By Tara Bannow • The Bulletin

Mosaic Medical’s patient population ballooned roughly sixfold in the decade that ended in 2015.

Most medical providers in Central Oregon saw an influx of patients at the beginning of 2014 because the health care program Medicaid, known here as the Oregon Health Plan, expanded to cover more low-income individuals. But Mosaic, being a federally qualified health center, was positioned as a natural home for the largest proportion of those newly insured patients. FQHCs receive federal funding to treat underserved populations, including the uninsured and those on Medicaid.

Today, Mosaic provides health care for roughly 18,500 of Central Oregon’s 50,000 OHP patients, more than any provider in the region. The month before the expansion took effect, Central Oregon had fewer than 30,000 OHP patients.

That doesn’t mean it’s been easy. Early on in the expansion, Megan Haase, Mosaic’s CEO, recalls one of her providers seeing 14 new patients in a single day. First-time appointments take longer than follow-ups, since the provider has to get to know the patient. Doctors generally only see between two and four first-time patients in a single day, she said.

At the time, Haase thought, “We have this wonderful group of people who really want to take care of patients, but it’s getting to the point where it’s unsustainable.”

As evidenced by Mosaic’s recently released 990 tax form, a financial document all nonprofits are required to send the federal government, things have calmed down at the provider’s 13 care sites.

In fact, the number of patient visits to Mosaic’s clinics in Bend, Prineville and Madras declined slightly between June 2014 and the end of May 2015, according to the 990 tax document.

The Bend clinic provided about 28,600 patient visits in fiscal year 2014, compared with nearly 36,000 in fiscal year 2013, tax forms show. The provider’s Prineville clinic — its oldest one, open since 2002 — provided about 11,400 visits in fiscal year 2014 compared with 12,700 the previous year. The Madras clinic provided about 1,700 fewer visits during the same time period.

The Redmond clinic, however, bucked the trend — its fiscal year 2014 visits exceeded the previous year by more than 500.

Kirk Schueler, Mosaic’s chief financial officer, said the provider’s fiscal year 2014 patient care figures were inflated by a dramatic bump in new patients, many of whom were newly insured and came in with lists of health issues that had gone unchecked for years.

“Then once they passed through, things settled back down,” he said.

In addition to the Medicaid expansion, 2014 also marked the first time people were required to have health insurance, much of which was subsidized by the federal government depending on income. Although 63 percent of Mosaic’s patients relied on Medicaid last year, 14 percent had private insurance.

For Mosaic’s providers, trying to manage all those patients at once was rough. Schueler said the fiscal year 2014 numbers also reflect Mosaic’s efforts to lessen those loads.

“It was so much, such a burden on them,” he said.

One patient hadn’t gotten a mammogram for 20 years because she had never had health insurance, said Elaine Knobbs-Seasholtz, Mosaic’s director of programs and development. Another had been waiting several years to see an endocrinologist for a thyroid problem, she said.

In the future, Schueler said he projects Mosaic will see modest growth — within the 1 to 2 percent range — but nothing like what they saw at the beginning of 2014. In fiscal year 2013, which ended May 31, 2014, Mosaic’s total revenue was about $18.3 million. Its expenses were $17.8 million. Those numbers reflect huge leaps from the beginning of that year, when revenue was $13 million and expenses were just under $12 million.

Fiscal year 2014 shows continued growth, but not quite as steep as the previous year. By May 31, 2015, revenue was just under $23 million. Expenses were about $21.5 million.

Most of Mosaic’s revenue comes from the money the government pays to care for OHP patients. It also gets reimbursed for Medicare and commercially insured patients. A smaller chunk comes from government grants and other contributions.

Mosaic’s providers have been trying to expand the ways they provide care from the traditional office visit. So-called “touches” involve things like phone calls and emails. The clinic in Prineville also has a remote patient monitoring program that allows patients to check their own blood pressure, oxygen levels and weights at home and have the results automatically transmitted to the clinic.

But it has so far been difficult to get paid for such work. Haase said Mosaic is currently working with its electronic health records provider to create ways to report such encounters into its patient records system.

“Eventually patients will say things like, ‘I need to email my care team,’ instead of, ‘I need to see my doctor,’” Knobbs-Seasholtz said. Meeting people where they are to provide care eventually will prevent serious health issues and the need for more office visits, she said.

“That is the future,” Knobbs-Seasholtz said, “but we’re not there yet.”

— Reporter: 541-383-0304,