In-school health clinics not only meet the health-care needs of students and staff, but also their families

School-based health clinics in Kentucky could become a trend,  especially as the state searches for solutions to meet the health care needs of schools as budgets for school nurses continue to be slashed.

Southern Kentucky has Cumberland Family Medical, based in Burkesville, which has clinics at the five schools in Russell County and a deal to do likewise with the four in adjoining Adair County.

Western Kentucky has three such clinics, with two more likely to open next year, Genevieve Postlethwait reports for The Paducah Sun. 

The clinics are at McCracken County's Reidland Middle School, Lone Oak Elementary School, and Paducah's Morgan Elementary. Next school year a full-time clinic will open in McCracken County High School, hopefully followed by a clinic at McNabb Elementary.

These clinics exist as a partnership between Mercy Medical Associates and the local public school districts; the school districts supply the space, Mercy supplies and staff and the Lourdes Foundation helps with funding, Postlethwait reports.

An advanced practice registered nurse with Mercy Medical, Julie Higdon, said she has seen well over 30 patients at the Lone Oak clinic since it opened in mid-April. "That's not busy by ER standards," she said, "but that's busy for a little clinic that's just softly opened."

The clinics serve the entire "school family," from the students and their parents and siblings to the districts' teachers, staff and administrators, regardless of their ability to pay. "Their goal is to give the community the preventive, acute and critical health care it needs while reducing students' and teachers' time away from school, and parents' time away from work," Postlethwait writes.

"It's a big deal when you start talking about dollars and cents, too," Tennille Rushing, director of clinical operations for Mercy, told Postlethwait.  "Not only in the impact for the schools to have kids staying in the classroom and helping with attendance numbers, but for parents. If you only have a limited number of days that you can take off, and you have to take off half a day to go sit in a lobby somewhere with your child, you've missed a half day of pay."

These clinics will also help those without a primary-care provider, which are in short supply in the Paducah area. The Lone Oak clinic will remain open by appointment only this summer.

"I feel like these clinics really have the potential to meet a need for the community," Higdon told Postlethwait. "I feel like it has great potential to grow, I really do." (This story is behind a paywall.)

Southern Kentucky physician expands his in-school clinics; already in Russell County, will be in Adair County next year

Dr. Eric Loy
(Columbia Magazine photo)

An entrepreneurial physician in Southern Kentucky has developed a way to deliver school health services that could have a broader impact on communities.

Cumberland Family Medical, based in Burkesville, has clinics at the five schools in Russell County and now has a deal to do likewise with the four in adjoining Adair County.

Dr. Eric Loy, who owns the clinic, "said that the agreement could have an important impact on the community both short term, by helping create a healthier and more focused student body; and long term, by creating a culture where people get acclimated to seeing doctors and nurses for physicals and regular checkups on a consistent basis," Wes Feese reports for The Adair Progress.

“We have a chance to change the culture of health care in Kentucky,” Loy told the Adair County Board of Education, which voted to spend $80,000 next year on the clinics. That is "roughly the same cost the district currently pays for school nurses," Feese reports. "If the trial run next year is successful, both parties will have options to continue the agreement."

"Cumberland Family Medical will pay two-thirds of the nurse expense and will bill the insurance of the patient," Toni Humphress reports for the Adair County Community Voice.

School Supt. Alan Reed complimented the dedication and service of the county’s school nurses but said costs to employ them were “soaring,” Feese reports. Reed said of Loy's plan, “This is kind of a novel approach, and from all we’ve seen, we really like it. It cuts down on time and any barriers for a kid getting health care.”

Loy agreed, saying, “A lot of times that’s the barrier, that it’s hard [for parents] to miss work.”

School principals said sick students may have to sit in an office or lobby all day because working parents are unavailable to come pick the students up and take them to a doctor. "Director of Pupil Personnel Robbie Harmon said that this move could have a bigger long-term impact on the community than any project he’s worked on in his time in the school system."

