DADE CITY — By many measures, the medical clinic did not seem the kind of place that would last this long.
Early years in a humble downtown storefront. Reliance on uncertain federal funding. Times when it couldn't hang on to its talent. Times when it ran huge deficits and barely made payroll.
And yet, here it is, the 30-year anniversary of Premier Community HealthCare Group.
The nonprofit medical group has scrimped, saved and reinvented its way into becoming a $7-million organization that got nearly 65,000 visits last year from uninsured and insured patients at its clinics in Dade City and Zephyrhills.
Survival is not easy. In recent days, administrators were scrambling to finish another round of federal grant applications to help pay for providing care at a low cost. Day-to-day practical matters — Can this patient afford to get an X-ray? Can this one find a bus ride home? — take up a lot of the staff's time. And just last week, the clinic learned its federal grant could be cut next year.
"We have, from day one, had to keep it as austere as possible," said the clinic's new marketing director, Susan Hutson.
Yet Premier has managed to expand its services from pediatrics, family health and obstetrics to include mental health care for children, dental care and diabetic management. It merged old locations and last year used the lease money that was freed up to renovate its Zephyrhills clinic.
The number of employees has grown from one nurse and one doctor in 1979 to 100 employees today.
And based on the results of a state-funded, one-year pilot program last year, Premier decided to add longer weeknight and Saturday hours, which are geared toward people who can't afford to take time off work to get medical care.
Just in that one year program, which ended in September, the clinic saw nearly 700 new patients — some of whom might have gone to local emergency rooms for their medical needs had the clinic not been open late.
"I'm very proud of what this center has become," said Mary Elder, a county social worker who sits on Premier's board of directors.
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Across the country, in isolated, rural areas and in poor urban neighborhoods, federally-funded "community health centers" like Premier are often one of the only affordable and dependable providers of basic care.
Premier has its origins in the late 1970s when a group of east Pasco residents realized that migrant workers needed medical help, especially when it came to prenatal care.
"There were a lot of poor people who didn't have anything," said Dr. Marcelino Oliva of Dade City, who served on the original board of directors.
The federal grants — for Premier it's about $2.24-million, or a third of its budget — allow the centers to provide reduced-price care to the uninsured and underinsured, who may otherwise seek more costly help in hospital emergency rooms.
That grant doesn't last long. Half of the patients who show up at Premier each year have no insurance and pay based on their income. Less than six months into the current fiscal year, Premier used up its federal money, Hutson said.
Additional revenue comes from insured patients. Medicaid patients make up another 35 percent and Medicare about 2 percent of the payer mix at Premier. Privately insured patients are about 10 percent, a percentage that clinic officials say they must grow to help make up for covering the costs of the uninsured.
That means battling a perception, they say, that the clinic is only a place of last resort.
Norma Bruce, director of clinical operations, said when Premier first started, most of the doctors were fresh out of medical school, signing up to work with a federally funded community health center because they could get credit to pay off their student loans.
"But today professionals are choosing to be in public health," she said, noting Premier's accreditations. "The quality of care has grown immensely."
Premier started out as East Pasco Health Clinic and later became Health Resource Alliance before once again changing its name in 2004 to Premier. That move, said former board chairman Wilton Simpson, was to make a point.
"We didn't want to have this stigma that we were just this low-cost organization," he said. The name Premier "kind of summarized what we thought we were."
Even so, staff at community health centers face practical daily challenges that private centers do not because of the large percentage of patients without a lot of money.
That means anything from making sure patients can afford the medicine to making sure they can afford special diet restrictions.
And since it does not offer any specialty services, such as orthopedics, Premier struggles to find specialists who can provide care at a reduced price for its uninsured patients. Even ordering X-rays must be a very selective process because the clinic has a limited number of cases for which it can get reduced prices.
"We have referral clerks who get on the phone," said Hutson, "and just start shaking the bushes."
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Despite its longevity, and the prominent location of its largest center on Church Avenue, Premier is not one of the best-known agencies in the county. This month, in fact, the clinic is holding an online fundraiser — the first fundraiser in its 30-year history.
Kim Schuknecht, a former Dade City banker who took the helm as the group's chief executive in 2006, has been talking up the clinic's work at Rotary and chamber meetings.
She said she wants to make sure small businesses that can't afford to provide health insurance to their employees know about Premier's services. She knows, too, that during a recession, the demand for the clinic's services will only grow.
"People don't know about us until they need us," Schuknecht said.
West Pasco has learned a little more about Premier in recent years as the group wants to run a primary care clinic for the medically needy at the planned regional hurricane shelter in Hudson. An analysis a few years back showed that west Pasco's uninsured and underinsured face huge problems when looking for affordable care.
But so far, the feds have not said they would kick in money to make that move possible for Premier. Clinic administrators' response?
They will keep trying.
Times researcher Shirl Kennedy contributed to this report. Jodie Tillman can be reached at firstname.lastname@example.org or (727) 869-6247.