Focus on efficiency keeps clinic in black

When Michael Rodolico talks to folks in the private sector, he doesn't make a pitch for money for his nonprofit health clinic.

After all, the clinic more than covers its expenses already and has a million dollars in the bank to deal with future needs.

Instead, Rodolico is looking for more patients especially patients whose employers aren't able to provide health insurance.

Not that Health Access Washoe County HAWC, for short is a well-kept secret.

The community health center at 1055 South Wells last year recorded 42,000 visits from patients a figure that represents about 17,000 individuals and HAWC expects the number of visits to approach 50,000 this year.

The dental side of the clinic, which recorded 782 visits from patients when it was launched in 1998, grew to 9,145 visits last year and is expected to double in 2002.

"The need is there," Rodolico said a few days ago.

"You can't grow unless the need is there."

But this isn't yet another story about the need for health care for uninsured families.What's noteworthy is how Rodolico and his team manage to provide this care without begging for help.

"We are a solid business," said Rodolico, HAWC's executive director.

"We owe not a penny."

Slightly more than half the patients who come to HAWC's shiny clinic don't have health insurance, and nearly all of them live in poverty.

But most have jobs "We're talking about hard-working Nevada families," Rodolico said and they're willing to pay what they can on a sliding scale.

Those who can't pay even the slidingfee scale look for other arrangements.

One mother, Rodolico said, worked off the cost of her child's medical care by cleaning the clinic's parking lot at $10 an hour.

The clinic's accounts receivables are breathtaking $800,000 recently on annual revenues of $6 million but HAWC officials have learned most of their clients pay their bills within a couple of months.

They're encouraged to keep in good standing with HAWC by prices for medical services that often are below what they'd pay elsewhere in the medical community.

The 25 percent of HAWC's annual budget that comes from federal funds gives the clinic some flexibility on its pricing, but Rodolico said a bigger factor is an unrelenting emphasis on efficiency.

"We have to be incredibly efficient and see a lot of people," he said.

HAWC's three doctors two more physicians are on their way in July see an average of 6,200 patients a year.

Nationally, the average in similar clinics is 4,200 patients a year, and HAWC ranks in the top 20 among some 3,500 similar facilities nationwide in efficiency.

Along with the physicians, the medical professionals on the staff of HAWC include three nurse practitioners, two dentists and two dental hygienists.

The clinic provides physicians with incentives for boosting their productivity the target is to see four patients an hour and the entire organization shares in incentives when targets are met.

By careful scheduling, Rodolico said, the clinic can handle the 1,000 walk-in patients a month who arrive without appointments.

The emphasis on productivity runs deep through HAWC.

The 20,000- square-foot clinic is laid out for the best possible flow of patients and the paperwork that accompanies them.

And it shows up in the nonprofit's unwillingness to accept gifts of used equipment.

"We turn away donations of equipment because they're more problem than they're worth," Rodolico said.

The clinic doesn't look like a place that accepts used equipment.

As Rodolico shows a visitor through the HAWC clinic, he stops to pick up a gum wrapper from the floor setting a standard he expects others in the organization to follow.

The waiting room with its toys for youngsters might be found in a suburban physicians' office.

Dental stations are similar to those found in offices in high-income neighborhoods.

HAWC's focus on efficient care will be put to the test with this summer's arrival of an additional family practitioner and a second physician with combined specialties in pediatric and internal medicine.

"I need more patients," Rodolico said.

One of the ways he hopes to see enough patients to maintain HAWC's efficiencies is by making sure that Renoarea businesses know about the clinic.

His pitch? Use of the clinic can reduce absenteeism and is more cost effective than emergency-room visits for the community as a whole.