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Rx for Rural Health Care

As Hidalgo Medical Services expands its reach, it may become a national model for serving rural and low-income populations.

Story and photos by Donna Clayton Lawder

 

Hidalgo Medical Services–known popularly as "HMS," the letters emblazoned on the organization's clinics throughout Grant and Hidalgo counties–had its beginnings serving areas with less than seven lonely souls per square mile. It has become a recognized success story and leader in "frontier medicine." But these days the fast-growing organization has a broader, more ambitious mission, its goals reaching throughout the state and beyond.

HMS' Med Square facility in Silver City.

"With the number of uninsured people in the state, this kind of medical services model could fill an important gap," says Charlie Alfero, founder and CEO of HMS. "It could certainly be an important piece of the puzzle throughout the US."

In recent years, HMS has added additional medical services, seeing almost explosive growth both in patient visits and in its own facilities and staff. HMS' various clinics saw some 48,000 office visits last year, up from around 8,000 in 2002. Family-support visits jumped from 2,000 to 30,000 in the same four years. The organization now boasts more than 100 staff and a budget in excess of $6 million.

To grasp the scope of HMS–what it does and how far it has come–one has to know a bit of the organization's history, Alfero says. Actually, the nonprofit medical services provider is in its "second incarnation" as a community health center.

Hidalgo Medical Services started out in the early 1980s in Hidalgo County–hence the name–in a trailer behind the closed hospital in Lordsburg, as a National Health Service Corps site. Physicians and other health care professionals with educational scholarships to repay were assigned by the federal government to serve in "Health Professional Shortage" areas. For several years, the Lordsburg area enjoyed the fruits of this arrangement–until those initial providers worked off their scholarships and left, with no replacements forthcoming due to a change in federal policy.

As a result, between the years 1986 and 1995, there were no providers in Hidalgo County outside of Playas, a Phelps Dodge-owned copper smelter town.

In 1994, the Hidalgo County government applied for funds from the New Mexico Department of Health for the purpose of re-establishing local health care services. Thanks to the $35,000 that was awarded, the county was able to hire a clinic director and some support staff to begin developing the infrastructure for medical services delivery.

Later that same year, Alfero and a handful of others–including two physicians, both family practice residents at the University of New Mexico–traveled to Lordsburg to discuss a plan to initiate medical services delivery in the small town.

"In July of 1995, we opened our doors in a wing of the old hospital, Hidalgo County Hospital, in Lordsburg," Alfero recalls. "It was humble, but it was effective, and it was a start." The operation utilized a rotation of four doctors–the two UNM residents, plus two MDs from Southwest Family Medicine in Silver City–each traveling to Lordsburg one day every other week, managing to staff a two-day-per-week clinic there.

Alfero shakes his head and smiles at the memory of that early success. "At that point, we were up and running. We had a new board of directors and could begin looking for a doctor for Hidalgo County."

The program was still running on minimal state funding. In 1996, the county turned the clinic over to HMS completely, while continuing facility and financial support. That fall, the community formed the Hidalgo County Health Consortium, a model that provided a planning basis for much of the development of HMS over the years.

About that same time, Alfero says, HMS obtained a contract with the Department of Health's Border Health Office to provide Promatora services. Promatoras de salud are community health workers, local laypersons who receive training in chronic disease management so they can serve patients in their rural communities. Promatoras are the backbone of Hidalgo's health care delivery system, serving as liaisons and translators and as a much-needed social support network. The diabetes outreach arm of HMS in particular relies heavily on promatoras to get the job done.

The following spring, HMS applied for and received federal funding, enabling it to expand clinical services, add to its administrative infrastructure, and build on its relationship with UNM. Consequently, a full-time physician assistant was hired in the spring of 1998, and a full-time family physician and part-time dentist were added that August. By that time HMS had grown to occupy about 60 percent of the old hospital building.

 

La Vida, a diabetes awareness and outreach program, kicked off in 2001. La Vida, an acronym for "Lifestyles And Values Impact Diabetes Awareness," is a bilingual program designed to raise the level of awareness of diabetes and how lifestyle choices can affect it. The goal is both to prevent the disease and also to offer lifestyle support to those already afflicted.

