Guilford County's largest comprehensive clinic that serves uninsured residents is closing. 
42-year-old Angelique Drzymala calls the HealthServe Community Clinic a life-saver. She's on partial disability, unemployed and uninsured. Angelique is also an ovarian and cervical cancer survivor but now fears she may now have breast cancer and it won't be caught early.

“The actual mammogram is $485 and if it comes back and they see more spots, I have to have an ultrasound," she says. "You've got the lab person to pay, the doctor to pay and the ultrasound. There's a chance I could have breast cancer but I can't afford to have it checked out.”
Since 2010, the South Eugene Street facility has provided free and reduced health care to Guilford County residents who have little or not health insurance. It's a part of a larger system operated by Triad Adult and Pediatric Medicine, also known as TAPM. At the beginning of this year--the group was operating 7 clinics in Greensboro and in High Point. But three weeks ago, it announced it will close the South Eugene location on August 30 because there is not enough money to keep it going. Brian Ellerby is Chief Executive Officer of Triad Adult and Pediatric Medicine.
“In the last year in a half, we've lost about 2.2 million dollars. That's why HealthServe is closing.” A big part of TAPM's $4.3 million dollar budget comes from Cone Health and High Point Regional hospitals and Guilford County. But this year, Cone Health reduced funding by about $1.2 million because it said HealthServe has not upheld its part of an agreement put in play in 2010. Tim Clontz is Executive Vice President of Health Services at Moses Cone. “They were to fully staff the clinics, which would be about seven physicians. In fact the adult component was down to 1.5 doctors," says Clontz. "They were to also see our out-patients and reimburse us for medical salaries. But we've not been paid since November 2011.”  

According to Ellerby, there are several reasons why the clinic has not paid Cone Health. "The loss of $1.9 million dollars from Guilford County, the state not expanding Medicaid coverage for adults and delays in the use of its new electronic medical record system," says Ellerby. "We lost  between 15-20,000 visits and most of the patients had Medicaid coverage. So we did not have the cash to pay the salaries for pediatric physicians. Nor did we have the cash from Cone to cover the adult side.”  Ellerby says as the staff has learned the new electronic medical system, it has not been able to see as many pediatric and adult patients. It's anticipated 7-8,000 people will be affected by HealthServe's closure.

Clontz says the hospital is still giving TAPM about $2.4 million dollars to cover the salaries for pediatricians at the High Point clinic.  Guilford County Commissioners also reduced its funding by about 1.9 million dollars when TAPM's leadership thought it would get federal funding.

Merle Green is the director of the Guilford County Health Department. She and Clontz are also on TAPM's 13-member board.  According to Green, the staff was responsible in managing the South Eugene Street location and diligently wrote grants to help fund the organization. "But grants go away and are not enough to cover all of the expenses. Also, the cost of providing health care continues to rise. So that equation cannot stay balanced. This problem is not unique to HealthServe. It happens every day, it happens everywhere.” Green also says HealthServe's board has long know its funding sources were not reliable. As a result, Green stresses creative partnerships are needed. Already across North Carolina, 13 counties have merged to create public health service districts. Green says 2-4 counties make up each district--which is able to provide affordable health care to the un-insured and under-insured. Another option is called cross jurisdictional sharing of public health services. And Guilford County has just been awarded a grant to swap services with Cabarrus County. “Cabarrus has a more robust pediatric dental clinic than Guilford does while we can teach them epidemiology because they don't have that service in Cabarrus County," explains Green. She says the incentive is there is grant money giving you access to one another.”
Meanwhile, Tim Clontz with Moses Cone says the hospital is working to create another comprehensive community clinic. Until then, HealthServe has provided a 3-month supply of prescriptions to patients and a list of 13 Guilford County community health providers that offer reduced priced services. One is Cone Health's Urgent Care, but Angelique Drzymala says this is not an option for her. "I've called Cone Health's Urgent Care," says Drzymala. "They want $250 before they will ever see me because I don't have insurance. I can't afford that.” A situation she says most people who used HealthServe will be in.


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