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RALLS — The new Ralls Family Medicine Clinic is a quaint building with big ambitions: to be an oasis in a health care desert. It has a small waiting room with open windows to let the sun shine after several days of rain. Two receptionists greet incoming patients. There are two waiting rooms and an office for the primary caregiver, John Hodges.
The clinic is a welcome lifeline for many in the small town and the rest of Crosby County.
On a recent Thursday morning, Hodges walked one of his older patients out the door. “God bless you for being here, John,” the patient said, shaking the nurse practitioner’s hand on his way out.
“It’s a security blanket,” said Hodges, a native of the area. “I have elderly patients come in saying, ‘I can come here, I can’t go to Lubbock.’”
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 — 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.
“We’re going to need to make it through these first three to six months,” Hodges explained.
Downtown Ralls on Sept. 1, 2022. Credit: Mark Rogers for The Texas Tribune
The hurdles in Crosby County’s access aren’t unique in the state. In the last decade, 20 rural hospitals closed in Texas, the most in the nation. The closures are typically rooted in financial hardship — 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 exacerbated by the COVID-19 pandemic. According to the United Health Foundation, Texas is the least healthy state in the country and has the highest uninsured rate at 18.4% in 2019.
“There are big swaths of West Texas, miles and miles without a lot of people,” said John Henderson, CEO of the Texas Organization of Rural and Community Hospitals. “But the people who do live and work in those areas deserve access to care, just like the rest of the state.”
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’s hospital until 2019, when management announced changes coming to the clinic. Hodges found a job in Lubbock but felt guilty leaving his patients who didn’t have the resources to make the trip.
“When I left, I had a couple of patients who said, ‘What’s going to happen when you leave?’” Hodges recalled. “There’s 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?”
The clinic was not Hodges’ original idea — Terry Hitt called Hodges earlier this year. Hitt, the new mayor of Ralls, said Crosbyton’s hospital is barely there — there are only two open beds for patients — so he wanted a clinic in Ralls. And he wanted Hodges, who treated so many people in the town before, to lead it.
“It is something we needed here, instead of driving over to Lubbock,” Hitt said. “We 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.”
The clinic does have the support from city leadership. The city owns the building that houses the clinic and offers Hodges a “generous” rate, and Hitt said he and the city council will continue to support the clinic and its possible expansion.
“Every time I’ve been there, he is snowed under. There’s always a lot of people in there,” Hitt said. “So if John needs something, he’s going to get it. We’re going to make sure of that.”
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.
“There’s a gap that everybody knows about, but nothing’s ever done, and it’s the gap of people that don’t qualify for Medicaid but can’t afford insurance,” Hodges said. To balance it, Hodges offers fixed rates regardless of insurance — $35 office visits, $20 lab tests, $15 COVID-19 tests and free strep tests.
It’s different from what Hodges is used to. He’s worked in offices that charge significantly more, but that cost weighed on him.
“Knowing all day, there’s somebody that can barely pay their bills and I’m charging them $100 an office visit? I can’t do that,” said Hodges.
So far, his rates have proven successful. The clinic saw 359 patients in its first month.
“Our price is right where we’re not breaking people to come in,” Hodges said. “Patients can come in and get a whole set of annual labs for $100-$150, you don’t have to charge $1,000.”
Henderson said that what Hodges is offering in Ralls is the kind of care that could help keep patients out of hospitals.
“Wellness visits and chronic conditions are your bread and butter in rural Texas,” Henderson said. “Playing offense instead of defense, trying to keep people from needing more care or hospitalizations, that approach is the center of primary care.”
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’s 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’t many avenues for funding by the state.
“People might wonder why other people don’t open up rural health clinics or clinics in general,” Hodges said. “It’s very difficult.”
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Correction, Sept. 23, 2022: An earlier version of this article incorrectly reported John Hodges was a native of Ralls. He is a native of Crosbyton.