Nan's Donuts, located in Sugar Valley in central Pennsylvania, is open only on Wednesdays and Saturdays. That's why Don Lynch parks his Evangelical Community Hospital mobile clinic in the parking lot of an adjacent Amish grocery store on the first Wednesday of every month.
Nan's Amish Bakery offers more than 40 varieties of donuts, including seasonal flavors like pumpkin streusel, to tempt the sweet tooth of valley residents far beyond Loganton's town limits.
Loganton has a population of only 463 people. However, Nan's has about 1,600 followers on her Facebook page.
Lynch, a paramedic and the hospital's mobile coordinator, is trying to capitalize on Nunn's traffic to attract rural residents for free preventive blood tests. The hospital itself is 30 miles to the east, a daunting journey for the elderly and those traveling by horse and buggy.
The use of mobile health clinics has exploded during the COVID-19 pandemic. This was also facilitated by the need to reach patients in decentralized locations outdoors and by the trillions of dollars in federal aid that Congress poured into the economy. In rural areas, mobile clinics often replace dwindling preventive care networks, keeping patients healthy and avoiding emergency rooms.
Next year, the 2022 law will also authorize further expansion of mobile clinics. But Congress would need to fund it first.
Pennsylvania is home to the largest Amish population in the country, with approximately 90,000 people living in 61 reservations within the state. according to Young Center for Anabaptist and Pietist Studies at Elizabethtown College.
Evangelicals' presence in established communities is important for reaching the region's large Amish community, which generally avoids the use of modern technology and may be skeptical of modern medicine. Additionally, Amish people often do not have health insurance, which can make medical costs too high for them to afford.
The hospital set up a mobile clinic before the pandemic. This month, Mr. Lynch visited 24 of his clients in Loganton. This is almost three times his usual attendance, even though it was snowing. He estimated about seven people were Amish.
The hospital's community-based approach is evident in the number of Amish patients it serves, Lynch said.
“But there's always hesitation,” he added.
Mobile medical treatment boom
Evangelical purchased the mobile clinic in 2018 with a combination of philanthropic grants, local businesses, and funding from the Amish and Mennonite communities. When the pandemic hit, there was a flood of demand for mobile devices, leading to waiting periods of up to two years, administrators and industry representatives told his CQ Roll Call.
The battle centered on the nation's 1,377 federally qualified health centers that received $6.1 billion in funding from the March 2021 COVID-19 Assistance Act. Centers had until March 31, 2023 to disburse the funds, but many received extensions. Steve Messinger, policy director for the Nevada Primary Care Association, said spending $500,000 to build a new mobile clinic is a good use of money.
This, coupled with loose new restrictions on funding for mobile clinics set to take effect in January, is pushing mobile health care into a new era. Messenger worked with Nevada Democrat Jacky Rosen in the Senate and Susie Lee in the House to craft the 2022 legislation.
“Innovation is about to explode,” he said.
In January, health centers will be able to request federal funding for new mobile units without having to open additional brick-and-mortar clinics. This is a change from previous legislation. However, no Health Resources and Services Administration “New Access Point” grants have been awarded since 2019. And while the Health Resources and Services Administration previously predicted new funding would arrive this month, Congress is still fighting over spending for fiscal year 2024.
HRSA required: over $5 billion In President Joe Biden's fiscal year 2024 budget request for the grant, he noted that in 2019, only 75 out of 550 applications were funded.
Nevertheless, Covid-19 funding helped fuel the boom. The Mobile Healthcare Association saw a 30% increase in 2023, following a 21% increase in 2022, according to executive director Elizabeth Wallace.
The benefits of mobile health have become increasingly apparent during the pandemic.Wallace pointed to study The experiment in Loma Linda, California, demonstrated the success of mobile clinics and mass vaccination events in delivering COVID-19 vaccines to Black communities.
“Mobile Health has a proven track record of reaching vulnerable populations,” she said. “Reaching out to people who don't want or can't access traditional health care.”
Jana Eubank, executive director of the Texas Association of Community Health Centers, said interest in mobile clinics has increased during the pandemic, but wait times for one can be up to a year.
In Texas, growth is concentrated in rural areas where hospital closures are increasing. Maternal mortality is a major concern, with some women driving hours just to go to the emergency room. Not even a hospital with a maternity ward.
Health centers, rural clinics and emergency rooms are “almost a safety net,” she said. Eubank said health centers often partner with hospitals to reduce unnecessary emergency department visits and fill gaps in care, and mobile clinics help expand their reach.
“We are all in this together,” she said. “And we have to find ways to maintain that infrastructure in communities that are really in need.”
parts backlog
Mobile clinics typically range in size from vans to recreational vehicles, and are usually built from the shell of an American-made car or RV.Recent delays are due in part to a backlog of shells, but Wisconsin-based CGS Premier avoided the worst of the disruption by maintaining its own inventory.
The company manufactures “drop trailers” that are lower to the ground for easier patient access, and is interested in increasing curb appeal and other exterior touches to improve the patient experience. is increasing.
President and CEO Greg Peterson said orders have tripled since March 2020, with a focus on reaching underserved areas such as tribal lands. . Clients such as Eli Lilly and Co. are also using them to conduct decentralized clinical trials to reach more diverse patient populations, and Molina's Health Care Co., Ltd. We used them to respond to tornadoes.
“The governor called me and said, 'We need a clinic,'” Peterson said. “We need a base. People need to get their prescriptions filled.”
Disadvantage
Mobile clinics are not the cure for this country's myriad medical problems. You still have to staff it, maintain it, drive it from place to place, and that takes money and people. Both are often in short supply in rural areas.
Placing a clinician in a mobile unit typically results in one fewer clinician at the main hospital or health center. And in many rural areas, he is often the only doctor available, even if there are practitioners in each specialty.
Nor does the existence of mobile clinics automatically attract skeptics. Lynch sometimes goes outside his RV to try to recruit smokers to stay around his Pennsylvania clinic, but he is usually ignored.
“People just say, 'You're going to die because of something,' and people don't care, they don't even come to see it,” he says.
But progress is often measured in modest increments. Lynch said foot traffic continues to improve, with more and more repeat customers.
Dawn Jeffries, community liaison for Sugar Valley Rural Charter School, helped coordinate monthly visits to the evangelical Nan's home. The school district's recent decision to close local schools was a blow to the town, making the need to strengthen its community base especially acute.
“At that time, our community was divided,” she said. “It's getting better, but it still doesn't feel the same.”
Last year, Jeffries also brainstormed a winter festival that would bring together local businesses and community organizations to give away free food, cocoa and sleigh rides to valley residents.
This year, we saw an increase in participation due to word of mouth, and we're seeing a similar effect with our mobile clinics.
“The fact that they're talking about it and the fact that it's out there and the knowledge is out there is a good thing,” she said.
