Skip to primary navigation Skip to main content

A health director shares her views on doctor shortage, Affordable Care Act

Haefner.blog
"In the exam room when the patient says, ‘I’ll take my blood-pressure medication,’ they mean it. They’re not bulling you. Then the door opens and their life smacks them in the face." – Joanne E. Haefner, executive director, Neighborhood Health Center. (Sharon Cantillon/Buffalo News photo)

By Scott Scanlon

Refresh Editor

The Neighborhood Health Center, which just completed a $1.5 million renovation of its headquarters on Lawn Street in Riverside, also has two other locations – the Mattina center on the West Side and the Southtowns OB/GYN center in Hamburg.

The locations may treat a growing number of underserved patients from across Western New York, but its staff of about 130 also serves as a model for health care laid out in the Affordable Care Act, which underlines the need for more preventative and organized medical care.

Executive Director Joanne E. Haefner sat down with me last week to talk about how the center operates, as well as the renovations. That interview, conducted for the In the Field segment of WNY Refresh, also is available in a previous Refresh Buffalo blog entry.

During that interview, Haefner talked in more detail about the center and how health care reform will start reshaping the regional health care system in the months to come. She also talked about how the center works to plug its patients in with hard-to-get doctor specialists.

Here are more excerpts of our conversation:

What services are available?

We have pediatrics, adult health, family health, OB/GYN, so we deliver babies in the community and take care of pregnant women. We have podiatry services on site in two of the three offices. We have behavioral health counselors who do adult and child counseling here on site. We have nutritional services specialists who do nutritional counseling in terms of dietary intake and obesity prevention, dental services and then we have our community health workers who help patients link to the services they need and provide outreach into the community and tell people about the services we have.

We also help existing patients learn about the services that we have and services available in the community and we  just started with the Health care for the Homeless Department.

How many patients do you see?

We saw 18,500 people last year. Our visits were around 66,000 between the three sites.

What percentage would you say have health insurance?

Eighty-five percent of our patients have some kind of insurance for some of the year. People will lose coverage. That patient could be insured for some of their visits during the year but we’re helping them to get insurance. They’ll have a lapse in their insurance or we’re helping them get Medicaid or some other type of insurance coverage. We try to help them get connected back into care.

Of those insured, what percentage are on Medicaid?

More than 50 percent.

Medicare patients?

Only 5 to 10 percent but we’re certainly happy to help people along the life span.

How will what you do change with new facets of the Affordable Care Act starting next year?

Some of the things we’ve historically been known for is what the Affordable Care Act is asking primary care to do – to work in a team model, not just within your office but with other partners in the community who might be better at things than you are, really cooperating and having partnerships. We’ve done that historically, but now it’s even more important for us to be able to create partnerships with other organizations and make sure there’s a community based approach to the patient getting the services that they need.

Then there’s the reimbursement issue. That reimbursement model will be changing, so really understanding that one, being in those partnerships and relationships is part of getting paid in the future, and two, making sure that we help patients as the exchanges open – 15 to 20 percent of peoples’ insurances are going to change – and to help them shift into the best available insurance for them is part of our goal.

Do you expect more patients as a result of the insurance exchanges and people being required to have health insurance?

We expect primary care to be more important in peoples’ minds now that they’ll be able to access health care with health insurance, so the issue is can we be prepared for the additional people who are going to want care?

The thing that keeps people out of prevention is that prevention’s not free, so people wait until they have an issue to deal with. So when there’s health insurance coverage that includes that, certainly people will see preventative health as a higher priority.

Do you have a sense of what happens next year in terms of patient numbers?

Statewide and nationally, there’s an expectation there is going to be an increase in patients. We’re guessing it’ll be at least 10 percent.

First exchange open enrollment, starting October 1, is going to be the test. We think that probably the most glaring issue is people who have some current product and how that’s shifting, and then really focusing on uninsured who’ve never thought about themselves as someone who could get insurance coverage.

What do non-insured people need to know about the changes on the horizon?

Right now, there is someplace to get care already. That there’s a sliding fee scale available which is based upon financial parameters and there’s a support system that exists already. Our model is the federally qualified health center model. There are certainly other organizations in Western New York who we partner with who aren’t federally qualified health centers but who still take care of a lot of Medicaid patients. There’s a safety net and we all try to work together to assure that there are not big gaps in access to care.

