LaSalle Family Medicine Clinic
Located on the campus of LaSalle General Hospital. For appointments please call (318)992-6311
LaSalle Family Medicine Clinicbegan operations May 2008 to enhance access to primary care services in East Central Louisiana. The clinic is a collaborative venture between the State of Louisiana, the Louisiana Rural Hospital Coalition, and the Hospital Service District #2 of LaSalle Parish d/b/a LaSalle General Hospital. Funding promulgated under the 2006 Regular Legislative Session of the Louisiana Legislature enabled LaSalle General Hospital to create a new access point in LaSalle Parish for integrated delivery of primary care services. The clinic was created to expand services to underserved and vulnerable populations including women, children, and geriatric patients.
HISTORY OF RURAL HEALTH CLINICS
In the mid-1960s, the physician shortage in rural areas had reached a crisis. The supply of physicians had become insufficient to meet the demands of many communities, particularly in small, isolated rural areas. To alleviate the effects of this crisis, midlevel health professionals were introduced to serve as physician extenders.
While midlevel providers, such as physician assistants and nurse practitioners, were easily accepted by many communities, their services were not eligible for reimbursement by Medicare (or by Medicaid in some states). For most midlevel providers, third-party reimbursement remained dependent upon them working under the immediate supervision of a physician. This lack of third-party reimbursement from public payers was a substantial disincentive for physician assistants and nurse practitioners to locate in rural areas.
After considerable political mobilization directed toward resolving this issue, Congress passed Public Law 95-210, the Rural Health Clinic Services Act, in December 1977. The act was intended to redress the midlevel reimbursement issue and increase the availability and accessibility of primary care services for residents of rural communities.
The Act authorized Medicare and Medicaid payment to qualified RHCs for “physician services” and “physician-directed services” whether provided by a physician, physician assistant or nurse practitioner. Reimbursement under the Rural Health Clinic Services Act became available to midlevel provider practices, even when services were delivered at a clinic in the absence of a physician, as long as the practice of the physician assistant or nurse practitioner was within the scope of state law and regulations.
In 1977, Congress passed the Rural Health Clinic Services Act (PL 95-210). The legislation had two main goals: improve access to primary health care in rural, underserved communities; and promote a collaborative model of health care delivery using physicians, nurse practitioners and physician assistants. In subsequent legislation, Congress added nurse midwives to the core set of primary care professionals and included mental health services provided by psychologists and clinical social workers as part of the Rural Health Clinic (RHC) benefit.
Improving access to primary care services in underserved rural communities and utilizing a team approach to health care delivery are still the main focuses of the RHC program. The law authorizes special Medicare and Medicaid payment mechanisms for rural health clinics and uses these special payment mechanisms as the principal incentive for becoming a Federally-certified Rural Health Clinic. For Medicare, the payment mechanism is a modified cost-based method of payment. For Medicaid, States are mandated to reimburse Rural Health Clinics using a Prospective Payment System (PPS). Federal law allows States to use an alternative payment method for Medicaid services, as long as the payment amounts are no less than the clinic would have received under the PPS method.
A RHC may be a public or private, for-profit or not-for-profit entity. There are two types of RHCs: provider-based and independent. Provider-based clinics are those clinics owned and operated as an “integral part” of a hospital, nursing home or home health agency. Independent RHCs are those facilities owned by an entity other than a “provider” or a clinic owned by a provider that fails to meet the “integral part” criteria.
The mission of the RHC program has remained remarkably consistent during the lifetime of this unique benefit. Improving access to primary care services in underserved rural communities and utilizing a team approach to health care delivery are still the main focuses of the RHC program. The information found in this book is geared toward those individuals and organizations that share that mission.
There are over 3,000 Federally-certified RHC located throughout the United States. The RHC community is almost evenly split between independent clinics (52 percent) and provider-based clinics (48 percent). According to a national RHC survey conducted by the University of Southern Maine (USM), independent clinics are most commonly owned by physicians (49 percent) and provider-based clinics are most commonly owned by hospitals (51 percent). Approximately 43 percent of RHCs are located in Health Professional Shortage Areas and 40 percent are located in Medically Underserved Areas.
Also according to the University of Southern Maine, 69 percent of all RHCs are located in ZIP codes classified by the Department of Agriculture as small towns or isolated areas. A small town or isolated area is a community with fewer than 2,500 people. Another 17 percent of clinics are located in so-called “large towns”. These are communities with populations between 10,000 and 49,999. The majority of the remaining clinics are located in areas defined as suburban.
