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Pardee clinic affiliates with BRCHS

Pardee Hospital's family practice center on the hospital campus will become a Blue Ridge Community Health Services clinic on Monday in a move that hospital leaders say preserves a valuable residency training program, saves Pardee money and expands access.

The Hendersonville Family Health Center in the Pardee Medical Office off Oak Street west of the hospital will keep its name, its doctors and staff. The personnel will become Blue Ridge Community Health Services employees on June 1. On Monday the clinic "will reopen as a teaching health service affiliated with Blue Ridge Community Health Services," Pardee CEO Jay Kirby told the Pardee Hospital board Wednesday.
The change culminates a nine-month process to restructure the Hendersonville Family Medicine Residency Program, a joint program of Pardee and the Mountain Area Health Education Center of Asheville, and join it with BRCHS.
"I think what we've seen with this collaboration is not only a productive and collaborative effort by three providers but also an increase in residents trained in this region, an increase in primary care" and lower costs for the hospital and patients, Dr. Robert Kiskaddon, Pardee's chief medical officer, told the board.
The agreement with BRCHS and MAHEC caps Pardee's annual cost at $250,000.
"When the subsidy got to more than $1 million, to $1.4 million, we were having serious discussions over eliminating this residency program," board chairman Bill Moyer said. "When you look at the significance of this change, it preserves the program and enhances it and it limits our exposure to $250,000 a year."

Dr. Shannon Dowler, the chief medical officer of Blue Ridge and currently the president of the North Carolina Academy of Family Practitioners, said the collaboration has created a model of a teaching health center that will train primary care physicians to serve the uninsured and underinsured population.
"If you train residents in the setting of a rural community health center they're much more likely to pursue a career serving that population," she said. "It's a very cool opportunity for each of our organizations but also for our entire community."
The organizations got a federal funding to increase the number of residents from three to four per year. Half will train at the Hendersonville Family Practice clinic and half at BRCHS.
"All of their hospital rotations will remain at Pardee," she said. "It's important for patients to know that the Hendersonville family health center is staying where it is with the same doctors and same procedures."
Clinics and hospitals are ramping up efforts to train more primary care doctors in advance of the Affordable Care Act, which is expected to create a pool of before-now uninsured patients. Although North Carolina's governor and Legislature refused to expand Medicaid coverage as the federal law offers, the number of covered patients is expected to increase starting in 2014, Dowler said.
"I think once North Carolina expands coverage and we have more patients, having this expanded (physician) work force is going to be very important for our community," she said.

The director of the MAHEC residency program said the three-party agreement should help training and potentially expand the primary care options.

"It allows to bring an extra resident into the program, which is great because we're small as it is," said Dr. Geoffrey Jones, the MAHEC residency program director. "My job is to recruit residents into the program and there's a lot of interest in working in an underserved setting. So they're really interested in this model and we've had great success" recruiting a strong class of doctors in their final three years of practical training.
Joining the Blue Ridge clinic with the Hendersonville Family Health Center enables the residents to gain a broader experience.
"We're trying to balance the benefits at each side," he said. "It's doubling our ability by highlighting the best of both worlds."
As a clinic qualified under law to serve the needy, Blue Ridge is able to get more money for services than Pardee.
"They've got a long list of requirements they have to meet but as part of that they get special reimbursement rates for Medicaid patients," said Kris Peters, the chief strategy officer for Pardee. "Their reimbursement rates are better than the hospital would get for the Medicaid patients."
Both the Hendersonville Family Center and the Blue Ridge accept all patients, from insured patients to sliding scale to the uninsured. As those patients become covered — either through Medicaid or lower-cost insurance policies offered through the Affordable Care Act — the clinics should see more income, Peters and Jones said.
"Anybody who goes from being uninsured to Medicaid or covered by the exchange still provides more reimbursement than the nothing that many of them are getting now," she said of the providers.
As part of the restructuring, MAHEC faculty "got raises they had not seen in five years," Kiskaddon said. "There was a great effort in the restructuring to bring the Blue Ridge salaries in line with MAHEC."
Blue Ridge, a federally qualified health center that serves the poor and uninsured, and county-owned Pardee are adding more partnerships as both providers adapt to the requirements of the federal Affordable Care Act.
"We hope to increase our working relationship with Blue Ridge," Kirby told the board.