Three days after Cedar Hill Regional Medical Center (CHRMC) opened at 1200 Pecan St. SE, the facility had already saved one life that would probably have been lost just one week earlier.
On April 18, two people drove themselves to the hospital’s emergency department (ED). Suffering from gunshot wounds, they collapsed into the ED trauma unit, which delivered immediate care.
“At least one gunshot wound victim would not have survived a longer commute across the Anacostia River,” a report from the hospital said. That patient was transferred by helicopter to a facility offering a higher level of care. Both survived, said the hospital, and are now at home with their families.
It’s been nearly three months since CHMC opened and the recovery of the two gunshot victims is just one testament to the impact the hospital has had on the medical landscape in Wards 7 and 8. But there are still gaps in care, gaps that the opening of the new hospital has thrown into stark relief—and gaps that could be exascerbated by federal funding decisions that were in the works as this article went to press.
Stark Need
CHMC is the first hospital to open in the District in 25 years. It offers 136 beds (with expansion to 184), trauma care and a 54-bay emergency department—30 for adults and 24 for children. The hospital also features maternal health and delivery services, including a six-bed well-baby nursery and a Level II NICU; five operating rooms (expandable to seven); an ambulatory pavilion and an array of outpatient services.
In the first 45 days the hospital was in operation, officials say there were more than 5,300 visits to the emergency department, 1,300 of those patients were children. That’s almost twice the daily visits received at the former United Medical Center (UMC). Doctors performed 27 surgeries, transferring 10 patients via helicopter. Cedar Hill can respond to 85 percent of trauma needs.
For the first time since 2017, babies were born on the east side of the river. 11 babies were delivered at CHRMC in the first 45 days, including the first, Reign, born at CHMC on April 27. “These are the first Washingtonians born in their own communities since labor and delivery services ended east of the river in 2017,” said CMHC CEO Anthony B. Coleman. “They represent the future — and the fulfillment of a promise made to our community.”
But the statistics are also telling, pointing to a need that remains unfilled in neighboring communities, officials say. 80 percent of the patients that walked into the ED could have been seen in an urgent care facility. That’s unusually high: the 2018 DC Primary Care Needs Assessment found that 21 percent of ED visits from Wards 7 and 8 could be addressed in clinics.
The high number of non-emergency visits to ED indicates an unmet need for primary and clinic care, said hospital administration and the need to broaden services. It is a goal they will be pursuing throughout the remainder of the year. CHRMC plans to open new primary care, OB/GYN and outpatient dialysis clinics to help fill the gap.
One problem might be education, pointed out At-Large Councilmember Christina Henderson (i), Chair of the Committee on Health, during a summer committee hearing. “We spent all this money to build these new urgent care centers, but they haven’t gotten the same level of promotion as the new hospital,” Henderson said, “but I think overall all of our hospitals would benefit from some sort of public education campaign.”
DC Health Director Dr. Ayanna Bennett said DC Health is working on expanding medical care options and on promotion. She said that the DC Hospital Association (DCHA) will lead a campaign promoting urgent care and when to go to ED. But she added that the District health systems plan indicates a need for more urgent care and alternative models to get care according to a variety of schedules. “We are looking at all of these things and you’ll see some interventions in that space,” Bennett told Henderson.
Filling the Gap With Care
More facilities are on the way. In March 2024, Universal Health Services (UHS) announced they will open a $22 million, 14-bed freestanding emergency department in Ward 7 on the Fletcher Johnson Campus as part of the deal that included CHMC, which UHS also operates. It will provide 24 hour 7 day a week hospital quality services to patients, with a full-service ED and team that can treat life-threatening injuries, chest pain, broken bones and illness and is scheduled to open in late 2027.
It is part of the UHS agreement with the District to invest $75 million in health care infrastructure east of the river. Two urgent care clinics were also planned as part of the hospital package, one in each of wards 7 and 8. Cedar Hill Urgent Care Center in Anacostia opened in 2022. That clinic has gone on to serve more than 12,000 patients a year. District officials did not respond to a request for comment on the status of the pending Ward 7 clinic.
“Cedar Hill will change the trajectory of health care in our community. This is a first-class hospital staffed by some of the most prestigious health institutions in the world,” Mayor Bowser said at the opening. For years, the backbone of the health system has been Federally Qualified Health Centers (FQHCs). In 2020 these clinics provided primary care and other services to about 200,000 people in the District regardless of ability to pay at locations such as the Elaine Ellis Center of Health, Community of Hope and the seven separate Unity Health Clinics in the wards.