You really don’t have to wait till you’re sick to get care. There’s a network already.

It’s like buying your first computer, you’ve just got to get in the game. I think it’s overwhelming to people to think about how hard will it be to apply and what information will they need. Inquire. Come in and ask. That’s why we do outreach, to ask people what’s their barrier to come in and get care.

Does it take a special doctor or dentist to do this Neighborhood Health Center work?

This is not for everybody, the diversity of the patients, the complicated nature of the variety of insurances that we take – we take over 100 different insurances. And our patients face a lot of barriers, and having the compassion to understand how hard it is to be a person, how hard it is to be a patient, the people who feel good about coming here are the people who get that.

And that truly isn’t for everybody. The term ‘non-compliance’ comes from you believing you’re right and being a patient means, ‘I really get a choice in this.’ So if I decide I’m not going to do what you say, sometimes that could be dangerous but most of the time it’s me flexing my choice in my health. Doctors and medical practitioners who understand the difference do better here.

There are some doctors who see themselves almost as Godlike, in terms of their commands. To have patients come in and those doctors to have to ask, ‘What do you mean you’re not taking your blood pressure medication?’ must be really frustrating.

The thing is, in the exam room when the patient says, ‘I’ll take my blood-pressure medication,’ they mean it. They’re not bulling you. Then the door opens and their life smacks them in the face: They’re getting kicked out of their apartment or their kid just got suspended, they don’t have enough money to pay all their bills and buy the medicine. Some medical professionals are not recognizing that they’re just a person, like I’m a person. This, I think, is what gets in the way of us creating a long-term relationship with somebody.

The first time somebody comes in, you can just see they feel that nobody’s ever listened to them. They’re articulation of their problems today is particularly overt.  We’re not special. We’re just people who get that people are people, and so are we.

Talking to a couple of specialists for a recent story, they’re overwhelmed and they feel they can’t get to every patient who needs their help, and these doctors have gatekeepers who can really be difficult for patients to deal with.

It’s not always elegant, but we try our best. That’s what’s being human is all about. This is what the community health worker does. … Our referral person who works as a community caseworker, she’s magical. She knows everybody in the (specialty medical) office, who will take what insurance, what the patient will need to get in, here’s the form this doctor is going to need, which doctors need records first or they’re not going to get in. She knows all of that. What an invaluable resource. She’s the most efficient at the secret handshake.

You go into subspecialty because you see something that’s fascinating and you want to make a difference, and then this is a community that can’t support many of the things we want because of decreasing size and reimbursement. You’re not going to attract a lot of international specialists in a lot of things. The ones we have, we have to protect.

But that’s the primary care model. Primary care does its best to maintain a patient’s health, find a subspecialist to find out what’s going on, bring them back and manage things themselves. When we do that, we open the door for more people to be cared for.

That newer model – where younger (doctors and other health-care workers) people refer, refer, refer – and gatekeep? There are a lot of things we can do. Sometimes, you just need a second set of eyes on something. Nurse practitioners, for example, can do 90 percent of what a physician can do. Everybody needs to know their limit and should be working up to what they should do in a system which doesn’t have enough providers.

email: refresh@buffnews.com

Video: Fitness practitioner Robbie Raugh's kickboxing class

Fitness practitioner Robbie Raugh's kickboxing class focuses on shaping your body using jabs, punches and kicks.

Video: Fitness practitioner Robbie Raugh's raw cuts class

Fitness practitioner Robbie Raugh's raw cuts class focuses on shaping your body using free weights.

Video: Fitness practitioner Robbie Raugh's training tips

Fitness practitioner Robbie Raugh's training tips focus on home exercises to keep fit and shape your body.

Neighborhood Health Center undergoes $1.5 million renovation

Haefner.blog
Joanne Haefner, right, executive director of the Neighborhood Health Center, talks with Dr. Ferdinand Yates, center medical director, in their newly remodled digs on Lawn Street. New renovations have added clinical and staff space and included fresh coats of paint one staffer has described as "like being bathed in hot chocolate every day," (Sharon Cantillon/Buffalo News)

By Scott Scanlon

Refresh Editor

Joanne E. Haefner is feeling pretty good these days.

