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Casa de Salud in the South Valley Bucks the U.S. Health Care System by Charging $30 Per Visit, and Business Is Booming

By Olivier Uyttebrouck
Copyright © 2010 Albuquerque Journal
Journal Staff Writer

          Dr. Andru Ziwasimon has chosen to opt out of the $2.3 trillion system that finances health care in the United States.
        He and three other medical practitioners at Casa de Salud medical clinic run a cash-only operation that serves throngs of the poor and uninsured in Albuquerque's South Valley.
        And don't try making an appointment. About 90 percent of patients are walk-ins who grab a seat in the cramped waiting room at the 2,500-square-foot abobe-style clinic.
        Among them on a recent Wednesday morning was David Garcia, 23, who wants to kick an addiction to heroin. He waited in the narrow hallway that doubles as a cramped reception area at Casa de Salud medical clinic.
        "I'm about to be a dad," said Garcia, who emigrated from Colombia in 2002. "It's time to be mature and be a man."
        Ziwasimon, 39, dressed in jeans and a plaid shirt, summoned Garcia into a tiny examination room. Earlier that morning, Garcia attended a class for substance abusers held at the clinic each Wednesday.
        Garcia wants a prescription for Suboxone, an opioid drug that blocks the agonizing withdrawal symptoms that discourages many addicts from kicking the drug.
        "This medicine is very effective but it always comes down to willpower," Ziwasimon warned. Suboxone isn't a magic cure.
        "You've got to want to stop," he said. "You've got to do the work. You can't just take the Suboxone pill and expect the anxiety to go away."
        Garcia is a triple member of a population Ziwasimon says has been neglected by the U.S. health care system: the uninsured, immigrants and substance abusers.
        "The motivation for building this clinic is that I didn't feel that these patients' needs were being met in the medical clinic system," he said.
        An estimated 449,000 New Mexicans, or about 23 percent of the state's population, had no health insurance in 2009, according to the Kaiser Family Foundation, a nonprofit health policy group.
        Among New Mexico's uninsured is Vidia
        Wesenlund, 51, who visited Casa de Salud for the first time Thursday, complaining of pain in her ears and difficulty hearing.
        Wesenlund paid the standard $30 fee and waited about an hour for a doctor's examination, which found a blockage in her right ear canal. She paid nothing extra for an ear lavage of hydrogen peroxide and warm water that removed the blockage.
        "The atmosphere is just how it's supposed to be," Wesenlund said of the clinic. "They take time, and they connect with you."
        Wesenlund turned to Casa de Salud after several other clinics told her she would be unable to get an appointment before January.
        Ziwasimon set up shop in a two-bedroom house in the South Valley in June 2004 with Lorraine Cordova-Carriaga, a nurse practitioner and traditional healer who still works at Casa de Salud.
        "There were times when we just started when we only got one or two patients, but as time went on it got busier and busier," Cordova-Carriaga recalled.
        Casa de Salud soon outgrew the house and opened the existing clinic at Isleta and Arenal SE in January 2007.
        Demand for services at Casa de Salud has grown steadily. The clinic will handle an estimated 11,000 patient visits this year, up from about 8,000 in 2009.
        The clinic also operates a needle-exchange program under contract with the New Mexico Department of Health that brings an additional 7,000 visitors each year.
        The clinic has drawn up plans for a $300,000 expansion that would double the clinic's size and is seeking donations and grants to pay for it. Ziwasimon predicts that the expanded clinic could handle about 17,000 patient visits a year.
        Casa de Salud also serves as a proving ground for aspiring doctors and nurses, he said.
        Much of the work is performed by six work-study students and more than 20 volunteers who want hands-on experience in a clinic.
        "These students are given a lot of oversight but also a lot of responsibility, and they feel it and step up to it," Ziwasimon said.
        The clinic accepts no insurance, including Medicaid, the government-funded insurance program for the poor.
        Instead, the clinic makes its money "the old-fashioned way," Ziwasimon said. Each patient pays a $30 per-visit fee, of which the medical practitioner receives $25. The remaining $5 pays for the clinic's overhead and one administrator.
        In addition, patients pay rock-bottom fees for medical services. For example, the clinic charges $15 for stitches, compared with $500 or more at a hospital emergency room.
        Dr. Jesse Barnes, another of the clinic's three physicians, said charging a reasonable fee is part of Casa de Salud's credo of treating patients with dignity.
        "Assuming that people want free health care is something we've broken with," he said. "We treat our patients with respect." Central to that is "charging a fair price for a quality service."
        Bargain pricing for medical services also means lean salaries for doctors, by industry standards.
        Ziwasimon estimates he earns $60,000 a year working four days a week at the clinic. He supplemented his income this year by working part time at an Indian Health Services hospital in Crownpoint, which paid him about $30,000 this year.
        By comparison, family and general practitioners in New Mexico earned an average $176,000 a year in 2009, according to the U.S. Bureau of Labor Statistics.
        Ziwasimon said he gets along quite well on $90,000 a year, thank you, even though he owes $270,000 in student loans for his medical degree at Virginia Commonwealth University in Richmond.
        The federal loan program offers favorable terms for doctors who work for nonprofit health systems, he said.
        "My friends working in other systems who make a lot of money seem to have the same stress that I do around their medical school debts," he said.
        Some other medical options for low-income and uninsured people:
        • Casa de Salud medical clinic, 1608 Isleta SW, charges $30 for a medical examination, plus fees for services. Call 907-8311.
        • UNM Care, a medical assistance program operated by University of New Mexico Hospital, serves Bernalillo County residents who fall below certain income and asset limits. For information, call 272-2521 or visit hospital.unm.edu and click "patient financial services."
        • First Choice Community Healthcare, a government-funded nonprofit with nine clinics in Albuquerque, Belen, Los Lunas and Edgewood, offers medical and dental care on a sliding fee scale. For information, call 873-7400 or visit www.fcch.com.
        • First Nations Community HealthSource, 5608 Zuni SE, offers free medical care to qualified Native Americans and on a sliding fee scale to others. For information, call 262-2481 or visit www.fnch.org.
       





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