BERNE — On Tuesday morning, as Ray Schimmer was planning a June 24 community meeting to find ways to bring medical care to Berne in the wake of its only doctor’s office closing, he received an email that he would no longer be seeing homebound patients in the Hilltowns.

Schimmer is employed as a “vitalist” through CapitalCare Family Practice in Berne, in which he and about a dozen other vitalists visit patients at their rural homes. They are not doctors, but act as proxies for a doctor, nurse, or physician’s assistant who are able to communicate with the patient via webcam and view data on vital signs taken by Schimmer and other vitalists.

The vitalist program was set up by Kristin Mack, a doctor of osteopathy, who left for a practice in Ticonderoga. The practice in Berne, with 1,900 patients, is closing at the end of June.

The nearest practices in the Hilltown community, outside of a micropractice operated by one doctor in Westerlo that takes a limited number of patients, are 25 to 30 minutes away.

Schimmer told The Enterprise on Tuesday afternoon that he was informed that appointments scheduled from that day until the end of June were cancelled.

Joan Hayner, the chief operating officer of the company owning the practice, Community Care Physicians, PC, had told The Enterprise last month that the company wanted to continue the vitalist program out of its Slingerlands office after the Berne practice had closed. This week, a spokesperson for Community Care did not return calls or email for comment before press time.

Last month, in response to Hayner’s statement, Schimmer, who lives in Berne, said he would not be able to work out of the Slingerlands office as a vitalist due to the distance. He expressed concern that the program was likely going to close, and said that it was not only important for homebound patient’s health, but also was a way for patients to stay connected to the community.

He told The Enterprise on Tuesday that he does not know if the patients served by the vitalists have been contacted, and he has not been informed of what his employment status is at this point.

The vitalist program had been funded by a grant obtained by Mack and her office from the Alliance for Better Health, a state-funded performance-provider system. Charles Wiff, a communications consultant speaking for Alliance for Better Health, said that what happens to the program will be up to Community Care, and said that the organization would refer questions about the program to Community Care.

The next step

Schimmer has been working with others involved in the practice to find a means of bringing back a medical office to the Hilltowns. He announced a meeting open to the public to discuss options for Monday, June 24, at 7 p.m. at Helderberg Ambulance’s building on Cole Hill Road.

Schimmer volunteers as an emergency medical technician on the squad and wrote a letter to the Enterprise editor this week, inviting Hilltown residents to the meeting.

Schimmer said that he has also been contacting local politicians for support.

At meetings in the Hilltowns, residents have asked what could be done.
The Knox Town Board, at its meeting on June 11, discussed whether the town could sponsor part of the operations of an office. In Berne, Schimmer went before the town board — which includes his wife, Councilwoman Karen Schimmer — to update the board and the town on his findings.

Mack told The Enterprise last week that in her final days at the office — she was scheduled to leave last Friday — she has been trying to help find what might be a good solution.

Mack and other staff members in the practice had thought that Community Care Physicians would find a replacement for Mack and the office would keep running. However, a month before the closure date, a letter was sent to patients, urging them to transfer their records and care to the company’s offices in either Guilderland or Slingerlands. Staff members were not guaranteed jobs elsewhere.

“Is there a better model? Is there a system that serves the community?” Mack told The Enterprise were questions she was considering.

She believes that designating the area around the doctor’s office as medically underserved with the federal government could open up options for the community, such as funding for a rural health center, where many different medical needs could be addressed, or grants to help bring a new physician to the area.

Mack’s predecessor and mentor, Gary Kolanchick, M.D. retired from the office in 2015 and now lives in Maine. He sold the building the office is located at last fall to Jim and Kim Conklin of Berne. He said funding to help a doctor start a private practice is essential and young doctors now often can’t afford to go into primary care or run their own practice due to so much debt from medical school.

He added that gaining the support of a politician would be helpful as it could expedite the process of getting the area designated if the governor could be persuaded to award the designation himself.

Kolanchik said he had let lapse his license to practice medicine in New York State but may try to get certified again in New York so he can help out in the future in Berne.

A designation

To qualify for certain grants and other funding, the area in or around Berne would have to qualify as a medically underserved area or population through the federal Health Resources & Services Administration.

Melissa Ryan, the operations director of policy and shortage designation at HRSA, said that there are very specific criteria that must be met. Eligibility depends on what is called the index of medical underservice. Ryan said that this takes into account the ratio of medical providers to the population, the population at or below the federal poverty level, the infant mortality rate, and the number of people age 65 or older.

Points are assigned based on the calculation, and an area or population may be designated based on whether these points are under a certain threshold, said Ryan. An area can consist of a census tract, an entire county, or a minor civil division, she said.

However, Ryan said, state agencies are responsible for helping an area or population apply for the designation. The Center for Health Workforce Studies, an academic research center with the University at Albany, is under contract with the New York State Department of Health to develop such applications, according to Jeffrey Hammond, a spokesman for the health department.

If an area cannot meet the requirements to get a designation, an exception can be made by a recommendation from the governor, though Ryan said that most states have criteria for granting exceptions.

The designation can provide funding, such as for a federally qualified health center, or allow providers to work there through the J-1 visa program. Physicians from other countries who are educated in the United States are usually required to return to their home countries for two years before being able to come back, but an exception is made if they agree to work in a designated area.

The federally qualified health centers closest to the Hilltowns are either through Schenectady Family Health Services Inc., known as Hometown Health Centers; or through Whitney M. Young Jr. Centers.

David Shippee, who has served as the chief executive officer of Whitney M. Young for about a year, said that the center originated decades ago when staff at Albany Medical Center noticed patients primarily from Arbor Hill were being admitted with advanced stages of diseases that should have been treated and would have been more manageable early on, as well as higher morbidity in that neighborhood.

As a health center, at least 51-percent of the people on its board must be from the area, said Shippee. Other factors that are considered when applying include how many people might already be served by another health center, or how many non-users of a health center work in healthcare.

“So what they’re trying to avoid are people who are, you know, physicians, local physicians in the community who don’t want to have a bunch of uninsured, Medicaid people sitting in the waiting room,” said Shippee.

The distance from a practice is considered, said Shipee, but he said that it is not weighted more than other factors like income. The designation may also depend not just on where the closest provider is, but also on where the closest provider is that accepts Medicaid, he said.

Shippee noted that the application process occurs only once a year, and only around 35 areas across the country are chosen.

“It’s against every low-income rural and urban and suburb in the country,” he said.

Another option would be having an existing health center apply to open a new “access point” in the community, said Shippee.

A sad farewell

Mack, who started working at the practice in 2014, said that it was an incredibly difficult decision to leave the Berne office. She will be working at Hudson Headwaters Health Network in Ticonderoga, in Essex County, where she said that she will be able to practice the “full spectrum” of family medicine in rural communities.

She said that Community Care declined some of the ways that she offered to help in the search for her replacement. She told the company six months ago that she would be leaving. She said that she and other doctors in the organization were surprised that a replacement could not be found in the amount of time between when she announced her departure and now.

During her time in Berne, Mack said the practice offered “birth to death” healthcare ranging from physical exams, to more acute visits such as to treat an asthma attack, to prenatal services and partnering with Bellevue Women’s Center in Schenectady on deliveries.

Mack added that she has to thank her staff members for the work they’ve done, as well as community partnerships such as with Helderberg Ambulance. The dozen or so vitalists employed at the practice are members of the volunteer rescue squad.