[Congressional Record Volume 155, Number 22 (Wednesday, February 4, 2009)]
[Extensions of Remarks]
[Pages E204-E205]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009

                                 ______
                                 

                               speech of

                       HON. ELEANOR HOLMES NORTON

                      of the district of columbia

                    in the house of representatives

                       Tuesday, January 27, 2009

       The House in Committee of the Whole House on the State of 
     the Union had under consideration the bill (H.R. 1) making 
     supplemental appropriations for job preservation and 
     creation, infrastructure investment, energy efficiency and 
     science, assistance to the unemployed, and State and local 
     fiscal stabilization, for fiscal year ending September 30, 
     2009, and for other purposes:
  Ms. NORTON. Mr. Chair, I rise today to applaud a particular section 
of the stimulus package that will have a profound impact on the 
citizens of the District of Columbia. The hundreds of millions of 
dollars in AIDS/HIV testing and prevention contained in the legislation 
before us will assist an amazing organization in the District called 
the Whitman Walker Clinic. When it is time to award these funds, I 
strongly urge the Secretary of HHS and the Director of the CDC to look 
favorably upon the Clinic's application.
  The District of Columbia is facing an HIV/AIDS epidemic of untold 
proportions. It is estimated that 1 in 20 citizens of the District now 
have HIV or AIDS. This is one of the highest incidences in the Country 
if not the highest compared to other major metropolitan areas.
  The Whitman-Walker Clinic (WWC), a comprehensive primary care clinic 
with centers of excellence in HIV/AIDS care and Lesbian, Gay, Bisexual 
and Transgender (LGBT) health care, has been providing healthcare and 
supportive services to residents of the District of Columbia for 30 
years. WWC is one of the largest nongovernmental HIV/AIDS medical and 
service organizations in the metropolitan

[[Page E205]]

Washington area. The Clinic provides a full spectrum of medical and 
support services to patients residing in the District of Columbia 
metropolitan area through its two District of Columbia sites: Elizabeth 
Taylor Medical Center (ETMC) and Max Robinson Center (MRC).
  The overall aim of WWC HIV/AIDS services is to improve health 
outcomes of persons living with HIV/AIDS (PLWHA) by providing clients 
with comprehensive and coordinated primary medical care; dental care; 
HIV/AIDS specialty care; medical adherence case management; mental 
health and addictions counseling and treatment; HIV education, 
prevention, and testing; support groups; nutrition counseling; legal 
services; and day treatment programs. The Clinic offers a comprehensive 
continuum of HIV/AIDS-related medical, behavioral health, and social 
services through our ``one-stop-shop'' approach to service delivery 
where all client services are available and integrated at a single 
location at each of our sites. The WWC ``one-stop shop'' approach 
combined with a newly implemented Electronic Health Record (EHR) 
enhances and ensures coordinated treatment, continuity of care, 
confidentiality, and elimination of duplication of effort and/or 
services. The co-location also allows better and more efficient access 
to services for clients.
  Among the many recent accomplishments of the Clinic are the four key 
new services which advance care for HIV patients: (1) the addition of 
an electronic health record (EHR) system; (2) the establishment of the 
Medical Adherence Case Management Department; (3) implementing the 
Public Benefits Department; (4) and implementing a new visit type: the 
``Rapid HIV'' visit.
  (1). The Electronic Health Record: WWC implemented an electronic 
health record system, ``eClinicalWorks,'' in order to achieve 
significant clinical and operational efficiencies that are needed to 
support a high quality client/physician encounter. WWC EHR allows for a 
complete multidisciplinary approach to health care. All clients of WWC 
are established in our electronic health record (EHR) system in order 
to track progress in an organized and efficient manner. This allows 
physicians, mental health practitioners, nurse case managers, and other 
providers to coordinate the care of that client, exchange information, 
and communicate with each other in an efficient and trackable manner. 
When we receive information from an outside health service, that 
information is scanned into the patient's Clinic-based EHR. Similarly, 
when we send out information to an external provider, a note is made in 
the EHR as to the nature of the communication.
  (2). Medical Adherence Case Management Department: The Medical 
Adherence unit consists of Medical Adherence Case Managers and Medical 
Adherence Care Coordinators. The Medical Adherence Case Managers, all 
of whom are RNs, provide the following: barriers to care assessment, 
care planning, disease process education, medication/treatment 
management support, 24-hour support via pager and pillbox initiation. 
The Medical Adherence Care Coordinators provide support by addressing 
clients who no-show as well as: prescription refill reports and 
followup, home visits, accompaniment to medical appointments, social 
services as they relate to barriers to care (like emergency financial 
assistance clinics, housing clinics, access to food and transportation) 
and other elements as they relate to life skills for managing a healthy 
lifestyle. This unit provides an immediate point of care for our new 
clients, establishing the relationship from the minute they walk in the 
door, or receive an HIV positive test result. WWC recognizes that for 
many of our clients, access to food and transportation can be a huge 
barrier to maintaining their medical care. Each staff person in Medical 
Adherence will be trained in accessing resources available to assist 
clients in these areas. The Medical Adherence Department also employs 
two full-time referral coordinators who assist patients in securing 
specialty and subspecialty appointments. For HIV-positive patients, the 
Medical Adherence staff members, in conjunction with our physician 
providers, pay close attention to identifying those patients at risk of 
failing their treatment regimens.

