Located in central Pennsylvania’s Sugar Valley area, Nans Donuts is open Wednesdays and Saturdays only. That’s why Don Lynch parks in the parking lot of the Amish grocery store next to Evangelical Community Hospitals’ mobile health clinic on the first Wednesday of every month.
Nans Amish Bakery offers more than 40 varieties of donuts, including varying seasonal flavors like pumpkin streusel, that attract the sweet tooths of Valley residents well beyond Loganton’s city limits.
Only 463 people live in Loganton. But Nans has about 1,600 followers on Facebook.
Lynch, a paramedic and hospital mobile coordinator, participates in Nansi’s foot traffic to attract rural residents to free preventive blood tests. The hospital itself is 30 miles to the east, a difficult journey for the elderly and those traveling by horse and buggy.
Mobile clinic use exploded during the COVID-19 pandemic, driven by the need to reach patients in outdoor, distributed locations and also by the trillions of dollars worth of federal aid that Congress poured into the economy. Mobile clinics in rural areas replace the often dwindling preventive care network that helps keep patients healthy and out of the emergency room.
Next year 2022, the law will also authorize the further expansion of mobile clinics. But Congress would have to fund it first.
Pennsylvania is home to the nation’s largest Amish population, with nearly 90,000 living in 61 settlements across the state, according to the Elizabethtown Colleges Young Center for Anabaptist and Pietist Studies.
The community presence of evangelical incumbents is important to reach the regions’ large Amish community, which generally avoids using modern technology and can be skeptical of modern medicine. The Amish also often do not have health insurance, which can make health care too expensive to afford.
The hospital established a mobile clinic before the pandemic. This month, Lynch saw 24 customers in Loganton, nearly three times more than usual, despite the snow. He estimated that about seven were Amish.
The hospitals’ community-based approach is reflected in the number of Amish patients it serves, Lynch said.
But there is always hesitation, he added.
Mobile clinic boom
Evangelical purchased its mobile clinic in 2018 using charitable grants and money from local businesses and the Amish and Mennonite community. When the pandemic hit, the rush for mobile units led to wait times of up to two years, administrators and industry representatives told CQ Roll Call.
The fight centered on the nation’s 1,377 federally qualified health centers, which received $6.1 billion in funds from the March 2021 COVID-19 relief package. The centers had to use the money by March 31, 2023, although many were given additional time. Dropping half a million dollars into a new mobile clinic was a good way to spend the money, said Steve Messinger, director of policy for the Nevada Primary Care Association.
This, combined with the new, looser funding restrictions for mobile clinics that will come into effect in January, will take mobile health into a new era. Messinger worked with Nevada Democrats Jacky Rosen in the Senate and Susie Lee in the House to craft the 2022 bill.
Innovation is starting to explode, he said.
In January, health centers can request federal funding for new mobile units without establishing new stone clinics, compared to the previous law. But the Health Resources and Services Administration has not been awarded any new base station grants since 2019. And while the agency previously predicted new funding was expected this month, Congress is still struggling over the 2024 appropriations.
HRSA asked for more than $5 billion in grants in President Joe Biden’s 2024 budget request, noting that it was only able to fund 75,550 applications in 2019.
Nevertheless, the COVID-19 money is fueling the rally. According to CEO Elizabeth Wallace, the Mobile Healthcare Association will grow 30 percent in 2023, up from 21 percent in 2022.
The benefits of mobile health became increasingly clear during the pandemic. Wallace pointed to a study in Loma Linda, California, that showed the success of mobile clinics compared to mass vaccination events in delivering COVID-19 vaccines to black communities.
Mobile health has a proven track record of reaching the vulnerable, he said. Reach the hard-to-reach, who don’t want to use or can’t access traditional health care.
Jana Eubank, executive director of the Texas Association of Community Health Centers, said interest in mobile clinics grew during the pandemic, but wait times for a unit stretched up to a year.
In Texas, growth is concentrated in rural areas, where more and more hospitals are closing. Maternal mortality is a major concern, with some women driving hours just to get to an emergency room, not even a hospital with a maternity ward.
Health centers, rural clinics and emergency clinics are pretty much a safety net, he said. Health centers often partner with hospitals to reduce unnecessary emergency room visits and fill care gaps as well, Eubank said, and mobile clinics help expand their reach.
They were all in this together, he said. And we have to figure out how to maintain that infrastructure in these communities that really need it.
Backlogs of spare parts
Mobile clinics typically range from vans to recreational vehicles, and are usually made by customizing Americanstatestatemobilemobile homes mobile shells from mobile mobiles to mobile vehicles. Recent delays are partly due to backorders for shells, although Wisconsin-based CGS Premier avoided the worst of the disruption by maintaining its own inventory.
The company manufactures drop-down carts to facilitate patient access, and has seen a growing interest in raising curbs and other cosmetic details to enhance the patient experience.
CEO Greg Peterson said orders have tripled since March 2020 with a focus on reaching underserved areas, including tribal lands. Customers like Eli Lilly and Co. are also using them to run decentralized clinical trials to get a more diverse patient population, and Molina Healthcare used them to respond to the 2023 tornadoes in Mississippi.
The governor called and said, hey, we need your clinics, Peterson said. We need a base. People need to fill their prescriptions.
Mobile clinics are not a cure for the countries’ countless healthcare problems. They still need to be staffed, maintained and driven from place to place, which requires money and people. Both are often missing in rural areas.
Placing a clinician in a mobile unit usually means one clinician in the main hospital or health center. And in many rural areas, there is often only one professional available for each specialty, if any.
The presence of a mobile clinic does not automatically win over skeptics either. Lynch sometimes ventures outside the RV to try to recruit smokers who hang out at clinics in Pennsylvania, but usually gets cleaned up.
The ones that just say you have to die for something and you don’t care, they’re not even going to watch it, he said.
But progress is often measured in modest steps. Lynch said he’s seeing more and more repeat customers, and the turnout continues to improve.
Dawn Jeffries, community liaison at Sugar Valley Rural Charter School, helped coordinate the evangelicals’ monthly visits to Nans. The school district’s recent decision to close a local school was a blow to the city, so the need to strengthen community foundations was particularly acute.
Our community was fractured at the time, he said. It’s getting better, but it still hasn’t felt the same.
Jeffries also planned a winter festival last year that brought together local businesses and communities to give out free food, chocolate and sleigh rides to valley residents.
Word of mouth increased turnout this year, and it’s doing the same for the mobile clinic.
The fact that they’re talking, he said, and it’s out there, the knowledge is out there, is a good thing.
This reporting is supported by a grant from the Association of Health Care Journalists and funding from the Commonwealth Fund.
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