COVID-19 pressures urban clinics

COVID-19 has forced the clinics that give Monroe County low-income residents free or low-cost medical care to take action.

“The way that we deliver care has changed quite dramatically,” says Laurie Donohue M.D., chief medical officer at Jordan Health.

Face-to-face patient interactions are limited, if they occur at all, and a great deal of medical care takes place over the phone or online. The decrease in on-site visits has cut into the clinics’ revenues, forcing some of them to scrabble to fill holes in their budgets. 

“A lot of these organizations are having to make tough decisions,” says Linda Clark, M.D., senior health adviser for Common Ground Health, a nonprofit that seeks to improve health conditions and medical care in and around Monroe County.

Nonprofits like Jordan Health offer affordable health care to low-income residents of the neighborhoods in which they’re located. Typically, these residents are at higher risk for heart disease, diabetes, stroke and other health conditions, and are often less able to access the health care they need. If employed, they stand a greater chance of contracting COVID-19 on the job.

“(These people would) be in service jobs, and very open to … multiple exposures,” says Sister Christine Wagner, executive director of St. Joseph’s Neighborhood Center.

St. Joseph’s offers a range of free or low-cost care to its patients, including medical and dental treatments, mental health counseling and case-management services. Without the clinic, many could not afford the care they need. In the 14620 ZIP code, where St. Joseph’s is located, nearly 12 percent of residents’ incomes fall below the poverty level.

When COVID-19 hit the area, St. Joseph’s immediately took steps to reduce the risk of spreading the virus among its staff and patients.

“We actually have locked our doors to reduce street traffic,” Wagner explains.

In the last week in March, St. Joseph’s began using its telehealth program to treat patients. In essence, those the nonprofit serves can use computers or smartphones to see and speak to counselors or medical personnel. About 20 people now work for St. Joseph’s on-site, half of the number that would be there normally. All of its 500 volunteers are staying home. 

As the threat of spreading COVID-19 began to lessen, St. Joseph’s started allowing face-to-face visits by appointment. From April to mid-May, 16 people were seen in person, a sharp decline from last year.

“In the first 11 business days in May, we (normally) would have seen a minimum of 100,” Wagner says.

Despite the nonprofit’s efforts, two of St. Joseph’s employees were diagnosed with COVID-19, and were asked to self-quarantine for two weeks.

Of Jordan Health’s nine sites, eight are located within a few miles of downtown Rochester and one is in Canandaigua. All but one of them have stayed open since the pandemic struck, and that site is inside a Rochester school that has closed. Approximately 75 percent of the nonprofit’s employees, most of them clinical staff, work at its different sites; the rest do their jobs remotely. 

Face-to-face visits are by appointment only, and patients must don safety masks before entering Jordan Health’s buildings. All who enter are screened for the symptoms of COVID-19, and tested for the virus if necessary. The nonprofit’s clinicians then determine what actions are warranted.

The threat of COVID-19, and Jordan Health’s efforts to keep the virus from its doors, have left some patients less willing to visit the health care provider in person.

“In general, people are scared. They don’t want to be out and about, particularly if they’ve got other conditions,” Donohue says. “For the first few weeks, we had a 70 percent drop-off in face-to-face encounters in the office.” 

On-site visits have picked up since then but are still down 40 percent from where they should be. Roughly 50 percent of all meetings with patients still take place by telephone or online.

Most of the Spiritus Christi Mental Health Center’s clients have been diagnosed with anxiety or depression.

“That is being exacerbated by the crisis,” says Maureen Marlow, the center’s director.

The nonprofit, which is part of Rochester’s Spiritus Christi Church, provides free therapy for about 50 active clients—about the same number it treated pre-COVID-19. The 18 retired social workers and mental health therapists who volunteer for the center talk to their clients once or twice each week. None of those conversations have been face-to-face since COVID-19 became a threat, and everyone is working from home.

“We’re doing phone consults. It’s working out very well,” Marlow says. 

Though group sessions have been suspended, two couples are receiving therapy by telephone.

In addition to their mental health issues, some of therapist Rick Massie’s five clients are also addicted to drugs, alcohol, gambling and the like. Though the pandemic has raised their stress levels, the center’s shift from face-to-face to weekly telephone sessions has actually had positive effects.

“I see less cancellations. I kind of think it’s because this is really convenient, instead of driving to offices,” he says.

Massie gives his clients homework to do between sessions. So far, they seem to be faring well.

“None of them have lost their jobs,” he notes. “That’s pretty key to why they’re doing well.”

The Spiritus Christi center, which has only two paid employees, also has fared well as an organization. Its annual budget, currently about $100,000, consists of donations from individuals, churches, banks, businesses and private foundations. In addition to those funds, the nonprofit receives roughly $80,000 each year in-kind donations of goods and services. All of the donations came in before COVID-19 hit.

Other providers of free or low-cost health care have not been as lucky. Approximately 80 percent of St. Joseph’s $1.6 million annual budget comes from individual and community donations, grants, fundraising and the small fees it charges for its services. 

“Those fees-for-service are just gone,” Wagner says.

The decline in revenue, plus the additional cost of responding to COVID-19, left the nonprofit struggling to eke out its payroll, which totals about $36,000 every two weeks. 

“It costs us about $100,000 a month for all our operations and payroll costs,” Wagner says.

The drop in face-to-face visits also hit Jordan Health’s bottom line. Insurance reimbursements and payments from patients account for 40 percent of the nonprofit’s revenue. 

In addition, the health care provider isn’t quite sure how much it will receive in reimbursements in the future. Most of Jordan Health’s patients are on Medicaid managed care plans, and it’s not clear how much that program or patients’ insurance companies will pay the nonprofit for telehealth visits. 

“We have not gotten clear directives from all of the parties involved,” Donohue explains.

Seeking to plug the holes in its approximately $40 million annual budget, Jordan Health obtained more than $1.5 million in additional aid from the U.S. Health Resources and Services Administration. In addition, the nonprofit received a Payroll Protection Program loan of almost $3.4 million.  

Wagner breathed a sigh of relief when St. Joseph’s received a nearly $190,000 PPP loan. 

“I do not stay awake worrying about money anymore,” she says. 

Not that St. Joseph’s money worries are over. The nonprofit had planned to hold its annual fundraiser in June, complete with a live auction and wine tastings. Instead, it will hold a virtual fundraiser. The event will feature an online auction, speeches and other attractions—and music. 

“We have some musicians among us. We’re asking them to tape some music that we can play,” Wagner explains.

Those who log on will be encouraged to do their own wine tastings—at home. Wagner says she hopes the revamped event will bring in at least $80,000 in donations. Last year, the live, in-person version raised roughly $140,000.

Mike Costanza is a Rochester Beacon contributing writer. All Rochester Beacon coronavirus articles are collected here.