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Equity Enters Conversation About Access to Health Care

Patti Singer

A rendering of the exterior of the UR Medicine orthopaedics project at Marketplace mall. Provided by SLAM Architects

At the groundbreaking in March for the $240 million orthopaedic complex that UR Medicine is building at Marketplace, an official with the mall developer pointed out how the location provided easy access from the Thruway, Interstate-390 and the airport.

The complex also is on the bus line, with RTS making 11 weekday runs.

The UR Medicine Orthopaedics & Physical Performance Center is the largest capital project ever undertaken by the University of Rochester. UR Medicine said that when completed in 2023, the complex will be among the largest and most comprehensive ambulatory orthopaedic facilities in the nation.

Both UR Medicine and Rochester Regional Health have been part of a national trend in health care – the migration to the suburbs of specialty care in particular. UR Medicine’s orthopaedics complex is the latest and perhaps grandest example.

However, a year of protests over racial and social justice and the evidence of health disparities exposed by COVID-19 have laid bare the need for equity in the distribution and availability of specialty health services.

To counter the continued march of health care to the suburbs, a new model for neighborhoods – the community health village – is emerging. The comprehensive approach is designed to improve the health of the city as it enhances the well-being of the residents.

“We have some ideas we need to validate — which components make sense for the community, which don’t, which are missing that needed to be brought in,” said Jason Dunn, the former chief operating officer of Anthony L. Jordan Health Center who now is a consultant for the health village project.

Community health as a way to help neighborhoods

When first built, suburban malls were retail centers anchored by large department stores. Next, entertainment became the attraction. Now, according to a Wilmorite official, medical services and lodging are what’s drawing traffic.

If that model can save struggling shopping centers, why not distressed city neighborhoods?

Jordan Health, after several years of exploring the concept, has plans to work with other health and social service providers on a community health village in the northwest quadrant and are working on finalizing a site.

Dunn, serving as consultant, puts the emphasis on community health. Through surveys, interviews and focus groups, needs are identified. In addition to medical care, Dunn said neighbors want to learn how to manage money. Cooking classes, social service appointments and community meeting places could be part of the village – putting various services in one place and cutting travel time.

Dunn said ideally residents would help run the site – giving high school and college students the opportunity to learn and earn. He said discussions involve the health systems, the city and provider groups. There is a sense of urgency because the latest round of COVID-19 relief money includes community investment.

The health village plan is the model that could be replicated in other quadrants, although it will look different based on the needs of the specific neighborhood.

“Individuals, to truly gain health, need to be living in healthy communities,” said Dunn. Medical services are part of the solution, “but what else would be needed to make the community healthy?”

Getting to services

Right now, though, specialty services gravitate toward the suburbs.

The UR Medicine Orthopaedics & Physical Performance Center was announced in November 2019, before equity became a part of every conversation. But given current events, the context in which the groundbreaking was announced earlier this spring struck some as incongruous.

“I had to read it two or three times,” said Sister Christine Wagner, interim executive director pf St. Joseph’s Neighborhood Center. “They’re putting this big grand thing out in a mall. I was unbelieving that they were going to that and where they were going to do that.”

The state Department of Health regulates the construction and expansion of services through a process called certificate of need. Certificate of need affects certain types of expansions by hospital systems and other entities that meet a threshold of expense. The CON process is not the only measure of investment by providers, but it does give a glimpse into how and where large health systems are spending money.

CONs for UR Medicine show that from 2015 to March 2021, many applications were for clinics in the eastern suburbs. UR Medicine did invest $2.1 million in a clinic on Culver Road and $1.8 million in a new clinic on East Ridge Road.

CONs for Rochester Regional Health show that the largest project was the $253 million construction of the seven-story tower at Rochester General Hospital. The CONs also show projects in excess of $2 million in east side suburbs. RRH also invested about $30 million in clinics on East Ridge Road.

Dr. Bridgette Wiefling, executive vice president at the RRH, said the system has balanced services for rural, suburban and city patients. “I feel like we’re looking at our population, determining what the need is and then addressing it.”

She cited a multicultural center that included gastroenterology on the campus of Rochester General Hospital; the multispeciality Reidman Health Center in the former Tops on Ridge Road; improvements at Alexander Park; and the expansion of specialty services at the St. Mary’s Campus.

