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Conversations: Mary K. Wakefield on getting ready to double the work of clinics

Monday, June 21, 2010; A15

Mary K. Wakefield, 55, is the administrator of the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services. The agency oversees community health centers across the nation and programs that bring health care to the uninsured.

The health-care legislation signed into law in March provides a major boost to community health centers: $11 billion over five years. The first of these federally supported primary-care clinics opened in 1965.

The health-care overhaul also provides funding to increase the supply of primary-care providers. On Wednesday, Secretary of Health and Human Services Kathleen Sebelius announced that the federal government will spend $250 million in programs to increase the number of doctors, nurses and other care providers. The programs come under the jurisdiction of HRSA.

Wakefield, a nurse who is a leading expert in rural health care, was appointed to the position in February 2009. She was associate dean for rural health at the University of North Dakota's School of Medicine and Health Sciences and directed the university's Center for Rural Health.

Here are excerpts of an interview with her:

Q What's your agency's role in implementing specific programs under the recently passed health-care legislation?

Probably the easiest way to think about HRSA's role is along four major themes, or areas of focus. One is supporting maternal and child health. Two is investing in the health-care workforce. Three would be broadening and expanding access to discounted drugs for safety-net providers. Four is increasing access to primary-care services.

The biggest component is the additional funds for community health centers, right? How will that work?

From the funding perspective, the answer to that would be yes . . . .

The health centers' expansion through the Affordable Care Act focuses in three areas. It expands the number of sites and locations. It also supports expanded health-care services, such as oral health-care services and mental health services. . . . The last area of focus is to support construction and renovation of community health centers.

How many patients do the centers serve, and how do you expect that to change?

Right now, the health centers, in total, serve about 19 million patients a year. That includes, so far, an additional 2.1 million served as a result of the [stimulus funds]. On that base, the Affordable Care Act provides $11 billion over five years, and we expect this investment will approximately double the number of people seen in health centers. It will enable us to serve about 20 million patients over five years.

Where are these centers located, and what kinds of services do they provide?

They focus on preventive and primary health-care services. There are 1,100 grantees across the nation. However, there are about 7,900 sites. Many [grantees] have satellite locations. They're located in rural and urban areas, in underserved areas; just over half are in rural areas. They are in every state and the District of Columbia.

Who uses health centers?

Some who come through the doors have insurance. There are patients who have Medicare, Medicaid, who are uninsured, self-paying and insured. Just over 90 percent of the patients seen are below 200 percent of the poverty level, and about 40 percent of patients are uninsured.

Do you expect the percentage of uninsured patients seeking service at health centers to increase over the next few years?

If you use Massachusetts after they passed universal coverage, between 2005 and 2009, Massachusetts health centers saw an increase in patients. There was an increase in the patient load by about 25 percent, even while their overall percentage of uninsured patients decreased by over 30 percent.

How will the funding process work, and when will it begin?

We're in the process of implementation on that program. The $11 billion will be allocated beginning this fall.

What do you like least about your job?

What I like least is that a 24-hour day isn't long enough to get everything done and to do it extremely well. We're all very busy.

What would you like people to know about you besides your job responsibilities?

I'm a nurse, and very proud of that. And that I'm from North Dakota, and there's not that many of us here in Washington or in North Dakota. It's a low-population state.

Are you hoping to have some vacation back in North Dakota?

My husband and my home are in North Dakota. I try to get back every third or fourth weekend. . . . I can tell you, it's not cheap.

Are there hobbies you've had to give up since coming to Washington?

I'm from Devils Lake. It's now become a top-ranked fishing lake. What I can't do here: birding, hiking, fishing and my favorite sport -- ice hockey. In North Dakota, that is the name of the game.

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