The Neighborhood Health Center executive director just oversaw a $1.5 million renovation of the nonprofit’s headquarters on Lawn Street in Riverside and has watched two other locations – the Mattina center on the West Side and the Southtowns OB/GYN center in Hamburg – help a growing number of underserved patients from across Western New York.

Haefner, 48, a Riverside High and D’Youville Nursing School graduate, oversees a staff of about 130, including more than 20 doctors and nurse practitioners and seven dental providers, as well as mental health counselors, outreach workers, a registered dietitian and nursing, billing and administrative staff.

This kind of community-based health care team has been held up as a model in the Affordable Care Act, which spells out the need for more preventive and organized medical care.

"This place started as a place for young moms and kids who couldn’t get care. Twenty-six years ago, this was our story," says Haefner, a nurse practitioner who continues to see patients as part of her job. "This is still the poorest city in the country to be a child and the third-poorest city in the country. That’s still the story of who we attract."

But your patient base has grown?

Last year, we served patients in 41 different languages between a live interpreter, other interpreters and written translation services. We’ve been able to take care of a much more diverse group of people than we were able to serve even when I came here seven years ago.

What is it like for a patient who’s coming in here and not feeling wonderfully and can hear questions in his or her own language?

Imagine that we put you in downtown Paris in the best hotel that exists, but nobody speaks English and your tummy hurts the worst it ever has. Now you’re scared. Now put you in the middle of Buffalo and you’re from Somalia or from Thailand and have lived in a refugee camp, and you come here and, lo and behold, you’ve found someone who can speak your language on the phone. How much more comforting can that be?

We see people who come in and speak no English on their first visit and over the course of the year, we always ask them, ‘Do you still want to use the interpreter, yes or no?’ And we see people move off of using an interpreter and they want to try it on their own.

So you’re really getting the sense of the new American melting pot here?

Absolutely, and helping to see people blend to be part of the community. … Our goal is to help open people’s eyes to other possibilities, consistency of health care and talking about the whole person. We talk about literacy in pediatric well visits, with every single kid. We make it an action item to talk to mom about reading and literacy and high school completion and its relationship to poverty.

So you’re a community-based operation?

My board is always at least 51 percent patients, so you can’t get around how the community’s changing, and you can be more nimble about what’s happening. Our board and our patients tell us what’s going on and what we should be thinking about.

It’s a doctor’s office for everybody. You can see somebody who’s a professor and you can see a mom who’s pushing babies in a double stroller and took two buses to get here. Then somebody experiencing homelessness and a refugee who just settled. That’s the fun of this. … There’s really good physicians, nurse practitioners and dentists here who could work anyplace but who want to be part of that.

Talk about the renovations.

This used to be the old auditorium (of Public School 79). When the center first opened, they never imagined we’d be seeing the number of patients we are seeing. We have 18 exam rooms. We used to have 14. We used to have 18 seats in our waiting room, and now we have 48. At the nurses’ station, if you were one of the last six nurses to get to work, you didn’t have a seat … so some of the renovations really made it a more humane workplace and a place where patients can feel proud of their neighborhood.

How many patients do you see?

We saw 18,500 people last year. Our visits were around 66,000 between the three sites.

What percentage would you say have health insurance?

Eighty-five percent of our patients have some kind of insurance for some of the year.

Do you expect more patients as a result of the insurance exchanges and people being required to have health insurance?

We expect primary care to be more important in peoples’ minds now that they’ll be able to access health care with health insurance, so the issue is can we be prepared for the additional people who are going to want care?

The thing that keeps people out of prevention is that prevention’s not free, so people wait until they have an issue to deal with. So when there’s health insurance coverage that includes that, certainly people will see preventive health as a higher priority.

Saturday: Haefner talks more on the Refresh Buffalo blog about the impact of the Affordable Care Act and how the health center connects with specialists.

Feeling pinched by a doctor shortage

Talk about feeling unwanted.

When I started reporting today’s Refresh cover story – on the quest of helping the unprepared find a medical specialist – I got a small taste of what it’s like to feel like a stranger in a very impersonal land.

