In his clinic in Frackville, Pennsylvania, primary care physician James Greenfield, DO, is treating a patient who needs psychiatric care. Like many rural, underserved areas, the town has few mental health resources. But this patient is in luck: Dr. Greenfield’s practice offers primary care, psychiatric care and social services under one roof, allowing the health care team to coordinate closely and expedite referrals when needed.
The clinic, Cornerstone Coordinated Health Care, is a federally designated rural health clinic (RHC). RHCs aren’t required to offer mental health services, and many don’t because it can be challenging to recruit staff and cope with additional administrative and billing requirements, according to the Maine Rural Health Research Center.
Dr. Greenfield’s practice model benefits patients by providing one-stop access to trusted health professionals. His work is also helping revitalize the town: the clinic is expanding and he’s working to start a nonprofit to boost community health.
As an osteopathic physician, Dr. Greenfield says expanding his clinic’s resources for treating mind, body and spirit was a natural move. The clinic team had noticed that primary care patients with mental health or social service needs frequently struggled to access that care, particularly if they faced socioeconomic challenges. “Many of our patients seemed confused about how to get referrals, or they were deterred by cost or transportation,” Dr. Greenfield explains.
Because the office offers multiple services, patients can seek treatment without concern that others will know why they’re there, which is helpful in a small community that offers little anonymity. It’s also easier for patients to visit a health care team they already know, Dr. Greenfield says: “When people are in an economic situation where they don’t have a car or have a hard time navigating the medical system, it’s so important for them to be able to get care in one place they trust.”
Business of medicine
Despite the benefits for patients, pioneering the combination of mental health services and primary care in an RHC has been challenging at times, Dr. Greenfield says. It took from 2012, when the practice was designated as an RHC, until last November for the clinic to be reimbursed fully for services provided to Medicaid and Medicare patients. During that time, Dr. Greenfield worked a second job as an emergency medicine physician to make ends meet. But ultimately, the experience has been positive, he says, and the state’s medical oversight has been supportive.
In the future, Dr. Greenfield hopes to expand the clinic’s mental health offerings and share his insights with other rural areas that could benefit from implementing a similar practice model. He’s also working to start a nonprofit that would use health-related grant funding to support local initiatives.
For now, Dr. Greenfield’s clinic is already making a difference for local patients. One is a man with uncontrolled bipolar disorder who’s been in and out of prison. “He knows if he’s in trouble, he can stop in here anytime and get counseling or whatever he needs to address his issues,” Dr. Greenfield says.
Moreover, the clinic is an encouraging sign in an economically depressed area that has struggled to recover from the decline of the coal mining industry.
“It can be hard to rekindle rural areas once they burn out,” Dr. Greenfield says. “Resources like the clinic can be little lights of hope that somebody else is invested in this community too.”