Two weeks ago, Evanston City Council gave enthusiastic support to Director of Public Health Evonda Thomas’s proposal to try and bring a Federally Qualified Health Clinic to Evanston. Since then, Ms. Thomas has been meeting with politicians and possible not-for-profit partners, studying similar public-private-partnership clinics in DuPage and Lake counties, and beginning the Request for Proposal process. If all the planning works, then the resulting clinic, she says, will be revenue-neutral for the City, serve residents regardless of their ability to pay, and fill a void that has existed since the City decided to close its public health clinic, a decision Mayor Elizabeth Tisdahl now calls the worst vote she ever cast as alderman.
Ms. Thomas envisions the FQHC as a primary care facility providing a full range of preventive, wellness and illness care from pediatrics to geriatrics and all ages in between. The “Federally Qualified” label means that federal funds cover the operating costs of the clinic, and that reimbursement for care that comes from federal and state programs such as Medicaid and CHIPs comes more easily. “The burden of payment does not fall on the [Evanston] taxpayer,” she said. A partner agency or association can help the City obtain Federally Qualified status because it is anticipated that such a partner will have gone through the process before and knows the ropes.
In contrast, Evanston’s public health clinic that closed several years ago was funded primarily by General Fund dollars. In the absence of an FQHC, said Ms. Thomas, communities often resort to public health clinics to provide the safety net of basic health care for citizens who cannot otherwise afford care.
Because Evanston does not currently have an FQHC, since the public clinic closed nothing has adequately taken its place said Mayor Tisdahl. “During my campaign, no one asked me what my worst vote as an alderman had been, so I told them anyway. It was my vote to close the City’s clinic,” she said, specifically because STD and family planning services are not now available to many residents. “We really need this clinic,” she added.
Evanston’s hospitals do provide some services for the indigent, but they are limited. “Evanston [NorthShore University Health System] Hospital has a four-month waiting list to get an appointment” in its outpatient public clinic, said Ms. Thomas. The hospital is also a regional center, accepting patients from as far away as Wisconsin, with no preference given to City of Evanston residents. St. Francis Hospital, a Catholic institution, does not provide any family planning services, for religious reasons.
There is another reason the hospitals could not fill the void left by the clinic’s closure: “Hospitals serve in a different capacity than a public clinic,” said Ms. Thomas. Hospitals focus on individual cases, but an FQHC provides “population-based services,” focusing on the health of the entire community. A clinic works in concert with the hospitals, she added,
saying “they are complementary.”
Evanston Township High School’s clinic provides important services regardless of ability to pay, but these services are restricted to the high school population. Also, parental consent is required to treat students, limiting the clinic’s reach, particularly when it comes to family planning and STD treatment and prevention. A clinic would not have the consent issue, said Ms. Thomas, because in Illinois adolescents are emancipated at age 12; no parental consent is needed to provide health-care services to students over the age of 12 in Illinois clinics.
Access for the entire community to primary care is the overarching goal, and for this reason Ms. Thomas is eyeing locations other than the Civic Center for the proposed new clinic. The Civic Center could still end up being the location, she said, because historically the clinic was located there, and the community may decide that the basement of the Civic Center is where they want a new clinic to be. But access to bus and train lines is also a priority. Ms. Thomas wants a location that is easy for everyone in the City to get to, and limited parking, less exposure, and significant distance from public transit all work against the Civic Center as a location. Ms. Thomas also said that generally people do not want to go to the doctor in the same place they go to pay parking tickets and building permits.
For now, Ms. Thomas is talking to elected officials and possible partners. She has met with Cook County Commissioner Larry Suffredin and plans to meet with State Representative Robyn Gabel soon. “All our elected officials are committed and invested” in the project, said Ms. Thomas. “The timing is absolutely right” to address public health issues with the new health-care law, she added.
A partner will most likely be brought in to operate the clinic along with the City’s health department. One organization that has been mentioned as a possible partner is the Heartland Alliance, but Ms. Thomas is talking to a number of possible partners. “Some prefer not to be mentioned,” she said. A partner organization would already be established and familiar with running an FQHC. “They have long-standing experience providing high quality care,” said Ms. Thomas, and they know the FQHC process.
Ms. Thomas received notification last Friday of a new initiative for local health departments to create public health centers with federal funding assistance. She will try to take advantage of the initiative if at all possible. For now, though, her department is gathering information, looking at locations, talking to elected officials and possible partners, and preparing the Request for Proposal. Ms. Thomas expects the RFP to go out in late summer or early fall. If all goes well, plans could be in place for a new Evanston FQHC by the end of the year.