  (3). Public Benefits Department: As of October 1, 2008, all WWC 
clients receive eligibility screening for public and private insurance 
through our recently established Public Benefits department. This 
screening and support service ensures that clients are able to identify 
and apply for public insurance programs for which they qualify. By 
thoroughly assisting clients in securing insurance, it also ensures 
that Ryan White funds remain the payor of last resort. Public Benefits 
Coordinators meet with all new HIV clients soon after they test 
positive at the Clinic or seek care at the Clinic as a new patient with 
previously diagnosed HIV. Potential patients will be asked to bring in 
proof of residency and income. Public Benefits Coordinators then assist 
potential patients in determining for what insurance programs they are 
eligible and provide assistance in applying for benefits. Public 
Benefits Coordinators, most of whom are bilingual (English/Spanish), 
work closely with medical providers and the Medical Adherence Case 
Management department to help clients overcome barriers such as a 
medication they cannot afford, lack of insurance, denial of a service 
by their public insurance, all to ensure easy access to the services 
that they need. They guide clients through every step of the process 
necessary to eliminating barriers to care related to payor source. Most 
of the D.C. patients seen by WWC are ultimately deemed eligible for 
payor programs such as Medicaid and DC Alliance.
  (4). The ``Rapid HIV Visit'': The development of a ``Rapid HIV'' 
appointment type has allowed the Clinic to retain new HIV clients in 
care. Through this system, all new HIV clients are seen by the Medical 
Adherence Nurse Case Management team as well as by their primary 
medical provider on the same day they test positive in one of our 
facilities or seek care at WWC for their previously diagnosed HIV. 
Medical Adherence Nurse Case Managers triage all new HIV clients and 
initiate their care at WWC. WWC reserves several ``Rapid HIV'' visits 
with providers for new HIV clients each day. Therefore, new HIV 
patients are almost always able to meet with a provider the same day 
they test positive or present to the Clinic as a new HIV patient. 
Medical Adherence Case Managers provide post-testing counseling and 
``HIV 101'' education to help patients understand their new diagnosis 
and navigate their treatment options. For new patients, providers take 
a full history, screen for mental health and/or substance abuse issues, 
order HIV and other labs, and assess immunization and tuberculosis 
status. Patients will also be given the opportunity to meet with the 
Public Benefits Coordinators on that same day as well.
  The Clinic offers expanded hours to accommodate clients who need 
services outside of the traditional work day. ETMC hours are Monday 
through Thursday from 8 am to 8 pm and Friday from 8 am to 5 pm. MRC 
hours are Monday and Tuesday from 8 am to 8 pm and Wednesday, Thursday, 
and Friday from 8 am to 5 pm. In addition to extended site hours, the 
Clinic provides an afterhours on-call nursing line pager with physician 
back-up for medical clients who may be experiencing a non-emergency 
problem or need medical advice.
  WWC clinics are well situated, geographically, to provide services to 
underserved communities, including Blacks, recent immigrants, Latino/
as, and men who have sex with men (MSM). Services at both sites are 
fully handicapped accessible and conveniently located on the Metro and 
bus lines. ETMC is located in Ward 2 near the U-street corridor, serves 
an area of the city concentrated with Latinos, African Americans, MSM, 
and where a significant number of people live below the poverty line. 
MRC is located in Ward 8, serves residents of Wards 6, 7, and 8, and 
residents east of the Anacostia River. Located in one of the city's 
poorest neighborhoods, MRC is well positioned to outreach and serve 
residents in Southeast, D.C., which is the area currently hardest hit 
by the AIDS epidemic. WWC's MRC location facilitates access to 
difficult to reach populations, such as IDUs, women with children, and 
sex workers.
  The funding that is made available in this legislation will help give 
the necessary tools to the staff and volunteers of the Whitman-Walker 
Clinic. I am told that the Clinic has major renovation and 
infrastructure needs as well. Funding awarded by the Secretary of HHS 
and the Director of the CDC will go a long way to help identify and 
treat HIV/AIDs in the Nation's capital. Again, I am thankful that this 
money is contained in this package and I respectfully urge a favorable 
ruling on the Whitman-Walker's application for funding.

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