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Rural Health Care Practices: Serving a Region In Need

Rural Health Care Practices: Serving a Region In Need

Dr. Tuckson speaks with Barry Martin, chief executive officer, and Dr. John Jones, DO, chief medical officer, of Primary Care Centers of Eastern Kentucky (PCCEK), who discuss PCCEK's variety of medical services contained in their facilities in Hazard and other towns that treat the rural population in eastern Kentucky.
S15 E16 Length 28:46 Premiere: 2.15.20

Rural Health Care Practices: Serving a Region in Need

Providing comprehensive health care services in rural America is challenging for a variety of reasons, and especially so in the Appalachian region that comprises the eastern third of Kentucky. Treating a population that lives in remote areas and has higher rates of heart disease, diabetes, and certain cancers requires a coordinated program that corrals physicians, technicians, administrators, and other professionals under a framework that prioritizes patient health.

Since beginning in 2003, Primary Care Centers of Eastern Kentucky (PCCEK) has grown to offer health care services in a wide range of specialties at its central clinic in Hazard and satellite clinics in Hindman, Hyden, and Vicco. The Hazard clinic employs four adult medicine doctors, two pediatricians, two OB-GYNs, a family practice doctor, and four nurse practitioners. The overall mission of PCCEK is to serve the entire area population and reverse trends in poor health outcomes while keeping the best and the brightest medical minds from the region working in the region.

“Our efforts are to recruit hometown providers, because eastern Kentucky has a lot of resources, has a lot of smart, intelligent kids that we need to get to come back,” says Barry Martin, chief executive officer of PCCEK.

Centralized Resources – Convenient Access – Improved Health Care

The PCCEK clinic at Hazard also houses dental offices, a program for addiction treatment, an onsite pharmacy, and the Mary E. Martin Diabetes Center for Excellence (see below). It offers extended weekly hours (8 a.m. to 9 p.m. M-F) and is also open on Saturday and Sunday.

“One of the issues we have is transportation, especially in eastern Kentucky,” Martin says. “And having as much as we have on site, it keeps patients from having to come back and forth. Any time we look at expanding into a different service or different program, that’s one of the things we look at, is how to incorporate that into the existing service. We really focus on making it integrated.”

Dr. John Jones, DO, chief medical officer at PCCEK, says that he knows from experience how difficult it is to receive health services in eastern Kentucky when offices are scattered through a region and accessible only through mountain roads. He has four children, and prior to PCCEK expanding, he and his wife would have to drive around and spend extra time accessing different clinics when she was pregnant. Now, they are all available in one building.

In addition to its onsite services, PCCEK also coordinates with Hazard Appalachian Regional Healthcare Medical Center. All PCCEK doctors have admitting privileges at the hospital. This enables most patients to get admitted faster and also continue care when in the hospital with the physician who has been with them from the outset and knows them best.

Jones recalls the experience of a recent patient of his with black lung disease, a common condition in the region. The patient contacted Jones and told him he wasn’t feeling well, and Jones was able to get him a hospital bed at Hazard ARH Medical Center without having to see him for an evaluation first. “We have some hospitalist nurse practitioners that work with us… they picked him up and put him into bed and we got treatment under way without the long ER wait, we took out the step of having him come to the clinic,” Jones says.

This level of coordinated care leads to long-term cost savings, explains Jones. “It’s just a continual check-in,” he says. “And that prevents the thousands of dollars in re-admission fees going to the ER, going to the ICU. It’s well worth the time and the effort and the cost savings.”

“When we look at our numbers for insurance companies and Medicaid and Medicare, our ER utilization is much lower than average, primarily because of our hours,” Martin adds. “One of the things we really focus on is patient convenience. We treat our patients like we are in the hospitality industry. We want to make things easy for them, and more convenient.”

Martin says that two health services PCCEK plans to increase coverage for in the coming years are behavioral health and addiction. Both Martin and Jones agree that Kentucky’s decision to expand Medicaid several years ago to include more of the working poor has helped PCCEK build up its business model and menu of services and, more importantly, helped improve health outcomes for patients in the region.

Expanding Medicaid increased the percentage of PCCEK patients who receive medical care through the government program from 50 to 60 percent, Martin says. But it also decreased the no-pay and low-pay rate for services from 12 percent to around 2 percent.

“Who else do we need to help as much as the working poor?” asks Martin. “(Medicaid expansion) has provided health coverage to them, so I really think we need to strive to keep that going.”

The Mary E. Martin Diabetes Center of Excellence

One of PCCEK’s most vital services is the diabetes care provided at the Mary E. Martin Diabetes Center for Excellence based at the Hazard facility. KET visited the Martin Center and spoke with staff and patients as part of its diabetes initiative.

Approximately 1,500 patients receive treatment, says Mary Collins, DNP, director at the Martin Center. They are able to have their feet checked, have digital retinal screenings conducted on their eyes, access dental services, and get their insulin and A1C testing done. But the staff at the Martin Center also makes the effort to build relationships with each patient and help them manage their diabetes while they are away from the clinic, says Collins.