Calls to doctor’s offices themselves were pretty similar.

They started with a recorded voice.

No, I wasn’t calling about a prescription.

I wasn't another doctor's office.

Nor did I have a billing question.

Then, oh please no ... I did not need to roll through a staff directory.

My emergency wasn’t so dire I needed to call 911, as many of the recorded voices directed. Thank God.

So I waited on hold, and in one case I was even given a prompt letting me know there were only a couple of callers ahead of me.

When I finally reached a person at one local dermatologist’s office, she was hardly impressed that I was a Buffalo News reporter looking to talk to her boss about tips to find specialists in short supply.

That newspaper name dropping usually works, although, it’s worth noting, not always.

I will say that Carl Paladino has always graciously returned my calls – I’m not kidding – and talked with me for a few minutes.

This woman was no Carl Paladino.

She seemed rushed, put off, unbowed.

Her boss didn’t have time to talk to a reporter, she told me. Never does. Never will.

I can be persistent.

"Can you at least ask?" I said. "Can he refer me to someone else if he doesn’t have time?"

I heard the huff familiar to those I hear from my daughters when I tell them they can’t borrow my car.

After the call, I thought it would be good medicine to name the doctor in this blog piece.

I calmed down and thought better of it, especially since his staffer did give me the name of another doctor who was willing to spend a few minutes on the phone with me to talk about what the Western New doctor shortage means from his perspective.

Like all other physicians I talked with, Dr. Robert Kalb recommended those looking to squeeze onto the appointment books of a specialist in short supply find themselves a good primary doctor – before they get sick.

Those family doctors can separate the truly sick, and in need of immediate attention, from those that a primary doctor may be able to treat, or stabilize, before a specialist is needed, he said.

A primary care doctor called Kalb as we started our interview. I understood, and appreciated, where I rated at that moment. The doctor called me back a few minutes later.

And here’s why Kalb, a dermatologist, and Dr. Ajay Chaudhuri, an endocrinologist, say it can be hard to get in to see a specialist in Western New York:

Many of them are really, really busy.

Kalb works out of the Buffalo Medical Group office on Essjay Road in Williamsville. A physicians assistant helps with his patients. Call yourself for a new patient appointment, without a referral, and be prepared to wait four months.

"We work 45 hours a week and see 150 patients a week," said Kalb, who also is a clinical University at Buffalo professor who teaches dermatology students in his office. He also sees patients at Buffalo General Medical Center a half-day a week.

"Unfortunately, a lot of dermatologists don’t even see new patients," Kalb told me. "Their practices are essentially closed."

Patients have to wait two or three months to see Chaudhuri unless it’s an emergency.

"All of us have some emergency slots" reserved for referrals from primary care doctors or for patients specialists have seen in local hospitals and need follow-up care, Chaudhuri said. "They cannot wait two or three months."

This is a typical day for Chaudhuri, one of three endocrinologists with the Diabetes and Endocrinology Center of Western New York:

"Each one of us sees approximately four or five new patients and 20 or 21 follow-up visits," he says. "After that, we go ahead and see patients in the hospital. In the interim, we’re also taking calls from patients calling in for something. We are reviewing any (medical tests) and calling those patients back."

His workday starts about 8 a.m. and ends about 6:30 p.m. each weekday. He’s also often on-call for hospital work after hours.

"We also work weekends and we do an outpatient clinic one Saturday a month," he said.

And his workplace changes, often day-to-day.

He and his two partners, as well as a physician assistant and a diabetes educator, split time between their center in Williamsville, offices in DeGraff Memorial and Buffalo General hospitals, and with UB MD in the Dent Tower in Amherst. "Then we have teaching and research going on," Chaudhuri said. "It’s demanding but it’s rewarding."

Kalb leads dermatology recruiting efforts for the Buffalo Medical Group.

"Some of major metropolitan areas are saturated with dermatologists because of cosmetic procedures," he said, "but in most areas of the country, there’s a shortage."

As the Bills and Sabres have at times discovered with top players, doctors aren’t always clamoring to come to Buffalo.

"It’s not for a lack of effort," Kalb said, "but t’s tough unless the person has a tie to the Western New York area.

