Wednesday July 18, 2012

GREAT BARRINGTON -- Despite recent expansion, the possibility that Community Health Programs could acquire a practice in Lenox that recently closed is "highly unlikely," according to an executive for the Great Barring ton-based, federally supported network of facilities.

"At this point, I don't see it happening," said CHP's CEO Bryan Ayars during an interview at the organization's South County headquarters.

CHP has been adding 150 to 200 patients each month and now serves more than 14,000 in the Berkshires. The Lenox practice that closed served 2,700 patients.

Other departures or semi-retirements by nearly a dozen physicians countywide has resulted in an estimated 6,000 or more patients seeking primary care providers in an area that has very limited availability.

In Lenox, Dr. Andrew Schamess stopped seeing patients at his Lenox Internal Medicine practice on Routes 7 and 20 (Pittsfield Road) last Friday because he is relocating to Ohio. Last month, Schamess was optimistic that a deal was virtually sealed for CHP to acquire his practice.

But Ayars explained that his nonprofit organization faces specific challenges and responsibilities as a federally qualifed health center. A complex, 90-day bureaucratic process is required for CHP to add a new site, which made it impossible to complete the acquisition of Lenox Internal Medicine in the brief time frame required by Dr. Schamess' deadline, according to Ayars.

"Where we struggle is that we have to meet federal criteria because of the federal designation," said Ayars.


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That designation also provides benefits such as en hanced Medi care and Medi caid reimbursements, he pointed out. Providers like Schamess "struggle because those reimbursements are not enough to cover their costs." CHP is also required to provide counselors and translators for clients.

Last Jan. 1, CHP took over Lee Family Practice, which has two primary care physicians, but the process was started three months earlier and went down to the wire.

Another complication when CHP takes over a practice is a set of state requirements, including extensive on-site renovations, which must be completed before approval can be received from the Health Resources and Services Administration (HRSA), the supervisory federal agency, Ayars said.

"That's probably one of the largest stumbling blocks we've got, the cost of making those renovations," said Ayars. "We couldn't coordinate the federal process with the state process to meet Dr. Schamess' timeline and find a physician. Bottom line: There were no extra physicians in our back pocket to slip in there. So, the timing was horrible.

"The answer is to find more providers," said Ayars, "not just physicians but nurse-practitioners.

"We have 100-plus health plans that we take," he added. "That's insane, and everyone has a variation on the theme, we'll pay for this but not for that. It's a constant struggle to keep up with who's going to pay for what and in what amount."

Schamess said Monday that "saying goodbye to my patients has been very sad and poignant," but that he has been able to find new providers for the 500 to 1,000 of his former patients who have serious problems.

"Other doctors in the community very kindly cooperated to take them on," he said. "This experience confirms for me that the Berkshires are in the midst of a huge primary care crisis. The bureaucratic obstacles are ridiculous. It's so hard to recruit physicians here and that needs to be addressed."

According to Schamess, for primary care doctors, "Massa chusetts is the lowest paid state and Berkshire is the lowest paid county in terms of reimbursements and physician income."