Number of School District-Affiliated Health Clinics on the Rise

In some school districts across the state, having to take time off work or from class to spend half a day or more attending a doctor’s appointment is becoming a less frequent inconvenience.

Although still relatively uncommon, a growing number of Texas school districts have opened health clinics over the last decade, with operational setups and served populations varying with local needs. The most common reasons cited for starting a clinic include combatting rising care costs, meeting the healthcare needs of underserved populations, and reducing both employee and student absenteeism.

While the prospect of opening and running a district-affiliated health clinic may seem daunting, the process is typically a joint endeavor with a third-party health care entity experienced in running such operations. Additionally, the scope of services provided can range from relatively basic, preventative care, to full-fledged primary care facilities with pharmacies and lab collection sites.

Taking the First Steps

The decision to enter the healthcare business is a local decision that should be based on demonstrable needs. While the populations served by these clinics frequently overlap, the distinct groups typically served include:

• Employees and their spouses/dependents enrolled in the entity’s health plan
• Students
• The community zoned to a particular district

The most frequent rationale for opening a health clinic, while differing based on populations served, includes:

• Cost savings for employees and families
• Cost savings via reductions in premium increases
• Treatment of minor symptoms to avoid worsening conditions and more expensive health care
• Employees less likely to miss annual physicals
• Reduced time spent away from work or class
• Ability to go during breaks or conference periods
• Avoiding high deductibles for doctor visits stemming from minor issues
• Helping with recruitment and retention.
• Providing low-cost or free basic care to those who would otherwise get sicker
• Decreased need for substitutes

Community and Employee Attitudes

A great deal of positive energy appears to surround the opening of a health clinic. Entities with employee-focused programs report grateful employees who value the time savings, affordability, and in many cases, cost savings. Those that include students report happy parents who, much like the populations served by the community-focused clinics, are finally getting care that they otherwise likely would not have been able to receive.

Getting Started

Considering salaries are the biggest continuing cost for running your own health clinic, the amount of money available for opening and sustaining one is arguably the most important factor to consider before moving forward. The second biggest decision is probably location. While on-site clinics appear to be the most prevalent, some are located off-site but within the proximity of the population being served. Additionally, partnering with an established health care provider operation is probably ideal. Other decisions that need to be made include:

• How will it be funded (e.g., federal, state, or local government dollars, private grants, donations, insurance billing, in-kind support)?
• Will it be staffed and managed by the entity or an independent healthcare company?
• Who will be the target population for services (e.g., employees, dependents, students, community)?
• If employee only, are services restricted (e.g., all employees or just full-time employees)?
• Will a pharmacy and/or lab collection site be included?
• How will operational decisions be addressed (e.g., walk-in policy, hours of operation, appointment requirements, seasonal operational changes)?
• Should there be age limits (e.g., some clinics limit care to 2 years old and up)?
• What will the cost be for office visits?
• How will uninsured patients be addressed (e.g., sliding cost scale or free)?
• What specific services will be provided (e.g., immunizations, physical exams, general check-ups, acute care, wellness care, biometric screening, sports physicals, lab services, pharmacy, dentistry)?
• Will children under certain ages be required to have a parent present?
• Will on-site clinics be available district-wide or just for particular campuses?

Lessons Learned

Like any well-prepared business startup, opening a health clinic is not without risk. It is entirely possible to open one only to have to shut it down a few years later. While some are funded by grant dollars that may or may not exist in the future, others are dependent on insurance reimbursements and/or service fees. Also, cost savings can vary or even disappear depending on changes in carriers, participation rates, management practices, and the ever-shifting sands of healthcare reform.

On a more practical level, some entities report finding themselves in a continual informational battle to reduce the number of patients that come in for services that are not offered. For entities that hire their own staff, the additional capacity needed to recruit, retain, and manage novel jobs like clinic managers and physician assistants may prove overburdensome.

Additional Resources

Opening a health clinic will undoubtably require a steep learning curve to reconcile regulations governing the health field with those in the education field. Rather than going it alone, reaching out to education entities that have already gone through the process is a logical first step. Some of the more established examples include Allen ISD, Bryan ISD, Conroe ISD, Garland ISD, and Humble ISD.