Each of these clinics was located in a Federally-designated or -recognized underserved area at the time the clinic was certified. In addition, all of these facilities are located in non-urbanized areas as defined by the Bureau of the Census. Despite the tremendous growth we have seen in the RHC program over the past decade and the considerable contribution RHCs are making towards alleviating or eliminating access to care problems, thousands of rural communities continue to receive the underserved designation.
Rural communities have historically had difficulty attracting and retaining health professionals. For some rural communities, the inability to access the health care delivery system may be because there are no health care providers in the area. The lack of health professionals may be due to the fact that rural communities are disproportionately dependent on Medicare and Medicaid as the principle payers for health services. In the typical Rural Health Clinic, Medicare and Medicaid payments account for close to 60 percent of practice revenue. Consequently, ensuring adequate Medicare and Medicaid payments is essential to the availability of health care in rural underserved areas.
There was tremendous growth in the RHC program through the early ‘90s. Between 1990 and 1997, nearly 3,000 clinics received initial certification as a Rural Health Clinic. Since 1997, hundreds of new clinics have been certified to participate in the program; however, many clinics approved in the early ‘90s have chosen to discontinue participation in the program. Consequently, we have seen a slight drop in the aggregate number of clinics.
The year 1997 is considered a threshold year for the RHC community because it was this year that Congress enacted legislation to better target growth in the RHC program. While the growth in the RHC program during the early and mid-90s was not unexpected, there were some in Congress that felt that some of the clinics certified as RHCs during this period were not really appropriate for participation in a program aimed at improving health care in underserved areas.
For example, it was discovered that the Medically Underserved Area list used for participation in the RHC program had not been updated by the Federal government since the early 1980′s. This meant that some communities that may no longer have been underserved were deemed eligible for participation in the program. One of the changes Congress enacted in response to this discovery was that new RHCs can no longer be certified in areas where the shortage area designation is more than three years old.
As successful as the program has been for thousands of rural communities, the fact is that the Rural Health Clinics program may not be appropriate for every rural underserved community. While the payment methodologies available to Rural Health Clinics can be attractive, they are not magical. Indeed, depending upon the payer mix or range of services you offer or plan to offer, traditional fee for service or some other form of payment could be better. It is important, therefore, that you complete a financial assessment to make sure that the methodologies are right for your particular practice.
 “The Rural Health Clinic Services Act: Pubic Law 95-210”, January 1991, A report of the Office of Rural Health Policy prepared by the National Rural Health Association
 “Starting a Rural Health Clinic: A How-To Manual” Winter 2004, A publication funded by HRSA’s Office of Rural Health Policy with the National Association of Rural Health Clinics under Contract Number 00-0245 (P).
LaSalle Family Medicine Clinic will deliver the highest quality, most affordable healthcare in a safe and satisfying environment focusing on the needs of each and every patient.
LaSalle Family Medicine Clinic will be a destination for primary care medicine in East Central Louisiana.
Creating affordable, available healthcare to anyone who wants it is so much more than building a clinic or adding a new physician. Actively engaging the patient, providing transportation, intentional and strategic marketing, and community participation is essential to creating successful access points. We understand our communities need more than buildings and that’s why we’re here.
Our providers are uniquely positioned in an integrated health delivery system. From the clinic to the hospital, to home health, to long term care—our providers are interested in helping patients navigate the continuum of care.
We want our patients out of our hospital beds. Taking a proactive approach to medicine we are emphasizing preventative healthcare, because we know the money saved by making healthy choices, plus we get a healthy and happy customer…for a whole lot longer!
We want to be remarkable. Everything we do, everything we say, we want it to be extraordinary. Our professional staff, our equipment, even our interior design has been selected for excellence. We want patients to know they can stop driving out of town to get the best, most affordable, healthcare available. We are committed to cultivating a culture of excellence where people consider us to be a destination for medical care.
An integrated electronic health record, telemedicine, digital diagnostic equipment…we’re serious about patient safety, high quality, affordable healthcare, and we’re ensuring future success through technological advances. Harnessing the power of the best technology available enables better care.
We are no longer relying on the old paradigms. We cannot function, much less succeed with a passive, reactionary business strategy. We’re committed to remain on the cutting-edge finding solutions that provide better more affordable healthcare.