From solo practice to community clinic
"My practice is small and it's not likely I'll be able to recruit any one to replace me. I'm not ready to leave but I have to start thinking about it," he said. "It's hard to find new medical students who want to come to a small town and try to make a living based on how busy they want to be."
The answer lies in transforming his present office, known as the Arlington Family Practice, into a federally qualified community health center. This center already has a name - the Battenkill Valley Health Center - plus a board of directors, which voted Monday, Feb. 25, to authorize a fund-raising campaign with a goal of bringing in about $600,000. This would be enough to open the doors of the new not-for-profit clinic, which could offer an expanded array of services that would include dental care, pharmaceutical and mental health services, alongside the traditional physician practice, said Mary Ann Carlson, the chairwoman of the clinic's board of directors.
About $150,000 has already been raised. Their goal is to get the clinic up and running within the next six months, she said.
Once the clinic has opened its doors and has an established track record, the directors plan to apply for eligibility for federal reimbursement as a health center "look alike" designed to serve federally designated communities deemed to be medically underserved. The Arlington-Sunderland-Sandgate area is one such underserved area, and the only one in Bennington County, Carlson said.
According to the U.S. Department of Health's Web site, a "look alike" health clinic is designed expand public access to quality primary care services consistent with all statutory requirements, but does not receive ongoing federal funding. What is gets instead is some federal reimbursement in cases where a patient does not have private insurance or coverage through programs like Medicare or Medicaid.
Such "look-alikes" allow for added federal reimbursement for an expanded range of services, obtaining such status does not involve the competitive grant applications that occur with securing a designation as a federally qualified health center, Carlson said.
The "look alike" clinic is however, only an interim step. Eventually, the board hopes to complete the clinic's transition to a fully federally qualified community health center, she said.
"We're looking at a time line of about three years and we understand that to do the initial look-alike application we'll have to be up-and-running," she said. "The state (of Vermont) has been open (to this) and they want these centers - they dovetail with where the state is going in healthcare policy." At present, there are eight other such community health centers which operate a total of about 40 satellite offices. Bennington County is the only one in the state without at least a satellite office, Welther said.
Right now, there are three organizations around the state, including the Arlington-based Battenkill Valley Health Clinic, who are hoping to secure 'look alike" status. The other two are in Bristol and Randolph, said John Olson, the chief of the state office of rural health and primary care of the state's Department of Health.
The state has distributed about $110,000 to the Battenkill Valley Health clinic to help it undertake obtaining the "look alike" designation. This money goes towards legal work, preparing transfer of ownership documents and the like, he said.
"There's significant work to do in the transition," Olson said. "The state is in full support of ensuring that a range of health services are available to all Vermonters in all counties. Working with practices like Dr. Welther's and the Battenkill Valley Health clinic are ways of ensuring the delivery, access and sustainability of healthcare services for the long term."
An earlier attempt Welther launched about two years ago to transition to community health clinic foundered when the competition for federal dollars need to make the transition proved extremely intense. Even with strong support from Sen. Bernie Sanders - whose support for the initiative has been steady and ongoing, Welther said - only one application for such a clinic was approved at the time across all of New England, he said.
Yet at the same time, the shortage of doctors interested in working in rural areas when they leave medical school and hospital residency programs with substantial debt to be paid off, alongside an aging population such as Vermont's, pose challenges for small practices such as his, which has been treading water financially in recent years, Welther said.
"My practice can't survive for long in the current situation - reimbursements are being cut left and right," he said. "For primary care it (a community clinic) may be the last, best hope."
The important thing for area residents he currently serves to understand is that he is not going anywhere or planning to retire in the immediate future, and that their primary health care needs will continue to be met by his practice, and then by the nonprofit health clinic, Welther said.
"The idea is to broaden access," he said. "What has to happen is the (nonprofit) board has to take over the practice."
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