Poor New York City neighborhoods get funds for primary care sites
NYC Funds / Primary Care
New York City will soon see a substantial boost in primary care capacity in some of its most underserved areas.The not-for-profit organization, Primary Care Development Corporation (PCDC), is leveraging funds for the construction of some 30 new or expanded primary care centers in 25 medically underserved neighborhoods.
One of the goals of the PCDC is to improve readiness for managed care in New York City, says executive director Ronda Kotelchuck. Applicants must have managed care contracts, managed care plans or participate in managed care. "That’s one of the things that we look for before we fund expansion projects," says Ms. Kotelchuck.
Created in 1993 as a unique public-private partnership to spur primary care development, PCDC has been embraced by city officials because it addresses primary care need without cost to the local government.
PCDC provides no-interest development loans and capital funds to community-based primary care practices and hospitals, which often have nowhere else to turn for financing. Financing for expansions come from a variety of sources including bond financing, commercial loans and from private donors. Currently, 12 corporations have donated funds. The City guarantees loans to the amount of $250 million. PCDC uses a $17 million revolving loan fund from the City for pre-construction planning and development (architect fees, feasibility studies and the like). Clinics repay the bond financing over 25 years.
"Many of us without big bottom lines can’t really get the funds on our own," says Maxine Golub, senior vice president for planning and development for the Institute for Urban Family Health, who credits PCDC financing for making it possible for the Institute to expand its network of family health centers. "If the (state Medicaid) waiver is going to be effective, there needs to be more primary care, and this is one way this can be done."
"PCDC has really been wonderful because they’ve educated the banks and helped them to get a better handle on risk," says Ms. Golub. In May, the Institute and its community partner, St. Edmund’s Episcopal Church, broke ground on a new $2.5 million, 5,175 square-foot family practice facility facility in the West Tremont section of the Bronx. The Institute currently runs a network of nine small family practice centers and its own small managed care company.
Some observers are less enthusiastic. Although they welcome the effort, they see it as limited in scope. "What’s missing, which is equally important, is that there are primary care physicians to take care of the uninsured," says Judy Wessler, spokesperson for the Commission on the Public’s Health System, a community-based advocacy group formed to oppose privatization and strengthen the public system in New York.
PCDC funds are used solely for facilities and do not cover physician costs. "We were very concerned from the get-go about that," Ms. Kotelchuck says. "In fact it hasn’t turned out to be a problem." Not one of the organizations have had trouble attracting physicians, Ms. Kotelchuck adds, perhaps because they can attract physicians with state-of-the-art facilities.
In selecting sites for primary care expansion, the PCDC has focused on 25 New York City neighborhoods that were flagged as sorely in need of primary care providers by the former Health Systems Agency in the early 1990s. PCDC now has 12 projects in construction, with one recently opened in Staten Island (the St. Vincent’s Medical Center of Richmond/New Brighton Family Health Center). All told, projects now in construction will add capacity for another half-million annual ambulatory care visits in New York City, says Ms. Kotelchuck.
PCDC initially set a target for another million primary care visits, but it plans to re-evaluate that goal because even that target may be inadequate, she warns.
The first bond sale in September 1996 generated $26.1 million at a low 5.45% interest rate. "We were able to get three major projects off the ground with those funds," says Ms. Kotelchuck. Settlement Health & Medical Services in East Harlem plans to consolidate and expand its operations at one site, permitting an additional 38,000 visits. Mary Immaculate/Catholic Medical Center in South Jamaica/ Queens will build a new facility it estimates will handle over 47,000 new yearly visits. The Community Health Project, a gay and lesbian primary care clinic, is relocating and expanding, adding capacity for another 47,000 annual visits.
Another $17.5 million raised through a second bond sale in March 1997, pushed another eight new ambulatory care facility projects onto the drawing board, says Ms. Kotelchuck. The new centers include one at Lutheran Medical Center in Sunset Park Brooklyn; an adult day care center to enroll homebound frail elderly at Beth Abraham Diagnostic and Treatment Center Bronx and Lower East Side sites; Narco Freedom in the Mott Haven section of the Bronx, Jamaica Hospital/ Neighborhood Health Providers in East New York and Cypress Hills/ Brooklyn; the Institute for Urban Family Health/St. Edmund’ Episcopal Church; and Community Family Planning Council/ Helen B. Atkinson Health Center in Harlem.
Three more projects are slated to begin construction in the second half of 1997: the consolidation of the Urban Health Plan in the Morrisania section of the Bronx; renovation of Union Health Center in Chelsea are of Manhattan; and renovation and expansion of the Community Family Planning Council sites in Bushwick and Williamsburg, Brooklyn.
Poor New York City neighborhoods get funds for primary care sites
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