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In South Jersey, New Options For Primary Care Are Slow To Take Hold

Apr 03, 2013

Camden, New Jersey, has serious health problems, with too many people going to local emergency rooms unnecessarily. But progress is being made – albeit slowly.

John Pike, age 53, is an example of a Camden resident who used to be a frequent flier at the ER. Pike has a smoker's cough, and when that cough, or pain in his bad hip flared up, he'd go to the ER -- maybe eight or nine times a year. But when he did, ER staffers didn't really remember him or his medical history.

"You get to feeling you are irritating them," he says. "It would be a simple problem. I'm wasting their time where they could be dealing with a real emergency."

Once, he says an ER nurse pulled him aside and said, “This is something your doctor can deal with.”

"Not much I could say, because she was telling the truth," he says.

But Pike didn't have a primary care doctor until a community group called the Camden Coalition of Health Care Providers opened a doctor's office right inside Pike's apartment building.

Ken Gross, the director of research and evaluation for the coalition, says the idea was to get "super users" like Pike to stop going to the hospital so frequently.

Gross says the group saw ER overuse in Camden as "a sign for us, from the data, that you don't have a source of primary care, or you have a loose relationship with primary care or you can't get an appointment with your primary care because of your work hours." 

Gross leads a team of health-data detectives at the coalition. For several years they gathered hospital billing information from across Camden. Then they mapped the data block by block.

It turns out that John Pike's building is marked as a bright-red "hot spot" on the map. John and his neighbors at the Northgate II building had been racking up more than $1 million a year in hospital admissions and trips to the emergency room for about a decade.

Dr. Madhumathi Gunasekarn examines John Pike at the Northgate II clinic in Camden. Pike is one of over 100 residents of the apartment complex who make the clinic their primary care provider. (Photo by Emma Lee for KHN)

These days, Pike rides an elevator to the doctor, just six floors down from his apartment. The space is bare bones, with just two exam rooms and a tiny file office, but Pike has his own doctor now. Her name is Dr. Madhumathi Gunasekaran.

"I feel comfortable with her. I can talk to her; she doesn't shove you off like some doctors," Pike says.

Dr. Jon Regis is a longtime member of the Camden coalition. His company, the Reliance Medical Group operates 21 offices across New Jersey, including the practice at Northgate II. The subsidized housing there is home to many low-income seniors and people with disabilities. Many people who live in Northgate II now see Dr. Gunasekaran for check-ups and other medical issues. But Regis says it took longer than he hoped to win over residents -- almost two years.

"We thought that since they were having such a difficult time, we could just open up the door and they would come down. That wasn’t the case," he says.

Regis says some residents told him that they didn't want their neighbors to know they're going to the doctor. But Regis was persistent in trying to get residents to use Dr. Gunasekaran instead of the ER.

"We had to do a number of different things, like health fairs and meet-and-greets. We had to engender a sense of trust in the residents before they would come down to see us. I think that was somewhat surprising. But we're starting to get past that now," he says.

About a year ago, only about 80 people got their primary care at the office. That number has grown to nearly 130 or about 19 percent of the building's residents. It was a slow start, but Regis is pleased with the progress.

Reliance uses revenue from private pay and private insurance patients at other office locations to help finance the clinic at Northgate II. This way, he says, "We don't have to turn anybody away, and we've been able to make this work."

This story is part of a reporting partnership that includes WHYY, NPR and Kaiser Health News.

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