Loy's in-school clinics are manned by a full-time nurse practitioner who travels between schools, and is overseen by a physician. "Loy said that all forms of insurance would be accepted, and that all children would be seen and treated, regardless of their ability to pay," Feese reports. "He also said that the clinics could help out with insurance enrollment."

Adair County had one of the state's highest percentages of people without health insurance until the federal-state Medicaid program was expanded under federal health reform. The uninsured rate has dropped dramatically, but some families are still without health coverage.

Ten-county Lake Cumberland District Health Department is the latest to ask schools to foot more of the bill for school nurses

The Lake Cumberland District Health Department told school districts in its 10-county area in December that it would no longer be able to pay for nurses for each school, setting off negotiations with the districts.

Somerset Independent Schools Supt. Boyd Randolph said one option would have the schools employ the nurses but contract them back to the health department in order to bill for the full extent of Medicaid services, Chris Harris reports for The Commonwealth-Journal.

Health Department Executive Director Shawn Crabtree told the Somerset newspaper that his agency was "running a deficit" because it wasn't being paid as much for treating Medicaid patients. 

Schools all over Kentucky have been faced with this "unfunded mandate," as Editor Stevie Lowery called it in an article for the The Lebanon Enterprise. If a student requires medical care in order to attend school, state law requires school districts to provide the care, but doesn't necessarily provide a way to pay for it.

The dwindling number of school nurses last year prompted a new law to allow school personnel who aren't licensed health care professionals to administer or help a student self-administer insulin and otherwise treat diabetes symptoms if they take certain training.

Surrounding Somerset, each school in the Pulaski County School District has its own in-house nurse, as does every school in the regional health department's coverage area, with the cost shared by the school system and the health department, Harris reports. Asst. Supt. Sonya Wilds told the Commonwealth Journal last month that the schools pay approximately $20,000 per nurse.

The department has proposed that the schools pay the full cost of employing 12 nurses, which will fall "in the neighborhood" of $750,000, about three times what they pay now, Supt. Steve Butcher told Harris. “Of course, we would receive money back from the health department on Medicaid claims, but . . . it’s hard for me to wrap my head around how much that would be worth to us,” he said.

As school officials consider all of their options, they are also looking at the individual needs of schools, with the understanding that these needs constantly change and are like a "moving target."

“We’ve got some schools that have kids with feeding tubes, and some schools that are heavy on [students with] diabetes,” Butcher told Harris. “It’s not necessarily bigger schools that have more issues, it’s just schools have specific kids that have got needs that we can’t do anything about and need additional help."

Telemedicine helps reduce waits for mental-health patients in ER and provides better health-care access in schools

Health professionals have used telemedicine to help delay Alzheimer's disease and reduce hearing loss in Appalachia, especially among children. Now the new approach is helping students access health care, and mental-health patients to get faster medical attention in emergency rooms.

AMD Global Telemedicine has been establishing telemedicine systems in schools, which allow "providers to care for students on-site with few clinicians to support it," Katie Wike writes for Health IT Outcomes. So far "the Center for Rural Health Innovation in western North Carolina used the technology to support 14 school-based programs and provide care to 4,000 students.

The health-care provider can ask the questions during the exam, and "it doesn't assume the presenter knows the questions to ask," said CRHI Executive Director Amanda Martin. This approach allows one nurse practitioner to provide care to thousands of children. Some Kentucky schools are already using the telemedicine platform, Wike reports.

Sometimes when patients seek mental-health care in emergency rooms, no psychiatric services are available. In this case, hospitals often contact and wait for a provider to arrive or send written evaluations for review, Karla Paris writes for Health IT Outcomes. Now KentuckyOne Health has a telemedicine program that gives faster response times for those requesting mental-health care. For example, patients who visit Louisville's Ss. Mary & Elizabeth Hospital for mental-health care will be able to videoconference with professionals from Our Lady of Peace Hospital. "Patients can then be referred for admission at Our Lady of Peace, another outpatient program or care center," Paris reports.