High Hopes For Healthier Washington
Effort Would Make Care Accessible Across the City

By Susan Levine
Washington Post Staff Writer
Thursday, June 15, 2006

Within the next three years, the Anacostia Health Center will abandon a World War II-era Quonset hut for the first-class clinic long promised members of that community. In Ward 7, doctors and nurses who work in a squat, windowless building will move to a custom-outfitted facility where summertime air conditioning will be a guarantee, not a gamble.

And in neighborhoods across the District where primary and specialty health services historically have been in short supply or nonexistent, clinics will have expanded physically, added programs and opened their doors for longer hours.

If everything goes according to plan.

It's all part of an ambitious undertaking championed by the D.C. Primary Care Association and supported by the city, which has committed $21 million toward ensuring that every resident has a place to go when well or sick -- a place other than emergency rooms, where care will not be contingent on a patient's ability to pay. Called "Medical Homes DC," it is a philosophy intended to bring new construction, renovation, record-keeping and quality.

"A fantastic vision," said David A. Catania (I-At Large), chairman of the D.C. Council's health committee.

The ultimate goal is to make the nation's capital, which suffers from some of the country's worst rates of chronic disease, a far healthier city. And even as debate and dissent continue on whether the government should spend more than $212 million on a new hospital to succeed the closed D.C. General, Medical Homes is moving forward.

"I've never seen, quite frankly, this much positive energy and focus on helping to develop a comprehensive health-care system in the city," said Kim Bell, executive director of the D.C. Area Health Education Center. "The need is so great."

The momentum may seem invisible to most residents, because the effort to date has involved mostly behind-the-scenes planning to ensure individual projects' success. The first round of grants, totaling $1 million and awarded last fall, were, with one exception, intended for hundred-page market assessments, detailed business analyses and space-use considerations.

"We've tried to be realistic," said Sharon Baskerville, who heads the D.C. Primary Care Association. "There was pressure to put shovels in the ground . . . but we're really trying to be much more circumspect. We want to create access, but not at the cost of long-term sustainability."

That is the crux of the issue confronting Bread for the City, which was awarded two grants to evaluate a medical expansion at its Seventh Street NW headquarters as well as a proposed satellite clinic in Northeast Washington. The first seems realistic; the other comes with much more financial risk because of the new operating dollars it would require.

"For a nonprofit of our size and on our scale, this kind of expansion has to be done very carefully," Executive Director George Jones stressed last week amid the constant activity of the organization's offices, housed in a converted lumber warehouse. Its health services, staffed largely by a corps of volunteer doctors, occupy much of the building's second floor and serve about 2,500 patients a year. The aim is to double that with a major addition on the lot next door.

"Missionwise, we're anxious to do more," Jones said. "The patients would be there."

The term "medical home" has been around since the late 1960s, coined in reference to special-needs children and coordinated, centralized care to best serve them and their families. The providers involved in Medical Homes DC give that concept their unqualified support for the District's more than 200,000 low-income residents, many of whom lack health insurance.

"It's not just building bricks and mortar for everybody. It's having the expectation of quality medical care for everybody," said Mary Ann Sack, health services administrator of So Others Might Eat.

"It means people have a health-care 'home' they go to regularly, someplace where everyone knows them, where they feel comfortable," said Kelly Sweeney McShane, executive director of the nonprofit Community of Hope.

In addition to city funding, the individual programs and the nonprofit association hope to raise or leverage more than $145 million from foundations and other backers. Another $500,000 will be awarded this year as part of a second round of planning grants targeting several neighborhoods: Zip code 20002 in Northeast, for example, and two specific areas of Wards 7 and 8.

The focus is welcome attention for Ward 7's council representative, Vincent C. Gray (D). His area has more than 15,000 seniors, he said, yet fewer than a dozen primary care physicians. It has only four community clinics (including one for women only and another for children), in contrast to Ward 1, where a half-dozen full-service programs operate within a couple miles of one another. Gray criticized the first round of grant announcements after only one award went to a project specifically serving his constituents.

"I want to see us step up the pace in Ward 7," he said. "We've never had, to my knowledge, clinics that were first class."

Vincent Keane, chief executive of Unity Health Care, agrees. Unity is ready to move from its Hunt Place Health Center, a windowless, ugly brick box a block off Minnesota Avenue NE in Ward 7 where staff members paint over dirty walls, patch leaks and try to ignore missing ceiling tiles. Despite its problems, which extend beyond aesthetics, the clinic has an ophthalmologist, dentist, podiatrist, psychiatrist and nutritionist -- health-care professionals otherwise in short supply in the ward. Each sees patients there on a constricted schedule.

"We're looking at making these clinics state of the art and bringing in more specialty care," Keane said.

With its Medical Homes grant, Unity, like other recipients, will be able to work with a special consulting group, developers and an architectural firm. Keane enthusiastically awaits actual construction.

"The bottom line is planning, planning, planning, but you've got to put a shovel in the ground," he said.