"Rural Health: Scenic Bluff Clinic" will air
Thursday, May 22, 2003
on Wisconsin Public Television's "In Wisconsin" at 7 p.m.
Encore on Sunday, May 25 at 6 p.m.

read transcript | watch streaming RealVideo (5:18)

Access to health care is hard to come by in many rural Wisconsin communities. These areas often have difficulties attracting doctors, nurses and other medical professionals. People in the small, rural town of Cashton in Monroe County worked together to solve this problem by forming their own health care clinic.

"Rural Health: Dentist"
premiered Thursday, May 15, 2003
on Wisconsin Public Television's "In Wisconsin"

read transcript | watch streaming RealVideo (5:30)

Dental care in rural Wisconsin can be hard to find, especially for low-income households. According to the Wisconsin Primary Health Care Association, 80 percent of primary-care dentists in Wisconsin will not accept new Medicaid patients. In 15 counties, there are no primary-care clinics willing to accept new Medicaid patients. One dental clinic in Ladysmith is trying to fill this gap for thousands of people. The clinic adjusts its fees based on a number of factors, including a patient's income level. Since November 2002, the Ladysmith Dental Clinic has attracted patients from 37 Wisconsin counties and has had a waiting list of more than 1,000.

TRANSCRIPT
"Rural Health: Scenic Bluff Health Clinic"

Narration
Farming in a wet spring is a dirty business but Larry and Sue Haackenson take it all in stride. The Haackenson's milk about 60 cows on their Monroe County farm. They also raise calves to Try to make ends meet. Making ends meet on the farm has always been hard. This year has been harder than most. Milk prices are down again and the higher cost of fuel rippled through the entire farm industry, raising the cost of everything from fertilizer to the fees charged by suppliers. Larry Haackenson says the bills add up at the end of the month

Larry Haackenson
Got to be able to meet all the stuff at the end of the month if you can. Some months you don't, and then you have to try and make up for it somewhere along the line.

Narration
But Haackenson adds that making up for it is almost impossible, expecially if a family member gets sick or has an accident. The Haackensons say they can't afford health insurance. It's estimated that, for a farming family of five like the Haackensons, health insurance costs five to six hundred dollars a month.

Larry Haackenson
As far as buying insurance, there's no way. If I don't make enough money to pay my farm payments and feed bills and still cover the insurance.

Narration
Cost isn't the only obstacle farmers like the Haackenson's must overcome when looking for health care. Access is another obstacle. Many rural towns in Wisconsin don't have a nearby health care clinic. One exception is Cashton. In 1993 Cashton business owners teamed up with the Wisconsin primary health care association. Their goal — to create a clinic that offered low cost health care. They wrote a grant and won federal start up funds for a non-profit community health center. Scott Wall is one of the business leaders.

Scott Wall
Now we were lucky to get funded. We were in a group of 500 applicants and we were one of less than 30 I believe in the country that got funded in the particular cycle that we did.

Narration
The grant helped create Scenic Bluffs Community Health Center. Scenic Bluffs has a variety of services under one roof. It started out with basic medical services optometry and chiropractic care. Over time it added a ten-chair dental clinic and a pharmacy.

Sue Haackenson
She said some just have to pay the nominal fee and others, you know they go according to your income. And I thought well that sounded real good deal to me.

Narration
The clinic serves a range of patients, from those who pay the full cost of care to those, like the Haackensons, who pay fees adjusted for their income. About 16% of the clinic's budget is supplied by federal funds in part because it serves a large low- income population. Without those patients the clinic wouldn't have a large enough patient population to stay solvent in this small community. Robert Jecklin is the clinic's executive director.

Robert Jecklin
Without the alternative funding for segments of the population that may not be able to afford it we wouldn't have a large enough market to exist in. So it's — people are connected even though some may have more wealth than others, they're connected in that if they don't all have access, you probably couldn't do it in a small town.

Narration
This small town connection continues in the way the health center is governed. A twelve-member community board makes the decisions. It's made up of members like a mail carrier, a nurse, a retired high school principal and a local farmer.

Scott Wall
I think the advantage to having the citizen board is their focus is not on, is not only on the bottom line, but the bottom line for the community.

Narration
The bottom line is a constant concern. With almost 75% of the budget coming from patient fees, including the reduced fees offered on the sliding scale, the clinic must attract a large number of patients to stay in business. In this regard the communit-centered approach seems to have paid off. In 2002 the Scenic Bluffs Health Center had more than 15-and-a-half-thousand patient visits. It isn't always easy but the Scenic Bluffs model offers promise for other rural towns around the state.