“Diabetes care management is where we call our patients in between visits,” she says. “A lot of times we’ll find out patients when they come into the clinic, they feel like they’re burdening you if they tell you, ‘I can’t afford my medicine.’ But sometimes when you call them back on the telephone you’ll get, ‘Oh, I went to the pharmacy but I couldn’t pick that medicine up.’ Or ‘I came home and tried everything you told me but my blood sugar is still 300 when I wake up.’ And we’re able to spend that time to troubleshoot and try to fix things before we wait three months.”

Debbie McIntosh, a patient at the Martin Center who has diabetes, praises the efforts made by staff to keep checking up with her and family members who also have the disease. She knows from past history that diabetes patients or those with prediabetes can become complacent, but adds that Collins and her colleagues “don’t let you go so long that you let things get out of control.”

“I’m their diabetic ‘mama,” Collins says. “I’m the mama bear. They will joke and say that I’ll try to hunt them down, but it’s true – if you’re my patient, I love you.”

The team at the Martin Center also works hard to help patients who have difficulty paying for insulin, which can cost several hundred dollars for a month’s supply, as well as other diabetes drugs. They negotiate with insurers and pharmaceutical companies to keep costs as low as possible and, through their status as a nonprofit, also pursue other avenues to obtain funding assistance for patients.

Barry Martin saw up close how devastating diabetes can be from his mother, who had it for 26 years. That experience helped form the impetus to create the Martin Center, he says, in order to help reduce the spread of diabetes in a region already severely affected by the disease.

“One of the things I realized is that we have the making of a of what I call a diabetes center of excellence, and we can do the labs, we can do the foot care, we have the ophthalmologist, we have all the services, we just needed to be able to coordinate it,” he says “When you look at diabetes centers, you’re looking at nutritional counseling, working on the activities of daily living, but what we do is kind of go one step further and do coordination of care.”

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Kentucky Health

About Kentucky Health

Learn how to improve your health through education and increased awareness. Dr. Wayne Tuckson, a colorectal surgeon in Louisville, hosts.

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Medications: A Modern Miracle, But Are They Safe and Available

Dr. Tuckson speaks with Angela Sandlin, PharmD, pharmacy director at Baptist Health LaGrange, about medication safety, availability and effectiveness.

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Otitis Media: Impact on Hearing and Learning

Dr. Swapna Kartha Chandran, an otolaryngologist with UofL Health, talks about the impact of recurrent otitis media (ear infection) on learning and hearing in young children.

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GERD: A Burning in the Chest and a Whole Lot More

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Season 15 Episodes

Catching My Breath: Lung Diseases and Their Causes

S15 E24 Length 27:25 Premiere Date 5.24.20

Pain Management and Treatment of Addiction

S15 E23 Length 26:55 Premiere Date 5.17.20

Intestinal Microbiome: Care and Feeding for Your Health

S15 E21 Length 25:51 Premiere Date 5.3.20

Health Care Networks

S15 E20 Length 27:11 Premiere Date 3.29.20

Diabetes: It's More Than Just Sugar

S15 E19 Length 26:56 Premiere Date 3.22.20

Filling Prescriptions: Why Can't I Just Buy Online?

S15 E18 Length 26:46 Premiere Date 3.15.20

Caring for Patients with Developmental Disabilities

S15 E17 Length 27:03 Premiere Date 2.23.20

Rural Health Care Practices: Serving a Region In Need

S15 E16 Length 28:46 Premiere Date 2.15.20

Pediatric Anesthesia: Making Surgery Easier for Kids

S15 E15 Length 26:54 Premiere Date 2.9.20

Rehabilitation: Getting Back to the New Normal

S15 E14 Length 27:26 Premiere Date 2.2.20

Microclinic: Simple Solutions for Complex Problems, Part 2

S15 E13 Length 27:35 Premiere Date 1.26.20

Microclinic: Simple Solutions for Complex Problems, Part 1

S15 E12 Length 27:26 Premiere Date 1.19.20

Changing Curriculum to Meet Unique Patient Needs

S15 E11 Length 27:14 Premiere Date 1.12.20

Colon Cancer: Can We Prevent Unnecessary Deaths?

S15 E10 Length 26:56 Premiere Date 1.5.20

Infections and Other Urinary Tract Problems

S15 E9 Length 27:02 Premiere Date 12.15.19

Health Insurance for All: What Does It Mean?

S15 E8 Length 27:50 Premiere Date 11.24.19

Huntington's Disease

S15 E7 Length 28:42 Premiere Date 11.17.19

Natural Approaches to Health and Nutrition

S15 E6 Length 26:52 Premiere Date 11.10.19

Vaping, E-Cigarettes and Kids: Not a Good Mix

S15 E5 Length 27:37 Premiere Date 11.3.19

Breast Cancer: Determining Your Risk

S15 E4 Length 27:36 Premiere Date 10.27.19

Cystic Fibrosis: Improvements in Outcomes

S15 E3 Length 26:53 Premiere Date 10.20.19

Rhinoplasty: Looking Good, Breathing Better

S15 E2 Length 27:42 Premiere Date 10.13.19

Child Psychiatry

S15 E1 Length 27:15 Premiere Date 10.6.19

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