Leader Publications

By JOHN EBY
Dowagiac Daily News

CASSOPOLIS – A physical expansion in the Cass County seat and operational growth in Niles lie ahead of 45-year-old Cassopolis Family Clinic, according to its executive director.
Besides enlarging its 1960 building, Cassopolis Family Clinic plans collaborations with Woodlands Behavioral Health Care and Rite Aid.

The pharmacy program would enable the uninsured to receive prescriptions at cost.
In Niles, “We would like, in the same building we are in now, to create a primary care clinic,” Mary Middleton said. “Currently in Niles, there are no providers who offer reduced fees based on ability to pay. Southwestern Medical Clinic, which is the largest provider of primary care and the largest provider of care for Medicaid patients, is not accepting new patients. There is a need there that we’re going to try to meet,” she advised the Cass County Board of Commissioners Thursday night.

She recalled such prominent Cassopolis names as Dr. Aaron Warren, Tom McCauslin and George Gohn as part of the “group here in town” which established the clinic and recruited physicians.

What is now classified as a community health center separated from Lakeland Regional Health System to be governed by its own 10-member board of directors.
Fifty-one percent of the board must be patients so it delivers “patient-driven” care.
“It’s been under different ownership models,” Middleton said. “We collaborate with (Lakeland) and they still provide some financial assistance.”

What distinguishes a community health center is that “it’s all about creating access to medical care,” she explained. “We serve all of Cass County and southeast Berrien County. We take all payers – commercial insurance and payers other private practices can’t afford to take. We take Medicare for seniors. We take Medicaid for the poor. And we take uninsured. Many private practices don’t do that or, if they do, they ask you to pay the full amount.”

Cassopolis Family Clinic also accepts Berrien County Health Plan cards. “Many people come from Berrien County to our office here in Cassopolis,” she said, “because there aren’t enough providers in Berrien County.”

On-site enrollment is offered for uninsured patients, so they can sign up for Medicaid or MIChild, a low-cost health insurance program for uninsured children of Michigan’s working families. “That coverage is very affordable,” Middleton said.

“We also have a breast and cervical cancer control program, which provides female exams and mammography for uninsured women who are older than 40 and less than age 65. We also participate with Plan First, which is a pregnancy prevention program for uninsured women. We can sign people up for those programs right at our office” built in 1960 at 109 School St., on the corner with N. Broadway by Clisbee Park.

In fact, the clinic sits on village-owned property.

“It was leased practically 50 years ago for $1 a year for 99 years. We’ve approached the village and they’ve agreed to allow us to expand. We’re creating a plan for that. By virtue of being a non-profit, we may actually qualify for grants from USDA (U.S. Department of Agriculture and its Rural Development).”

“One of the great things about a community health center is that we are able, because of federal funding, to offer reduced fees for people who have limited or no ability to pay. Sixty-eight percent of our new patients – three out of five – can hardly afford to pay for their medical care. The number of people in their family and their income qualifies them for our minimum fee, which is $20.”

Cassopolis Family Clinic, besides being an “economic engine”  with its 32 fulltime employees and nine part-time employees between Cassopolis and Niles, “creates access for obstetrical and gynecological services at our office in Niles,” which is located next door to the former Chuck Day music store, across St. Joseph Avenue from the hospital.

“Right now, we take Medicaid and uninsured at that office,” Middleton said. “Last year at that office we provided 543 deliveries. This year, we’re on target to do 600. It’s a very, very busy office. In addition to that, in January we added maternal infant health, a fabulous program that fits hand in hand with obstetrical care. It provides nurses, nutritionists and social workers to work with poor women, homeless women, women on drugs and in abusive relationships – things you and I didn’t grow up with.

“It follows mothers throughout their pregnancy and at risk children until they’re at age. We bill the Medicaid program.”

Middleton said Cassopolis Family Clinic contracts with Southwestern Medical Clinic for obstetrical services.

“We pay the cost of their salaries and benefits, but we don’t directly employ them,” she said.

Community health centers help create what Middleton calls “financially sustainable models for this particular population. We are reimbursed from Medicare and Medicaid patients, which is the big advantage we have over private practitioners’ offices. We also receive a federal grant which gives us dollars to pay our bills for all those patients who can only pay $20 for their care. We have savings in our budget by being covered by the federal tort claims act. Malpractice and liability provided by the government so we don’t have to pay for expensive policies for our physicians we employ.”

There are five such medical personnel, including three family physicians and two nurse practitioners.

In the summer of 2008, the clinic applied for and received special governor’s designation for the second office in Niles.

The office had already opened, but as another practice under the corporate umbrella rather than a community health center.

“Niles, at that time, did not qualify for cost reimbursement. In essence, we told (Gov. Jennifer Granholm) that without this program, women who are poor would have no access to prenatal care,” Middleton said.

A second application made the Niles office part of the community health clinic in April, so “now that site is also cost-reimbursed for Medicaid. Additional grant dollars are in the future.”
Middleton recalled that as part of the American Recovery and Reinvestment Act (ARRA), two stimulus grants were received.

One, an increased demand for services grant, allowed five days to file an application.
“I’m not a grant writer,” Middleton said. “We put our heads together and decided that the best thing we could do for our patients was to collaborate with the health department and refer patients to the dental practice in Dowagiac and pay for that care” at the Donald Lyons Health Center. “If you have no dental coverage, you can go there for $10 and get dental care,” she said.

Then the community health center received almost $463,000 in a capital improvement program grant.

“These grants are based on numbers we submit annually to the government that say how many patients we have and how many are uninsured,” she said. “We plan to modernize our facility. We try to keep it clean despite heavy use, but we’ve never had that kind of money to redecorate or buy new furniture. What a blessing to be able to improve our interior.”