson said, saying that managed care organizations traditionally only paid out just $25-30 per telephone visit, much lower than for an in-person visit.

On Monday, Erikson said employing more telehealth could threaten Neighborcare’s economic model.

That evening, he got good news.

The Washington State Health Care Authority directed managed care organizations to reimburse at approximately the rates they provide for in-person visits.

“It removes the financial harm” of reducing in-person visits, Erikson said.

Community health centers also are awaiting congressional budget action to firm their standing. Federal funding, authorized under a congressional budget extension, extends only through May 22.

The National Association of Community Health Centers, in a letter, urged congressional leaders to reauthorize the community health fund.

“Without action by May 22, health centers will lose 70% of their federal funding – and millions of patients will lose access to critically important healthcare services,” the association wrote.

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