Tuba City Regional Explores Ways to Expand Access within Navajo Nation

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With unique challenges to funding and its patient population, Tuba City Regional Health Care is committed to serving the residents of the Navajo and Hopi reservations in and around Tuba City, Ariz.

Tuba City Regional Health Care is a 638 self-determination organization, which means it receives some funding from the Indian Health Services, but it can operate independently and seek out other funding sources. The organization recently named Lynette Bonar as chief executive officer, after she served in an interim capacity. She succeeded the retiring Joseph Engelken, with whom HCE Exchange spoke back in 2011.

Bonar has been instrumental in expanding upon Engelken’s mission for the organization and has brought many new services to the community.

Improving diabetes care and outpatient care

Approximately 30 to 40 percent of Tuba City Regional’s patients have diabetic issues, including heart and vascular conditions, wound healing issues, and other comorbidities, Bonar estimates.

A few years ago the organization built a three-story, 34,000-square-foot outpatient clinic to provide better service to patients. The clinic is equipped with primary care, an outpatient pharmacy, and a healthy living center.

The healthy living center promotes positive lifestyle habits, particularly for those living with diabetes. Tuba City Regional received federal grants for health promotion and diabetes prevention in order to fund these programs.

“We are able to take more time with patients that are diabetic to give them medication counseling and nutrition information,” Bonar said. “We have a foot program, eye program, and dietician available to help patients manage their disease.”

She said the podiatry program has become a major factor in improving the quality of life for many diabetes patients. Patients are now able to receive wound care and treatment rather than having their symptoms worsen and risk amputation.

The next step for the center is to expand its interventional radiology program. Bonar credited this program with enhancing Tuba City Regional’s ability to address the vascular issues afflicting its diabetic patients.

With more than 8,000 residents, the center does its best to service all of Tuba City. The outpatient building stays busy with specialty care, family medicine, and women’s and children’s services.

“Since the outpatient center opened, our appointments have almost doubled,” Bonar said. “Everybody wants to come here.”

Tuba City Regional is able to maintain more than 100 physicians, all of them employed, across many specialties. The center is planning to contract with physicians from nearby medical centers to provide care a few days a week in specialties such as neurology and rheumatology.

Connecting with the community

In addition to the main campus, Tuba City Regional owns satellite clinics that are spread throughout the surrounding area. The reservation is expansive, and many patients have to travel 20 or 30 miles to receive care, with some being located as far as 70 miles away.

To help with access issues, Tuba City Regional is expanding its telemedicine and mobile care programs. The organization has three vans that travel to seven communities and provide dental care and medical care.

Tuba City Regional has also strengthened its mail-order pharmacy program to improve access to medications and assist patients in sticking with their care plans.

The medical center’s connection to the community is vital, Bonar said. There’s a huge diversity among the staff and patients with some coming from different tribes and others from outside the reservation. Bonar said the outpatient clinic has helped forge a stronger bond with the community.

“We have patients that were born here and receive end-of-life care here,” she said. “We can see their full medical history. We need to know what’s important to our community.”

In addition to providing for patients, inadequate housing has been a problem with recruiting staff and physicians. Tuba City Regional owns 300 housing units and is building three more apartment buildings with 36 units each just for staff.

“We need professionals out here, and we have to provide them a place to live,” Bonar said.

Funding the future

Funding is always a problem for smaller medical centers, and Tuba City Regional faces unique challenges. It can take years to obtain approval and money from the Indian Health Service. By being a self-determination organization, Tuba City Regional has more freedom and is able to use reimbursements from Medicare, Medicaid, and third-party payers. The organization recently procured a loan for the outpatient building and makes full use of all grants it receives.

In an effort to advance telemedicine and provide access to care across its 6,000-square-mile service area, Tuba City Regional is looking for investors to help improve the Internet services. An adequate broadband system is needed for future telemedicine vans and for general communication across facilities.

Tuba City Regional has also implemented electronic medical records in its inpatient hospital, but is looking to change vendors in the coming years.

For now, the organization is continuing to improve quality of care and access to care, as well as managing the sustainability of its programs in order to ensure that it is able to continue serving the Native American population far into the future.

by Patricia Chaney

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