American Recovery and Reinvestment Act of 2009
Floor Speech
AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 -- (House of Representatives - February 4, 2009)
BREAK IN TRANSCRIPT
Ms. NORTON. Mr. Chair, I rise today to applaud a particular section of the stimulus package that will have a profound impact on the citizens of the District of Columbia. The hundreds of millions of dollars in AIDS/HIV testing and prevention contained in the legislation before us will assist an amazing organization in the District called the Whitman Walker Clinic. When it is time to award these funds, I strongly urge the Secretary of HHS and the Director of the CDC to look favorably upon the Clinic's application.
The District of Columbia is facing an HIV/AIDS epidemic of untold proportions. It is estimated that 1 in 20 citizens of the District now have HIV or AIDS. This is one of the highest incidences in the Country if not the highest compared to other major metropolitan areas.
The Whitman-Walker Clinic (WWC), a comprehensive primary care clinic with centers of excellence in HIV/AIDS care and Lesbian, Gay, Bisexual and Transgender (LGBT) health care, has been providing healthcare and supportive services to residents of the District of Columbia for 30 years. WWC is one of the largest nongovernmental HIV/AIDS medical and service organizations in the metropolitan
Washington area. The Clinic provides a full spectrum of medical and support services to patients residing in the District of Columbia metropolitan area through its two District of Columbia sites: Elizabeth Taylor Medical Center (ETMC) and Max Robinson Center (MRC).
The overall aim of WWC HIV/AIDS services is to improve health outcomes of persons living with HIV/AIDS (PLWHA) by providing clients with comprehensive and coordinated primary medical care; dental care; HIV/AIDS specialty care; medical adherence case management; mental health and addictions counseling and treatment; HIV education, prevention, and testing; support groups; nutrition counseling; legal services; and day treatment programs. The Clinic offers a comprehensive continuum of HIV/AIDS-related medical, behavioral health, and social services through our ``one-stop-shop'' approach to service delivery where all client services are available and integrated at a single location at each of our sites. The WWC ``one-stop shop'' approach combined with a newly implemented Electronic Health Record (EHR) enhances and ensures coordinated treatment, continuity of care, confidentiality, and elimination of duplication of effort and/or services. The co-location also allows better and more efficient access to services for clients.
Among the many recent accomplishments of the Clinic are the four key new services which advance care for HIV patients: (1) the addition of an electronic health record (EHR) system; (2) the establishment of the Medical Adherence Case Management Department; (3) implementing the Public Benefits Department; (4) and implementing a new visit type: the ``Rapid HIV'' visit.
(1). The Electronic Health Record: WWC implemented an electronic health record system, ``eClinicalWorks,'' in order to achieve significant clinical and operational efficiencies that are needed to support a high quality client/physician encounter. WWC EHR allows for a complete multidisciplinary approach to health care. All clients of WWC are established in our electronic health record (EHR) system in order to track progress in an organized and efficient manner. This allows physicians, mental health practitioners, nurse case managers, and other providers to coordinate the care of that client, exchange information, and communicate with each other in an efficient and trackable manner. When we receive information from an outside health service, that information is scanned into the patient's Clinic-based EHR. Similarly, when we send out information to an external provider, a note is made in the EHR as to the nature of the communication.
(2). Medical Adherence Case Management Department: The Medical Adherence unit consists of Medical Adherence Case Managers and Medical Adherence Care Coordinators. The Medical Adherence Case Managers, all of whom are RNs, provide the following: barriers to care assessment, care planning, disease process education, medication/treatment management support, 24-hour support via pager and pillbox initiation. The Medical Adherence Care Coordinators provide support by addressing clients who no-show as well as: prescription refill reports and followup, home visits, accompaniment to medical appointments, social services as they relate to barriers to care (like emergency financial assistance clinics, housing clinics, access to food and transportation) and other elements as they relate to life skills for managing a healthy lifestyle. This unit provides an immediate point of care for our new clients, establishing the relationship from the minute they walk in the door, or receive an HIV positive test result. WWC recognizes that for many of our clients, access to food and transportation can be a huge barrier to maintaining their medical care. Each staff person in Medical Adherence will be trained in accessing resources available to assist clients in these areas. The Medical Adherence Department also employs two full-time referral coordinators who assist patients in securing specialty and subspecialty appointments. For HIV-positive patients, the Medical Adherence staff members, in conjunction with our physician providers, pay close attention to identifying those patients at risk of failing their treatment regimens.
