Access to Healthcare in Rowan County
Even though our County Health data indicates that Rowan County has a higher-than-average number of insured people (15% vs state average of 13%), we seem to be quite fortunate to have a number of physicians and other health care providers (Physician’s Assistants and Nurse Practitioners) to provide care. Even so, we often hear “access to care” as a problem, so I wanted to do a deeper dive on that issue.
“Access to Care” means different things to different people. Do we have enough physicians, and are we also talking about dental care and mental health? Are all people able to access what we have based on their insurance status or lack of ability to pay? Is the available care located where transportation to seek that care is not a barrier? Let’s take a look at each of those concepts.
1. Do we have enough physicians, including dental and mental health?
We have been blessed, in Rowan County, with a contingent of primary care physicians and specialists available through a number of agencies, independent practices, and also employed by the two large health systems in the region (Novant Health and Atrium). We also have a number of independent practices owned by Physician Assistants, as well as Urgent Cares owned by the health systems plus independent urgent cares. Many of these practices offer extended hours and weekend hours, so time of day to access care is pretty broad. From the dental standpoint, we are also blessed with a number of dental practices, including pediatric dentistry, oral surgery and orthodontics, although data indicates we still only have about half the number of dentists needed for the population of our county. Mental Health is where we have some work to do with only a small number of psychiatric or psychology practices available, and really limited pediatric psychiatry in Rowan County. Substance Use Disorder clinics are also at a minimum and is a strong target for improvement for our county with an active task force engaged on adding resources needed in this area. So the answer to the question of “do we have enough” should be pretty positive with only a few gaps, but one to keep a close watch on. Over the past decade Novant Health, in partnership with Rowan Diagnostic Clinic and others in the community, made great strides in adding needed specialists to the county to increase availability and access. Maintaining enough primary care physicians and keeping our specialists is always a challenge as physicians age-out and retire and as our community continues to grow. The use of Advanced Practice Providers, or APPs – meaning Nurse Practitioners and Physician’s Assistants (PAs)- will be even more important in the future. Our community will need to understand that these APPs will provide the needed breadth of coverage for a future that will likely see widespread physician shortages across our country.
2. Does everyone have access to these physicians based on ability to pay?
This is also an area where a lot of hard work has paved the way for practically every person in Rowan County to have access regardless of ability to pay. The Community Care Clinic of Rowan County, located at 315 Mocksville Ave. in Salisbury, has served our county for 27 years and continued to add resources in addition to primary medical care. They offer a dental clinic, lab services, pharmacy services, and many chronic disease management programs. Additionally, they have added a Spanish interpreter to make their services more accessible to the Hispanic community. To be eligible for care through the Community Care Clinic the client must be a low-income, uninsured adult (19+) resident of Rowan County. This includes patients with no access to insurance – in other words, you are not eligible for Medicaid or Medicare. Low-Income is defined as anyone who is at 250% of Federal Poverty Level or worse, and includes family size into the equation. In 2022, Federal Poverty Level was set at earnings of $32,200 or less for an individual, or $66,250 or less for a family of four. There is a $10 quarterly administrative fee, and you can apply to be a patient online or in person. Executive Director, Krista Woolley, who has been with the Community Care Clinic for the past 10 years says the clinic currently sees over 1300 patients, and is accepting more.
We also have the Cabarrus-Rowan Community Health Centers with locations in Spencer, China Grove, and Salisbury. These Federally Qualified Health Centers (FQHC’s) provide both primary care and behavioral health services (mental health), and dental services at certain locations. Their services also include lab and pharmacy. They accept all populations including those with insurance, those without insurance, Medicaid, and Medicare. Patients are eligible to apply for the sliding fee discount program which is based on income and family size, using the same methodology for defining Federal Poverty Level as does the Community Care Clinic.
Many people don’t realize that our public health department, Rowan County Public Health, located at 1811 E. Innes St. in Salisbury is another organization that provides primary medical care, as well as maternal health and prenatal care and serves patients of all ages, including children. With lab and pharmacy services as well as child dental services through The Smile Center, they see all populations including low-income, and uninsured as well as Medicaid, Medicare, and most insurances. Patients are eligible to apply for the sliding fee discount program which is based on income and family size as with the previously mentioned clinics.
These three organizations (The Community Care Clinic of Rowan County, Cabarrus-Rowan Community Health Centers, and Rowan County Public Health) make up what is often known as our Safety-Net Clinics for Rowan County. According to Krista Woolly, “these organizations work well together to collaborate and not to duplicate services, but to fill in gaps.”
Novant Health has a number of primary care physicians in our community and, according to Stacy Murray, Novant’s Director of Operations for Community Health and Wellness in Rowan County, “they all accept Medicare and Medicaid, and are all open for new patients.” Novant Health has a very generous financial assistance policy that utilizes 300% of Federal Poverty Level for uninsured applicants to qualify for charity care. They will also help you apply for Medicaid if you are eligible.
Atrium Health has several physician practices in Rowan County (China Grove and Salisbury), and also offers financial assistance.
3. Is transportation a barrier to access to care?
Over the past decade, there has been a concerted effort to place primary care clinics across Rowan County to improve access. Clinics in Cleveland, Rockwell, Gold Hill, Spencer, China Grove/Landis, Granite Quarry, and Kannapolis have extended the reach of medical care to those communities. In addition, many clinics are located on the Salisbury Transit bus lines, which also includes Spencer and East Spencer. Transportation is also available through the Rowan Transit System via RITA (Rowan Individual Transportation Assistance). This is available one day per week for each area in the county. Rowan Express provides service between Salisbury, China Grove, Landis and Kannapolis and connects with the Salisbury Transit System and the Concord Kannapolis Rider System. Another new option established through Rufty Holmes Senior Center is CARS. CARS works in conjunction with GoGo Grandparent, a California-based company that sprouted out of the idea of helping seniors use Uber and Lyft ridesharing services without having to navigate an app. Seniors that are registered with the CARS program will schedule rides by calling Rufty-Holmes which will then utilize the GoGo Grandparent dashboard to set up the ride.
In the final analysis, Rowan County is in a strong position to provide access to care to everyone in the county. The challenge is to continue to educate our folks on all the resources available to them, especially the Safety-Net clinics so that they establish with a primary care physician and take care of themselves before getting sick!