"The reimbursements are relatively low compared to other parts of the country, so it is somewhat tough to recruit people to Western New York. The people who train and have some sort of tie here are the ones you’re more than likely to have come and work in the area.

"It’s been a struggle the last couple of years."

As with other efforts here, slow and steady progress is being made.

Chaudhuri and his partners also are clinical professors with UB, and are helping train two new endocrinologists who will join the practice in September.

That should make Diabetes and Endocrinology Center patients – and the staff – very happy, indeed.

– Refresh Editor Scott Scanlon

Sharing will be part of Heart Association's Heart Ball tonight

The American Heart Association will host the Buffalo Niagara Heart Ball this evening but the black-tie event isn’t the big news coming out of the regional chapter this week.

Buffalo is also one of five cities across the country recently chosen to receive 1,000 Hands-Only CPR training kits funded by the American Heart Association.

"The more people who are trained in CPR, the more lifesavers we will have in communities who can act as first responders when citizens go into cardiac arrest," Dr. Glenna Bett, association Advisory Board president for the Buffalo Niagara Division, said in a news release.

"The City of Buffalo aims to use the hands-only kits to train 6,000 city residents in CPR training sessions led by local emergency responders, health agencies, and volunteers," regional Heart Association spokeswoman Jennifer Pratt said. "Buffalo will implement the Hands-Only CPR technique in schools to better equip teachers, professionals, and families for emergency preparedness."

Tonight’s Heart Ball will celebrate a local bystander who successfully saved a life by acting fast and performing CPR.

Rural/Metro Medical Services will be honored with the annual organizational Hero of the Heart award, as the company has embraced the heart association’s CPR in Schools initiative, which looks to train all high school students in Hands-Only CPR by graduation.

Also being honored is Dr. John Bell-Thomson, chairman of Cardiothoracic Surgery at Mercy Hospital, who become a pioneer in cardiothoracic surgery. During his 20 years in Buffalo, Bell-Thomson his innovation and dedication has led him to be among few surgeons nationwide who performs cardiac surgeries robotically.

Sponsors attending the dinner will have the opportunity to provide CPR Anytime kits for everyone at their table to take with them. The kits outline the skills of CPR and come complete with a DVD and mannequin.

Local team in the midst of 193-mile relay in Southern Ontario

Ragnar
Members of Kickin’ Asphalt pose on the Erie Canal Towpath in Lockport earlier this week. They started the Ragnar Relay at 6:30 this morning. (Matthew Masin/Buffalo News)

By Scott Scanlon

Refresh Editor

If you’re looking to visit Niagara Falls, Ont. on Saturday, expect things to get even more exciting than a typical summer weekend day at the hub of the region’s international tourist destination.

The Ragnar Relay will blow into the city for the first time.

This relay series is a big thing across the country but is new to the Niagara Frontier – and at least one team from Western New York will be there to represent.

Denise Salmons, 48, of Lockport, is operations manager at Cornerstone Community Credit Union, but she has another title this weekend: captain of Kickin’ Asphalt, a 12-member team from mostly Niagara County in the midst of a two-day relay race in Southern Ontario.

The team is among more than 100 participating in the 193-mile relay race, which starts in Cobourg, Ont., about 75 miles east of Toronto, at 6:30 a.m. Friday and ends Saturday afternoon at Table Rock in Niagara Falls.

Salmons and her team learned about the relay from a friend who ran one of the series races between Key West and Miami earlier this year.

Team members – ranging in age from 22 to 62 – will participate for Kickin’ Asphalt in the new Canadian installment of the series, said Salmons, who runs one to two races a month this time a year, and recently ran the Buffalo Half-Marathon in 2 hours, 20 minutes, 30 seconds.

"The miles won’t be harder than the half marathon but I think the fact that it’s going to take about 33 or 34 hours to complete is going to make it challenging because you will not get a lot of sleep," Salmons said.

They’ll also spend part of the run in the dark, and team members practiced by running along the Erie Canal Towpath in the late night the wee morning hours in recent weeks, while wearing "head lamps."

Kickin’ Asphalt will split up in two vans for the Ragnar Relay and take turns running legs that stretch up to 9.7 miles but tend to be 3 to 8 miles long.