According to the National Diabetes Information Clearinghouse, more than 10 percent of all Hispanic Americans have diabetes. In the US, Hispanics are twice as likely to have diabetes as non-Hispanic whites of similar age. Not only are Hispanics at higher risk for diabetes, they also suffer a higher incidence and higher rate of complications, such as circulation problems and kidney and eye diseases. And with southern New Mexico's high concentration of Hispanics, Alfero says the area is ripe for a diabetes prevention and support program like La Vida. Funding from the Centers for Disease Control (CDC) pays for the LaVida program

"La Vida is of huge impact to the health in this area due to the percentage of the Hispanic population who are affected by diabetes," Alfero says. "Making improvements there does a lot to improve the overall health of the area."

The La Vida dietary information signs, posted on shelves at local grocery stores and on restaurant menus, have become a familiar sight in Grant and Hidalgo counties. The goal is to help diabetics, and those at risk for the disease, make healthier food choices. Over the past five years, these point-of-purchase messages, coupled with the support from the promatoras, have helped reduce the impact of diabetes locally by 20 percent, Alfero says.

 

Having originally focused on Hidalgo County, HMS expanded into Grant County in 2002, opening Med Square Clinic in Silver City in July, a clinic in the Bayard High School in August, and the Mimbres Valley Clinic in November.

Just months later, in early 2003, HMS got the green light to open school-based programs, delivering primary medical care for students and faculty at Silver City High School. The program includes substance abuse and teen pregnancy counseling and mental health services, as well as all primary medical care services. The Silver City school clinic also offers family planning, including availability of condoms. A similar school-based clinic opened in the Cliff/Gila area the next year.

Services in the school programs are completely confidential, Alfero stresses. Students arrange with their teachers to go to the clinic during school hours for their medical needs.

 

HMS' treatment model, particularly with family support services, is key to its success, Alfero says. A disease as prevalent and serious as diabetes, for example, affects the whole person.

"Normally, a patient sees the doctor for about five to 10 minutes, gets a prescription and goes home," he says. At HMS, it's a different story. Through La Vida, for example, patients are taught how to read food labels and make healthy diet choices and are given information about and encouragement toward exercise programs, such as dance classes.

"The causes of ill health are often dynamic," Alfero says. "We saw this with the mine layoffs. People suddenly can't pay their electric bills. They're stressed. They don't have the money to feed themselves properly"–worsening a cycle of ill health and/or disability.

HMS is paid at the rate of $65 per office visit, Alfero says. "We make our money through the volume of people we see, not by how much time we spend or what we do for them. It's how we can offer prevention and support services."

Alfero says that 34 percent of HMS' patients are on Medicaid, 11 percent are on Medicare and 24 percent have private insurance. The balance, 31 percent, are uninsured; 60 percent of those uninsured are eligible for sliding-scale fees at the clinic.

"We've obviously filled a gaping hole in people's access to health care services," Alfero says, "through location and through the sliding-scale option for the uninsured and underinsured. That feels very good."

Looking toward the future, Alfero says he hopes to soon have funding for a family practice residency program. "Having enough basic family practice doctors available is a real problem for rural areas," he says. "This way, we'll grow our own!"

He also hopes to develop the program's psychological services component. With teen suicide rates in Hidalgo and Grant counties being twice the state suicide rate, Alfero thinks this will be "a ripe area to do some good."

And he hopes to "solidify the family support model," enhancing the availability of low-cost interventions for chronic diseases such as diabetes, hypertension, cardiovascular disease, asthma, depression and hepatitis C.

"Yes, we've done a lot," he says. "And we're also just getting started."

 

Hidalgo Medical Services operates seven facilities in Grant and Hidalgo counties. In Lordsburg and at Med Square Clinic in Silver City, HMS provides comprehensive primary care services, lab and X-ray, dental services, mental health and substance abuse services and family support. Call the clinic nearest you for hours of operation, services and eligibility information, and to make appointments: Hidalgo Medical Services & Dental, Main Clinics & Administration, 530 DeMoss St., Lordsburg, 542-8384; HMS-Med Square Clinic, 114 W. 11th Street, Silver City, 388-1511; HMS-Bayard Community Health Center, 805 Tom Foy Blvd., Bayard, 537-5068; HMS-Cobre School Health Clinic, 1100 Tom Foy Blvd., Bayard, 537-5069; HMS-Mimbres Valley Clinic, 2743-B Hwy 35 N., Mimbres, 536-3990; HMS-Animas Valley Clinic, #1 Panther Blvd., Animas, 548-2742; HMS-Silver Schools Health Center, 3200 N. Silver Street, Silver City, 534-1015 or 388-4252 or 388-4253; HMS-Cliff-Gila Community Health Center, 411 State Hwy 211, Cliff, 535-4384

 

Donna Clayton Lawder is senior editor of Desert Exposure.

 

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