(3). Public Benefits Department: As of October 1, 2008, all WWC clients receive eligibility screening for public and private insurance through our recently established Public Benefits department. This screening and support service ensures that clients are able to identify and apply for public insurance programs for which they qualify. By thoroughly assisting clients in securing insurance, it also ensures that Ryan White funds remain the payor of last resort. Public Benefits Coordinators meet with all new HIV clients soon after they test positive at the Clinic or seek care at the Clinic as a new patient with previously diagnosed HIV. Potential patients will be asked to bring in proof of residency and income. Public Benefits Coordinators then assist potential patients in determining for what insurance programs they are eligible and provide assistance in applying for benefits. Public Benefits Coordinators, most of whom are bilingual (English/Spanish), work closely with medical providers and the Medical Adherence Case Management department to help clients overcome barriers such as a medication they cannot afford, lack of insurance, denial of a service by their public insurance, all to ensure easy access to the services that they need. They guide clients through every step of the process necessary to eliminating barriers to care related to payor source. Most of the D.C. patients seen by WWC are ultimately deemed eligible for payor programs such as Medicaid and DC Alliance.
(4). The ``Rapid HIV Visit'': The development of a ``Rapid HIV'' appointment type has allowed the Clinic to retain new HIV clients in care. Through this system, all new HIV clients are seen by the Medical Adherence Nurse Case Management team as well as by their primary medical provider on the same day they test positive in one of our facilities or seek care at WWC for their previously diagnosed HIV. Medical Adherence Nurse Case Managers triage all new HIV clients and initiate their care at WWC. WWC reserves several ``Rapid HIV'' visits with providers for new HIV clients each day. Therefore, new HIV patients are almost always able to meet with a provider the same day they test positive or present to the Clinic as a new HIV patient. Medical Adherence Case Managers provide post-testing counseling and ``HIV 101'' education to help patients understand their new diagnosis and navigate their treatment options. For new patients, providers take a full history, screen for mental health and/or substance abuse issues, order HIV and other labs, and assess immunization and tuberculosis status. Patients will also be given the opportunity to meet with the Public Benefits Coordinators on that same day as well.
The Clinic offers expanded hours to accommodate clients who need services outside of the traditional work day. ETMC hours are Monday through Thursday from 8 am to 8 pm and Friday from 8 am to 5 pm. MRC hours are Monday and Tuesday from 8 am to 8 pm and Wednesday, Thursday, and Friday from 8 am to 5 pm. In addition to extended site hours, the Clinic provides an afterhours on-call nursing line pager with physician back-up for medical clients who may be experiencing a non-emergency problem or need medical advice.
WWC clinics are well situated, geographically, to provide services to underserved communities, including Blacks, recent immigrants, Latino/as, and men who have sex with men (MSM). Services at both sites are fully handicapped accessible and conveniently located on the Metro and bus lines. ETMC is located in Ward 2 near the U-street corridor, serves an area of the city concentrated with Latinos, African Americans, MSM, and where a significant number of people live below the poverty line. MRC is located in Ward 8, serves residents of Wards 6, 7, and 8, and residents east of the Anacostia River. Located in one of the city's poorest neighborhoods, MRC is well positioned to outreach and serve residents in Southeast, D.C., which is the area currently hardest hit by the AIDS epidemic. WWC's MRC location facilitates access to difficult to reach populations, such as IDUs, women with children, and sex workers.
The funding that is made available in this legislation will help give the necessary tools to the staff and volunteers of the Whitman-Walker Clinic. I am told that the Clinic has major renovation and infrastructure needs as well. Funding awarded by the Secretary of HHS and the Director of the CDC will go a long way to help identify and treat HIV/AIDs in the Nation's capital. Again, I am thankful that this money is contained in this package and I respectfully urge a favorable ruling on the Whitman-Walker's application for funding.
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