Buses run past the St. Mary’s campus at Genesee and West Main streets more than two dozen times a day. Multiple buses each hour go past Alexander Park, at the corner of Alexander Street and Monroe Avenue.

She also said RRH chose to build a $253 million, seven-story structure for medical/surgical and intensive care beds at Rochester General on Portland Avenue.

“There are a lot of health system leaders in the country that might have said, “Unity is a brand new hospital, basically it was redone and it’s beautiful, let’s build it out there,” she said. “We know that our center of gravity is RGH because we’re in one of the poorest ZIP codes in Rochester.”

Grading on equity

Dr. Linda Clark, co-founder and board president of the Black Physicians Network of Greater Rochester said it’s difficult to put brakes on projects.

“… I think using a lens of equity is important in all aspects, whether it’s hiring, looking for equitable income, educational opportunities or whether it’s access to things like an MRI,” she said.

Clark, who works at Common Ground Health but was speaking in her role with Black Physicians Network, said equity needs to be tied into evaluation of a certificate of need.

The CON process requires that projects account for how patients who are covered by Medicaid or who lack insurance will be served. “It’s not nuanced to say if you invest $20 million in the suburbs or more affluent communities, you have to invest $20 million in a low income community,” said Albert Blankley, chief operating officer for Common Ground Health. “It’s not that specific.”

According to the state health department, the review of CON applications is based on factors including demographics, patterns of use, epidemiology of selected diseases and conditions and access to services. Access includes availability of public transportation.

Common Ground Health provides recommendations to the state health department on CON applications. Blankley said the agency looks at bus routes, but he said they are not a precise measure of accessibility.

UR Medicine’s orthopaedics were concentrated in an area of Brighton that is not directly served by public transportation. So in one sense, moving to Marketplace could be seen as an improvement.

Wagner said she thought immediately of accessibility when she read about an orthopedics center at Marketplace.

“It totally leaves out people who don’t have their own transportation,” she said. “Especially when you talk about orthopaedics. People can’t walk, or push buttons on the bus. There’s a total lack of understanding of what orthopaedics issues and what access issues are.”

There also is the issue of time. The RTS schedule puts the weekday ride at about 45 minutes from the transit center.

“How do we get people to where they need to go without taking all day?” asked Clark. “Even myself, it’s difficult taking a little time off from work getting health needs met. Can you imagine taking a whole day, being carted around to do that?”

The report from the Commission on Racial and Structural Equity found that access to health care needed to be addressed. Leaders of the health work group either declined to comment or did not respond to a request for comment.

Emphasis on equity

Last June, at a rally organized by Black Physicians Network after the death of George Floyd, the University of Rochester Medical Center pledged changes.

Dr. Michael Rotondo, who among other positions is chief executive officer of the UR Medical Faculty Group, is leading an equity committee that is assessing community services.

He said UR Medicine is strengthening relationships with Anthony L. Jordan Health Center and Trillium Health. He said UR Medicine also is working with the YMCA of Greater Rochester at Lewis Street Equity Center, which just opened a pediatric telemedicine center with plans for practitioners to be onsite, and with housing officials to bring specialists to where people live. UR Medicine is using data to determine where and what needs exist.

“We’ve embarked on a comprehensive approach to this, to try to get to the right answers, to address the needs of the community as they perceive it,” he said.

The YMCA of Greater Rochester convened a task force on what it calls mission-critical city services. Starting in May, the 16-member group – with representatives from the city, county and state government and education and business – is supposed to generate ideas for new and enhanced programs and services to address inequity in the city.

“You’ve got have organizations coming together to make commitments together around helping to fill this inequity that exists,” said George Romell, president and chief executive officer of the YMCA of Greater Rochester. “ … We have a great group committed to doing things differently,” he said.

Chronic conditions such as diabetes, heart disease and high blood pressure are prevalent among Blacks and Latinos, some of whom may not have ready access to specialists that treat those illnesses.

Rotondo said UR Medicine is evaluating sites for those services, and the decision will be made with input from the steering committee and community groups. “What we don’t want to do is make an independent decision that we just think is the right thing to do, because we think it’s the right thing to do.”