By TONY COWAN
Up a steep hill from the city center on the Island of Vieques, Puerto Rico, past the VA hospital that has never re-opened, at the back of a cinderblock housing community, is the municipal diagnostic and treatment center or CDT. This small building and the three mobile clinics in the parking lot are the only medical care available without a plane or ferry trip off the island. The three mobile clinics include a dental office, a general exam clinic, and an OB-Gyn office with pediatric care. These clinics were purchased by SALUD (the Puerto Rican Department of Health) using FEMA disaster response funds.
That was 18 months ago. During those eighteen months, the three mobile clinics have generated their own power in the face of multiple failures in the island’s power grid and survived three named storms, sustaining no damage. Amidst this chaos, the clinics have been providing critical medical public health services, but most importantly, they passed their accreditation survey to become fully licensed facilities. Mobile clinics that were deployed for disaster response, pivoted into licensed healthcare facilities.
Thanks to Clinics on Wheels™, the people on the island of Vieques, Puerto Rico now have a General Exam Trailer with mobile X-Ray and telemedical capability to live chat with Sentro Medico in San Juan. They have a Dental Trailer with two, four-handed dental surgery chairs, dental X-Ray, and sterile processing. They have an OB-Gyn Exam Trailer with pediatric care, pharmacy stores, and sterile processing. Each clinic has an ADA compliant ramp, exceeding life safety standards, and generating and storing their own solar power. All three mobile units can store water, while being connected to the Internet via a satellite dish, which is also solar powered.
How is this relevant to our local issues with providing quality care to our rural health areas? Regardless, of a patient’s insurance provider or deductible, the most expensive way to begin a medical treatment is by starting it in the emergency room. Tragically, the number of people who are using emergency rooms as their primary care provider is growing.
Nearly half of all U.S. medical care is delivered by emergency departments, according to a study by researchers at the University of Maryland School of Medicine. A critical step in decreasing the need for people to turn to emergency rooms is the use of mobile medical units. The clinics on Vieques demonstrate how hospitals and physician groups can reduce costs and increase patient volume while still providing a superior level of service to the patient.
When diseases or medical issues are diagnosed in an emergency room, they have often already progressed to the point of causing severe symptoms. The hospital has few options but to admit the patient. These are the very kinds of situations that result in the highest rate of readmittance. At this point, the patient is in a health crisis.
When you consider that Medicare fines are incurred every time the hospital fails to provide a “30-day guarantee”, the need for a better solution is obvious for both financial and public health reasons. Hospitals have the added benefit of linking mobile capability with their non-profit foundations which gives them capital acquisition support as they care for the local community and generate revenue at the same time.
Now that healthcare has centralized around large hospital networks, rural small towns have lost independent practices, and healthcare deserts are a growing threat to the most vulnerable communities throughout the U.S. According to the Sheps Center, 104 rural hospitals have closed since 2010. Clinics like those providing services on Vieques are effective in reaching these communities as they can generate their own power, water, and revenue all while being towed to the most austere locations with a simple pick-up truck. While the specialist that a patient requires could be hundreds of miles away, with telemedicine, neighborhood consults are possible.
Today’s healthcare tends to start at the hospital, and patient care rarely leads back to the independent practitioner. Mobile clinics are a way for the independent practice to take back primary care of their patients while increasing the area they can serve.
Telemedicine by itself is not enough to deliver quality healthcare. This was illustrated in September 2019 when the American Telemedicine Association denounced the Video Doctor Network. While there are quality tele-health companies out there, it is difficult for the consumer to tell the difference between them. One way to ensure quality and avoid Medicare fraud, is to have services delivered in a quality mobile medical platform, not just via an Internet connection.
When the health professional is in a mobile medical facility that includes tele-health as part of its infrastructure, a full spectrum of services is available. The health professional does not need to be an MD or an RN, which will dramatically reduce cost, but with tele-health, a doctor can have direct access via a Point of View (POV) experience with the patient. The health professional in the unit has all the medical tools to complete diagnostic tests. One doctor can literally see hundreds of patients throughout underserved communities while never having to leave their office.
The patient provider relationship is intact, with true continuity of care being maintained. Connected health advocates have long noted the difference between (store-and-forward) systems in which a patient and provider communicate online or by phone, text, and messages, rather than in real-time via an audio/ video portal. Clinics on Wheels™ directly connects the provider and the patient to ensure true continuity of care is maintained.