Robert Jecklin
There's isn't anything that we've done here that couldn't be repeated in probably hundreds of communities around Wisconsin.

Narration
And for the Haackensons the clinic has helped make health care more accessible and more affordable.

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TRANSCRIPT
"Rural Health: Dentist"

Gertrude McBain (Patient):
I would not have been able to pay for dentures if it weren’t for the fact that the payments were based on my income.

Narration
Gertrude Mc Bain doesn’t have dental insurance so the cost of care is a serious concern. It’s a concern shared by many low income Wisconsin residents who may put off visiting a dentist until they’re in extreme pain.

Greg Nycz (Marshfield Clinic)
We have come across people who have for example taken a pliers to their mouth to pull teeth out with vicegrips. I can't imagine what kind of pain drives someone to do that.

Narration
Lack of insurance isn’t the only problem. In many parts of Wisconsin, particularly in rural areas, there’s a shortage of dentists. Dr. Blane Christman, of the Ladysmith Dental Center, has seen both problems up close.

Dr. Christman
… there were times you would walk out in your waiting room and there were people that were in dire need of help and could not find a dentist

Greg Nycz
If you look at map of dental health profession shortage areas Ladysmith is kind of in the center of a huge area in northwestern WI.

Narration
In addition to the problem of the shortage of dentists 80% of primary care dentists in Wisconsin will not accept new Medicaid patients. In 15 counties there are no primary care clinics willing to accept Medicaid patients.

The main reason for this limitation, according to the Wisconsin Dental Association, is that Medicaid reimburses only about 50% of what a dentist normally charges.

Dr. Michael Donohoo (President, WI Dental Assoc.)
It's very very tough when you get a caseload of Medicaid patients to cover your basic office overhead, much less have anything left over to take care of your own family. So it's been a huge problem and it's only getting worse as the state is undergoing its fiscal woes right now.

For a lot of dentists who do participate in the program, they are giving away their time and their effort in that one of the problems though is that charity is not a health care system. And we have a program here where the state has promised care to almost 500,000 people and unfortunately it's just not being delivered at the present time.

Greg Nycz
So we started seeing more and more of our patients coming into emergency rooms, urgent care settings, with problems that can't really be addressed there, that needed basic general dental care.

Narration
So Greg Nycz proposed a unique solution, one that’s been put into place in Ladysmith. He convinced Ladysmith dentist Christman to sell his practice to Marshfield Clinic and the Family Health Center of Marshfield. Christman took a cut in pay but in exchange, Marshfield handles all of the dental clinic’s operating expenses.

The sale converted the dental practice into a non-profit organization making it eligible for federal and state grants earmarked for "health professional shortage areas." In return the clinic provides care based on need, not on a patient’s ability to pay.

Greg Nycz
So we have a sliding fee and if you're under poverty for example and you're not on any public programs, it's a nominal payment of five dollars no matter what we help you with. And then we slide the fee from there.

Narration
The plan was just about in place when nature dealt a tragic blow. One month before the agreement was to take effect a tornado destroyed Christman’s dental clinic, along with many other buildings in downtown Ladysmith.

Greg Nycz
So that threw a big monkey wrench in our planning but through Dr. Christman's kind of heroic efforts, trying to pull the practice together, got all of his staff back working.

Narration
It took almost a month after the tornado but Christman managed to open his practice in the cramped quarters of a former school building on the edge of town.

Dr. Christman
I'm so happy that we are seeing patients now and I'm really proud
of our staff with what they've accomplished.

Greg Nycz
It's really like a field hospital and they're, you know the people there are doing heroic work in very difficult circumstances with people with tremendous needs.

Narration
Since the dental clinic opened in November of 2002, it has drawn patients from 37 counties and has had a waiting list of more than one thousand.

Dr. Christman
People are coming from as far away as Madeline Island

Greg Nycz
And people don't come from that distance unless they're in pain and there's no other alternative closer to home.

Narration
Dr. Christman hopes to trade the temporary quarters for a newly constructed dental office in the summer of 2003. The construction is being paid for with government grants and private contributions.

Finding dentists and other professional staff who want to work in rural areas is still a challenge but since the partnership with Marshfield Clinic was announced, Dr. Christman has been able to hire 5 full-time dentists and 5 hygienists.

Dr. Christman
I said you build it and they will come and we're seeing not only the patients but the dentists and the staff come in.

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