Health Forward Foundation

HCC Updates, Increases Services at a Rural Missouri Clinic

WAVERLY, Mo. — Thirty-some years ago, Dr. Gene McFadden and his medical partners built a squat primary-care clinic that housed six physicians and a dozen exam rooms.

The clinic still operates in this town of fewer than 900 residents, an hour and a half drive northeast of metropolitan Kansas City. Row crops and orchards of peaches and apples line the hilly, two-lane highways in this part of Lafayette County.

McFadden, 84, is now the only physician at the clinic, but it’s in the midst of a rebirth.

The Health Care Collaborative of Rural Missouri (HCC), a 6-year-old nonprofit organization serving Lafayette County and surrounding areas, is now operating the clinic as a Live Well Health & Wellness Center.

Situated as it is in such an isolated area, the clinic has always provided safety-net care to area residents, said HCC Executive Director Toniann Richard. But now, she said, “The safety-net services are much more intentional.”

The collaborative took over operation of the clinic on June 1 from Lafayette Regional Hospital in Lexington. The hospital still owns the building, Richard said, but HCC is running the business side.

She said the collaborative has made about $10,000 worth of capital improvements to the building, and it expects to spend at least $120,000 more in the next year on renovations and equipment.

Nurse practitioner Ashley English is already on the job, and Richard said Pathways Community Health, a nonprofit community mental health center, should begin providing behavioral health services on Tuesday.

She also hopes to have a dentist on board by mid-October, which she said would make the clinic the second dental provider in a four-county area that accepts Medicaid.

Richard said a dentist and hygienist could probably schedule about 3,800 appointments a year, and that all the patients in the first year likely would be Medicaid children.

HCC also expects to provide childhood vaccinations and well-woman services at the clinic.

Tom Emerson, administrator of the Lafayette County Health Department, said he was happy with all the changes underway at the clinic.

“That’s kind of a far corner of the county,” he said. “I think it’s going to improve access all the way around.”

HCC is taking on the clinics as it changes its business model. It is moving from an organization that largely coordinated services for low-income individuals to one that is now a direct service provider.

By early next year, Richard said, HCC hopes to earn certification as a federally qualified health center, which would allow the clinics to earn an extra 1 percent Medicaid reimbursement to help cover the cost of serving the uninsured.

Becoming a direct provider, she said, “was a business decision to keep the organization viable.”

HCC is almost entirely grant funded now.

But, Richard said, public and private insurance reimbursements likely would make up about half of the $2 million in annual revenue projected with the new model.

HCC anticipates about twice as many patients will be served at the clinic, though it’s unclear, she said, how many patients the clinic has served in the recent past.

The pairing of McFadden and English is a melding of generations.

English, 27, just passed her state board exam after earning her master’s degree at the University of Missouri-Columbia. Prior to that, she spent five years as a registered nurse in the intensive care unit of Saint Luke’s Hospital on the Country Club Plaza.

McFadden has been a doctor since 1959, and except for the first two years of his career, has practiced in his hometown of Waverly.

McFadden said he didn’t consider himself a mentor any more than he considers himself the boss of the other clinic employees.

“They don’t work for me. I don’t work for them,” he said. “We are a team.”

But English said she appreciates the opportunity to observe how McFadden interacts with patients.

“I think we kind of complement each other in past and present health care,” she said.

English said she wanted to work in a rural setting.

“I just want to be available to people who don’t have easy access to a health care provider,” she said.
McFadden said he was happy the clinic could provide better service to the itinerant workers employed in the orchards.

He said he doesn’t plan to slow down anytime soon.

He’s healthy, he said, and, “They tell me I’m alert.”

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