SOUTHERN OHIO HEALTH
SERVICES NETWORK
CINCINNATI, OHIO
Contact Person: Stephen Wilhide,
President
Southern Ohio Health Services Network
817A Eastgate South Drive
Cincinnati, OH 45245
Phone: (513) 752-8500
COMMUNITY DESCRIPTION
Clermont, Brown, and Adams counties lie in a line east of Cincinnati, Ohio. The Ohio River borders them on the south, separating Ohio and Kentucky. Highland County lies to the northeast of the other counties. This is a poor Appalachian area characterized by low educational attainment, a high teen pregnancy rate, and many rural elderly. Tobacco farming and tourism are the main local industries. Approximately 246,000 people live in this area.
BACKGROUND HISTORY
Medical care has always been scarce in rural regions. The four counties described above, known collectively as The Central Ohio River Valley Association (CORVA) Appalachian Region, were no exception: each had been federally designated a Health Professional Shortage Area. In 1975, CORVA, located in Cincinnati, began a new program to provide primary health care for the region.
PROJECT INITIATIVE
The Southern Ohio Health Services Network was founded in 1976 as a private, not-for-profit corporation to bring primary care physicians to the region. Five local hospitals assisted with physician recruitment, facilities procurement, and educational activities. The original idea was to provide three years of grant support to help primary care physicians build practices that they could then take over as private practices.
An executive director was hired who had a background in community organization and rural primary health care administration. An assistant director and a director of operations came on board the next year. Locating the corporation offices in a major city has helped the organization recruit and retain qualified administrative staff.
Facilities were already in place for the first two practices, which had been established earlier by other organizations. Because of requirements of the funding agency, the network purchased and operated these facilities themselves. The network also centralized many management functions, such as purchasing, payroll and fringe benefits, accounting, finance and, later, billing. All personnel, including the physicians, became network employees.
In 1977, a Brown county community approached the network with a request for a physician and dentist. No facility existed to house these practices, so a group of community residents purchased and renovated a building to lease to the network. By making that commitment and assuming some financial risk, the community created a vested interest in making the practice succeed. A physician and a dentist who volunteered with the Public Health Service’s National Service Corps were hired within two years.
GOVERNANCE
A board of trustees governs the organization. The original board was composed of 11 individuals, five from the most populated county and two each from the other three counties. When the network expanded to another county, board membership increased to 13. Management decisions are based on the needs of the corporation as a whole rather than of an individual county. The board and senior management set network policies and procedures, but each practice site makes operational decisions within stated parameters. One physician at each site is responsible for daily operations and reports to the network medical director.
FUNDING
During the first year, the Appalachian Regional Commission (ARC) gave the organization $49,455 to cover administrative expenses, including rent and salaries. ARC also provided a $64,200 grant to operate a practice in Goshen, in northern Clermont county. The Rural Health Initiative program of the Department of Health and Human Services (currently Section 330 of the Public Health Service Act, the Community Health Center program) granted funds to run a medical practice in Adams county. Both practices already had been established and were taken over by the network. Federal funds underwrote about 90% of operations. The central office staff became skilled in grant development.
Currently, the network has a $14 million budget, approximately 22% of which comes from Community Health Center program grants. Additional revenue is provided through Medicare and Medicaid (the largest source), HMO capitation, and patient fees. Patients pay on a sliding scale based on income and family size.
CHALLENGES
Recruiting and retaining qualified physicians has been a major problem. The network has addressed this issue through employing a full-time physician recruiter. It also provides reasonable call schedules and time off, professional networking, and continuing education. These efforts have enjoyed moderate success: ten of the network’s current physicians came to fulfill National Health Service obligations and decided to stay.
The original concept of creating private practices did not prove feasible because the population was too poor and geographically dispersed to support group practices. Physicians continue to be network employees. The centralized management provides economies of scale for purchasing, competitive incomes, and capital for facilities and expansion.
CURRENT STATUS
The network has succeeded in improving the quantity and quality of medical care in this very remote and impoverished region. New practices have been developed and a fifth county added to the network. Staff now include 35 full-time physicians, 3 dentists, and a contract podiatrist. In 1996 the various sites recorded 165,000 patient visits.