On a recent Thursday morning, John Hodges walked one of his older patients out the door. 鈥淕od bless you for being here, John,鈥� the patient said, shaking the nurse practitioner鈥檚 hand on his way out.
鈥淚t鈥檚 a security blanket,鈥� said Hodges, a native of Ralls. 鈥淚 have elderly patients come in saying, 鈥業 can come here, I can鈥檛 go to Lubbock.鈥欌��
Ralls, about 30 miles east of Lubbock, sits in Crosby County and is on the edge of a West Texas medical desert, with limited services offered at Crosbyton Clinic Hospital 鈥� the only hospital in the county. Other resources are also being stretched thin due to nearby counties that lack health care access.
Even as Hodges tries to help his community, he still faces the financial uncertainty that plagues the majority of rural clinics. His uncertainty is reflected on the bare walls of the Ralls Family Medicine clinic.
鈥淲e鈥檙e going to need to make it through these first three to six months,鈥� Hodges explained.
The hurdles in Crosby County鈥檚 access aren鈥檛 unique in the state. In the last decade, 20 rural hospitals in Texas, the most in the nation. The closures are typically rooted in financial hardship 鈥� patients may be uninsured, there may not be enough patients in a small town and Medicaid reimbursements are low. This has created a crisis for rural health care that was only exasperated by the COVID-19 pandemic. According to the United Health Foundation, Texas is the state in the country and has the highest uninsured rate at 18.4% in 2019.
鈥淭here are big swaths of West Texas, miles and miles without a lot of people,鈥� said John Henderson, CEO of the Texas Organization of Rural and Community Hospitals. 鈥淏ut the people who do live and work in those areas deserve access to care, just like the rest of the state.鈥�
Hodges is trying to bridge the gaps in rural health care. The small clinic serves the 1,740 Ralls residents and others in surrounding areas. About 20% of the town is older than 65.
Hodges worked at Crosbyton鈥檚 hospital until 2019, when management changes coming to the clinic. Hodges found a job in Lubbock but felt guilty leaving his patients who didn鈥檛 have the resources to make the trip.
鈥淲hen I left, I had a couple of patients who said, 鈥榃hat鈥檚 going to happen when you leave?鈥欌�� Hodges recalled. 鈥淭here鈥檚 two in particular that I remember, who are dead now. I still think, if I would have stayed in Crosbyton or if something was different, would they still be alive?鈥�
The clinic was not Hodges鈥� original idea 鈥� Terry Hitt called Hodges earlier this year. Hitt, the new mayor of Ralls, said Crosbyton鈥檚 hospital is barely there 鈥� there are only two open beds for patients 鈥� so he wanted a clinic in Ralls. And he wanted Hodges, who treated so many people in the town before, to lead it.
鈥淚t is something we needed here, instead of driving over to Lubbock,鈥� Hitt said. 鈥淲e have a very large senior population, and I thought it would be really nice to have someone here in Ralls that they could come to.鈥�
The clinic does have the support from city leadership. The city owns the building that houses the clinic and offers Hodges a 鈥済enerous鈥� rate, and Hitt said he and the city council will continue to support the clinic and its possible expansion.
鈥淓very time I鈥檝e been there, he is snowed under. There鈥檚 always a lot of people in there,鈥� Hitt said. 鈥淪o if John needs something, he鈥檚 going to get it. We鈥檙e going to make sure of that.鈥�
Hodges wanted to make the clinic accessible and affordable. About 16% of Ralls residents are living in poverty, and 20% of the county is uninsured.
鈥淭here鈥檚 a gap that everybody knows about, but nothing鈥檚 ever done, and it鈥檚 the gap of people that don鈥檛 qualify for Medicaid but can鈥檛 afford insurance,鈥� Hodges said. To balance it, Hodges offers fixed rates regardless of insurance 鈥� $35 office visits, $20 lab tests, $15 COVID-19 tests and free strep tests.
It鈥檚 different from what Hodges is used to. He鈥檚 worked in offices that charge significantly more, but that cost weighed on him.
鈥淜nowing all day, there鈥檚 somebody that can barely pay their bills and I鈥檓 charging them $100 an office visit? I can鈥檛 do that,鈥� said Hodges.
So far, his rates have proven successful. The clinic saw 359 patients in its first month.
鈥淥ur price is right where we鈥檙e not breaking people to come in,鈥� Hodges said. 鈥淧atients can come in and get a whole set of annual labs for $100-$150, you don鈥檛 have to charge $1,000.鈥�
Henderson said that what Hodges is offering in Ralls is the kind of care that could help keep patients out of hospitals.
鈥淲ellness visits and chronic conditions are your bread and butter in rural Texas,鈥� Henderson said. 鈥淧laying offense instead of defense, trying to keep people from needing more care or hospitalizations, that approach is the center of primary care.鈥�
Hodges said he plans to start taking insurance as soon as he gets approval to do so by medical regulators in the next few months. He鈥檚 optimistic but said the clinic is in sink-or-swim mode financially for now. Hodges is trying to have the clinic be a designated rural health clinic, which would enhance the reimbursement payments to the clinic for providing Medicaid and Medicare services. Hodges said there aren鈥檛 many avenues for funding by the state.
鈥淧eople might wonder why other people don鈥檛 open up rural health clinics or clinics in general,鈥� Hodges said. 鈥淚t鈥檚 very difficult.鈥�
