WHITESBURG Van Breeding, MD, has always been an early riser. He gets up at 4:30 am every day, arrives at the hospital at 5, completes his rounds by 7, exercises from 7 to 8, and then goes to work to see patients. It’s a routine he started as a child in Whitesburg, Ky., performing chores on the farm before going to school.
But, 3 am is early, even for Breeding. However, when he was young and his grandmother was suffering from heart disease, he and his family would get up at 3 am and make the four-and-a-half hour drive to Lexington for her medical appointments. He never forgot those trips.
“Those trips were just devastating,” Breeding says. “I saw how hard it was on her. I thought ‘this would be much better if we could do this right here in Whitesburg.’ I always had an interest in first aid when I was in Boy Scouts aid and just had a craving to see if I could help people to be healthier and not have to travel so far to get good healthcare.”
Now, his dream of providing comprehensive healthcare to the people of Eastern Kentucky is a reality. Breeding serves at the Director of Clinical Affairs at Mountain Comprehensive Health Corporation (MCHC), headquartered in Whitesburg. What began as a little clinic in a trailer in 1971 has become a non-profit corporation of clinics located in Letcher, Perry, Owsley, Harlan, and Bell counties. In all, MCHC operates eight clinics, 16 school- based clinics, and the largest black lung clinic in the United States.
And, true to Breeding’s vision, the clinics strive to offer a full array of primary healthcare services, so patients can get the care they need without the extensive travel. Though Breeding, himself, traveled to Lexington to complete his undergraduate and medical degrees, as well as a family practice residency at the University of Kentucky, he always intended to go back and serve the people of Eastern Kentucky.
“I always thought it would be better if I could manage everything my patient needed there at home, because we didn’t have very many specialists,” Breeding says of his decision to focus on family practice. “We needed more primary care doctors than we did specialists at that time. I always had an interest in being able to take care of the whole patient.”
MCHC offers a wide range of services, including family practice, internal medicine, pediatrics, OB-GYN, dental, and optometry. Each clinic has a pharmacy. Appointments with behavioral health professionals, licensed clinical social workers, substance abuse counselors, and psychologists are also available. In addition, MCHC also offers specialty care, including critical care pulmonology, infectious disease, and cardiology. Visiting specialists include neurology, orthopedics, and nephrology.
“We try to find what barriers are limiting our patients from getting the best healthcare they can get and break those and provide those services locally,” Breeding states. “We can offer our patients everything they need. We can provide their medical care in one stop.”
A Commitment To Community Healthcare
MCHC saw 40,000 unduplicated patients in 2017, totaling 200,000 visits. As a community health center, MCHC receives about $4 million per year. Overall, MCHC is a $25 million nonprofit operation, meaning any profits are invested back into the clinic in the form of facility upgrades, quality of patient care, and staffing. While the size and scope are impressive, Breeding is most proud of the quality healthcare provided.
“Most community health centers are kind of looked at as the clinic that you have to go to because you can’t go anywhere else,” Breeding explains. “We wanted to change that image. We wanted to make our community health center not the place that you had to go, but the place you wanted to go to.”
Breeding, whose wife Pauletta is a registered nurse, gets his determination to bring quality healthcare to the people of Eastern Kentucky by still being deeply rooted in his childhood and his connection to the community. “I’m kin to half my patients and the other half I grew up with,” he jokes.
But, to Breeding, community involvement is no laughing matter. He and the staff at MCHC have committed themselves to being visible, active partners and leaders in the community. Breeding gives all of his patients his personal cell phone number and encourages fellow doctors to do the same. He also encourages staff to be community leaders, coaches, and volunteers.
“My practice is like a country doctor,” Breeding says. “I saw how our local family doctors were able to thrive in the community. They were coaches and teachers and church members. We want to hire doctors who are doctor leaders who take an active part in the community.”
One example of MCHC’s connection to the community is the forming of the “Farmacy” program. Recognizing that many locals were taking up farming instead of working in the coal mines, MCHC saw a way to help the local economy and their patients at the same time. Through the program, any MCHC patient with two or more chronic illnesses can go to the farmer’s market and get $8 worth of fruit and vegetables each week. That includes every member of the family, all paid for by MCHC. Breeding points out, “That’s a $250,000 program that puts money back into the farmers’ pockets and helps our patients to learn to eat better.”
MCHC has responded directly to community health needs as well. Notified by Clinical Decision Support (CDS) that the rate of qualified patients who had their colonoscopy was a “dismal” 19 percent, Breeding and his staff formed a task force and made patient education a priority. Today, the percentage of patients ages 50 to 70 who have had colonoscopy screenings is up to 63 percent. A similar approach has helped the clinics fight diabetes. Four years ago, less than 40 percent of their patients had their diabetes adequately controlled. With education and dieticians going to every clinic, that rate is now over 65 percent.
Being responsive and innovative are central to MCHC’s goals of being a high-quality, one-stop shop for patients in Eastern Kentucky. Breeding, who was named Staff Care’s 2017 Country Doctor of the Year, says he and his staff are trying not only to make quality healthcare accessible, but also to break down misconceptions about the region.
“People in larger cities think that culturally, spiritually, financially, and educationally we are at a reduced level than where they are.” Breeding elaborates, “Our patients may not have gone to college, may not drive the finest cars, or have the best clothes, but they have strong wills and desires to be healthier. They have great common sense. They are very intelligent. They have never had the opportunities to be able to excel. But that’s changing.”
He goes on to say, “When people hear we’re from Eastern Kentucky, we want them to say ‘They know what they’re doing up there. They’re making a difference and making it every day.’ We are going to continue to be innovative and barrier-breaking. We are going to continue to blaze this trail that we’re blistering right now, no matter what happens.”
With so much to do, is there any wonder he gets up so early?
“We wanted to make our community health center not the place that you had to go, but the place you wanted to go to.”