Barring a last-minute windfall, the primary care clinic at Northern Virginia Community College’s Springfield medical campus will close at the end of August.
When the clinic opened three years ago, "it seemed like a win-win-win for everybody," said college President Robert Templin. The hope had been that the clinic would help solve a dearth of health care in the region, give the campus’ students hands-on experience with working professionals and provide health care for those who might not otherwise be able to afford it, particularly the area’s uninsured immigrants. Templin pointed out that many of the people the clinic serves would likely have ended up in the emergency room.
"It’s a great program. It’s just a shame that it ran out of funds," he said. The clinic has been running on a $500,000 grant from the Robert Wood Johnson Foundation and matching funds from various non-profit organizations. Templin said the plan had been for the clinic to eventually become self-sufficient by mixing paying customers with those who were unable to pay. However, he said, what the clinic found was that the volume of clientele it would have had to serve was more than it could have accommodated.
The case load also never came close to the 25,000 office visits per year that were originally expected, with patient visits ultimately topping off at less than 7,000 in one year. Templin offered several reasons for this shortfall, one being the building’s location. Although it is not far from Springfield Mall, the campus is in a somewhat remote area, behind the General Services Administration building and hundreds of yards from any through-streets, so that it is not easily accessible without a car.
Also, the few clients that the clinic has "lead very fragile lives," in which transportation, childcare and even jobs and housing are often precarious, he said. "Our experience was that they would only show about half of the time," said Templin. Finally, he said, "our marketing and outreach was not all that aggressive."
However, he pointed out that even if the clinic had reached its peak capacity, it still would not have been able to support itself because of a low ratio of paying customers.
THE CLINIC also might have partnered with another organization that was concerned with affordable health care, but it was unable to find any takers. Templin said the Washington, D.C.-based Mary’s Center for Maternal and Child Care considered such a partnership, "but they estimated that their expenses would be too high."
At this point, he said, the only hope is last-minute funding from the state legislature, granted before Aug. 1.
"I think the lesson learned was that we would need a sustainable revenue stream at the beginning and not just a grant," said Templin, adding that this may not be the last attempt at such a clinic. It’s possible, he said, that a unit of government or a nonprofit organization would partner in a future project, or, alternately, that local hospitals would find it cheaper to support such an effort than to treat the clinic’s clientele in the emergency room. "Somebody’s going to pay," he said. "It’s just a matter of who or where it’s going to happen."
"The reality is that the need is much greater than anybody is willing to provide affordable access for," said Templin, adding that this need will be "a growing problem for our region," with the continuing influx of immigration.
Supervisor Dana Kauffman (D-Lee) called the clinic's situation a problem that defies an easy fix. He said he raised the issue at the last Board of Supervisors meeting and is waiting to hear from staff to see if there is any way the county can help. The problem of treating uninsured immigrants, he said, is generally not a question of whether they are here legally, said Kauffman. "The issue is a number of people living in this area who have been working jobs for a number of years that don't include health insurance."
He said the clinic was an effective solution to the problem. "And we'll see if we can keep it."
THE CLINIC was not bustling late on Tuesday afternoon. Quentin Davenport, 16, had been brought in for a physical by his uncle, who is in the process of gaining custody of his nephew. Davenport was previously insured by Medicaid through his mother, but without insurance, he was referred to the clinic by the Health Department. He was uncertain where he could have gone in the clinic’s absence. "I don’t think it should close if it’s helping people who don’t have insurance," he said.
Teresa Mendez of Alexandria said she had been coming to the clinic for the past two years and was still unsure where else she could get treatment without health insurance. "I really need to be checked out because I have high blood pressure," said Mendez. She said she comes to the clinic about once every three months.
The clinic has begun handing out literature about other providers of affordable health care in Northern Virginia. However, many offer limited services, serve only residents of their respective areas or have income and citizenship requirements. The Northern Virginia Community College clinic, meanwhile, has served anyone lacking health insurance, regardless of residency or income and without asking about citizenship.
Although the primary care clinic may not have worked out, Templin noted that the dental service also housed on the campus is "doing great." The dental office received a grant from the county and charges clients on a sliding scale. "So uninsured people who need dental care can get it there for a nominal price or for free, depending on their income," he said, noting that with 32 chairs, this is the largest dental clinic in the Washington region.