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On a recent Thursday morning, John Hodges brought one of his elderly patients out the door. “May God bless you here, John,” said the patient, shaking the hand of the leaving nurse practitioner.

“It’s a security blanket,” said Hodges from Ralls. He said, “An elderly patient came in and said, ‘You can come here, but you can’t go to Lubbock.'”

Lubbock, about 30 miles east of Lubbock, is in Crosby County, on the edge of the medical desert in West Texas, with limited services at the county’s only hospital, the Crosbyton Clinic Hospital. Due to the lack of access to health care in nearby counties, other resources are in short supply.

Hodges is trying to help his community, but he faces financial insecurities that plague most of the rural clinics. His uncertainty is reflected in the bare walls of the Ralls Family Medicine clinic.

“You have to get through the first three to six months,” Hodges explains.

Crosby County’s access hurdles aren’t just statewide. Twenty rural hospitals have closed in Texas in the last decade. This is the highest number in the United States. Closures are usually rooted in financial hardship. Patients may not have insurance, small towns may not have enough patients, and Medicaid reimbursements are low. brought According to the United Health Foundation, Texas is the least healthy state in the nation, with her highest uninsured rate in 2019 at 18.4%.

John Henderson, CEO of the Texas Rural and Community Hospital Organization, said: “But people who live and work in these areas have the same right to care as they do in the rest of the state.”

Hodges seeks to fill a gap in rural healthcare. The small clinic serves 1,740 Lars residents and people in the surrounding area. About 20% of the town is over her 65.

Hodges worked at the Crosbyton hospital until 2019, when management announced changes would be made to the clinic. Hodges found work in Lubbock, but he felt guilty for leaving his patients without the funds to travel.

“When I left, I had some patients saying, ‘What if you left?'” Hodges recalls. “I especially remember the two who are now dead. If I had stayed at Crosbeaton, or if something had been different, would they still be alive?”

The clinic wasn’t Hodges’ first idea — Terry Hitt called Hodges earlier this year. He told Lars he wanted a clinic because he only has two. And he wanted Hodges, who had previously treated so many people in town, to head it.

“It’s what we needed here instead of driving to Lubbock,” Hitt said. “We have so many seniors, and I thought it would be really nice if they had someone here at Lall’s.”

The clinic receives support from city leaders. The city owns the building that houses the clinic and is offering Hodges a “generous” fee, and said Hitt and the city council will continue to support the clinic and its potential expansion.

“Every time I’m there, he’s covered in snow. There’s always a lot of people there,” Hitt said. “So if John needs something, he’s going to get it. We’ll make sure.”

Hodges wanted the clinic to be accessible and affordable. About 16% of Lall’s residents live in poverty, and 20% of her in the county are uninsured.

“There’s a gap that everyone knows about, but nothing’s being done. It’s the gap of people who aren’t eligible for Medicaid but can’t afford insurance,” Hodges said. For this reason, Hodges offers a fixed fee regardless of insurance: a $35 office visit, a $20 lab test, a $15 COVID-19 test, and a free strep test.

Not what Hodges is used to. He has worked in offices with fairly high fees, and the costs weighed on him.

“Knowing all day, there are people who can barely pay their bills, and I’m charging them $100 for an office visit? I can’t do that,” Hodges said.

So far his rates have proven successful. In his first month at this clinic he saw 359 patients.

“Our pricing is right in that it’s not deterring people from entering,” Hodges said. “Patients can get him a whole set of tests a year for $100 to $150. They don’t have to charge $1,000.”

Henderson said what Hodges provides at Rall’s is the kind of care that helps keep patients out of the hospital.

“In rural Texas, wellness visits and chronic illness are your bread and butter,” Henderson said. The approach is at the heart of primary care.”

Hodges said he plans to take out insurance as soon as he receives approval from medical regulators in the coming months. Although he’s optimistic, the clinic is in financial sink-or-swim mode for now, he said. Hodges is trying to make the clinic a designated rural health his clinic. This enhances reimbursement payments to clinics for providing Medicaid and Medicare services. Hodges said there aren’t many avenues for state funding.

“People may wonder why other people don’t open rural clinics or general clinics,” Hodges said.

The full program is now live from the 2022 Texas Tribune Festival in Austin, September 22-24. Inside tracks for the 2022 elections and the 2023 legislative session, the state of public and higher education institutions at this stage of the pandemic, why Texas suburbs are booming, why broadband, and more, the 100 things planned for TribFest Check out the schedule of mind-expanding conversations above. Access issues, the legacy of slavery, what really happened at Uvalde, and more. See program.