Salmons said she’s the No. 7 runner on the squad and that teammates need to run in order throughout the race.

"I have no idea what the race is going to be like," she told me this week. "I think it’s going to be fun, a lot of high energy because of the nature of a relay. I think the aid stations are going to be a lot of fun. I think there’s going to be a lot of people, a lot of stuff going on."

To find out what Salmons ate to prepare for the race, read What are you eating? in WNY Refresh on Saturday.

Refresh also will keep you up to date in the coming months about next year’s Niagara Ontario Ragner Relay.

Buffalo to celebrate National SUP Day Saturday

Jared Callahan looks to ride the success of his new business at Canalside on Saturday when he celebrates Standup Paddleboard Day.

Callahan, owner of the new City of Light Fitness, will give a dry land and water demonstration of the water sport he introduced last month to the Buffalo waterfront at noon Saturday on the east end of Canalside, near BFLO Harbor Kayak.

In honor of National SUP Day and Father’s Day, introductory lessons scheduled for the weekend will be offered half-off, as well. For more info, visit cityoflightfitness.com.

Meanwhile, read a story I wrote about the new business here.

– Refresh Editor Scott Scanlon

 


Meet DeChantell Lloyd, another member of Buffalo's creative class

Lloydcut
DeChantell Lloyd hard at work at Code Blu Juice Bar in Allentown (Sharon Cantillon/Buffalo News)

DeChantell Lloyd has a full-time job as an accountant at a local bank.

She also has another full-time job, as owner of the Code Blu Juice Bar at 23 Allen St., in Allentown.

Lloyd helped me out this week for the cover story in WNY Refresh on juicing.

She and Kayla Jemmott, her "master juicer," prepared two of their juice blends for a Buffalo News photo shoot: @Green.com and All Hail 2kale. Photographer Sharon Cantillon and I got to try them.

They both tasted great.

Anyone who read my column when Refresh debuted earlier this year knows that I’m not a fan of all vegetables.

Mixing them in a juice format, however, worked well. All Hail 2kale tasted better because it was a mostly fruit blend, but both were good. Fresh apple and a half lemon thrown into the mix helped.

As was the case a couple of weeks ago when I interviewed Jared Callahan about his new business, City of Light Fitness, at Canalside, a little time spent in Code Blu provided another taste of young entrepreneurs who are trying to make Buffalo a better place.

Lloyd, 30, is a city native and Bennett High School grad. She has a business administration degree from Erie Community College and also attended SUNY Buffalo State. She opened the juice bar in early 2012 and hopes to open another location in the coming months.

Her menu is creative, and so are Code Blu’s surroundings.

Bob Marley music was playing on Pandora when I first walked in Tuesday morning. Psychedelic artwork from Anthony Melice and other local artists seasoned the turquoise and tangerine walls.

Code Blu, at Allen and North Pearl streets, boasts one four-top table and four two-tops. Lloyd has placed cushions along the old metal heaters that line the place, too.

The place can make about 80 veggie and 20 fruit drink combinations, and offers healthy lunch foods, as well.

"Buffalo is new to the juicing concept and people don’t walk in knowing what they want, so I give them a variety of things to choose from," Lloyd said.

"I generally say, ‘What is your favorite fruit and what is your favorite vegetable?’ We’ll mix according to that."

She has two books – "The Smoothie Bible" and "The Juicing Bible," both by Pat Crocker – behind the counter, just in case a customer might wonder about a combination not on her lengthy menu.

Lloyd feels the excitement that is bubbling up in city neighbors in and around the downtown core, and has advice for all of us in the region when it comes to feeding that vibrancy.

"It’s very important," she said, "if you want to see these business stay in Buffalo, that you show up and you support them."

In this case, you can actually feed off that energy – in a healthy way.

– Refresh Editor Scott Scanlon

« Older Entries
Advertisement

About The Refresh Buffalo Blog

Scott Scanlon

Scott Scanlon

Scott Scanlon is an award-winning reporter and editor who has covered various topics in his quarter-century as a journalist in South Florida, Syracuse and Buffalo. He is aiming to pass along what he is learning these days about health, fitness, nutrition and family life.

@BNRefresh | refresh@buffnews.com

Subscribe

Advertisement