But signs of changes to the landscape are already visible. In the last few years as the hospital was planned and built, a series of new medical facilities have appeared east of the river. In December 2019, Unity partnered with Howard University Hospital and So Others May Eat (SOME) to offer co-located specialized care in high-risk maternal and fetal medicine, oncology, behavioral health, and substance abuse treatment and counseling at their East of the River Health Center location (4414 Benning Rd. NE).
Others include BlueRock Care (3230 Pennsylvania Ave. SE, www.bluerock.care), which focuses on accessible primary and same-day care for seniors and Endenbridge PACE Care (2211 Town Ctr. Dr. SE, www.edengridgepace.com). PACE, which stands for The Program of All-Inclusive Care for the Elderly, works to support older adults while they age in place at home. MBI Urgent Care officially opened in March 2022 (5140 Nanny Burroughs Ave. NE, mbiucdc.com) to offer treatment with or without an appointment and accept Medicaid.
Bread for the City opened the new Michelle Obama Southeast Center (1700 Good Hope Rd. SE, breadforthecity.org) in 2020, which unites medical dental and vision services under one roof. In 2023, Whitman Walker opened their new Max Robinson Center (1201 Sycamore Dr. SE. www.whitman-walker.org) on the St. Elizabeths East Campus near CHMC. The facility offers same-day medical care, but also ongoing primary and specialty services from testing to acupuncture and even a pharmacy. Urgent Wellness LLC (1924 Savanna Terr. SE – Unit C, www.urgentwellness.com), which focuses on ongoing health problems and regular check-ups in low income communities. Additional maternal care options exist, too. In June 2022, Mamatoto Village (www.mamatotovillage.org), a Black birth worker collective offering pre- and postnatal care opened a new clinic at 4315 Sherriff Rd. NE.
More Access to More Services
After twenty years working in communities east of the river, nurse practitioner Erin Athey found patients struggled with more than the limited availability of services. The major issue was how easy it was for residents to engage with providers, she said. Working at the United Medical Center (UMC) infectious disease clinic prior to the pandemic, she saw how hard it was for people to get there during office hours, juggling work, public transit and childcare schedules. Athey looks for ways to meet the community where they were. She used the UMC mobile bus clinics to visit 30 of the District’s 50 or so public housing complexes during COVID.
Surveys showed that people loved the place-based services, but, Abney said, there were limitations: buses were expensive to operate and required maintenance, gas and specialty drivers.
Looking for a way to more efficiently engage with the residents, she toyed around with the idea of barber-shop based health services before coming up with the idea for Community Concierge Care, or C3 Cares, in 2021.
C3 Cares is a system community nurse-led wellness hubs, each clinic embedded in a two-bedroom unit in a DC public housing complex. Abney says C3 Cares operates on a school health model, with a known nurse in the community working alongside health workers (often trained residents). Nurse practitioners are available on site and via telehealth. Each clinic is designed to serve 800 to 1000 people, keeping clinics intimate and staff familiar with patients. The idea was to provide early convenient access to clinical care, facilitating coordination and referrals.
There are now five C3 Cares locations. The clinics offer preventative screenings, exams and vaccinations; treat minor injuries and chronic disease and help with referrals, education and insurance to address health issues early. C3 Cares also pops up at community events to provide immunization.
Cuts by Congress
The availability of care on the east side of the District is steadily making gains. But budget cuts could truly hurt patients, medical providers say. Congress proposed $1 billion in cuts from medicaid alone, forcing states and DC to shoulder more costs. These decisions could upend the District’s health care system. According to the DC Fiscal Policy Institute (DCFPI) more than 1 in 3 DC residents get their health care through Medicaid or the Children’s Insurance Program (CHIP), rising to nearly one in two Black residents.
In DC, Medicaid costs are expected to increase $182 million over the next fiscal year. The District is proposing to cut eligibility of about 25,000 participants, largely childless adults and adult caregivers who earn between $21,597 and $31,200 annually, or between 138 and 200 percent of the federal poverty level.
Cuts have a trickle-down effect on uninsured patients seeking care at an FQHCs, undermining the basis of care before a new medical health ecosystem truly takes off. Cuts to funding to programs like Medicaid and Medicare as well as to federal grants to medical and healthcare providers have already been felt, even as District and federal politicians debate budgets. Abby Goldstein of Mary Center’s Nurse Family Partnership Program (NFP) told the DC Council Committee on Health that she was grateful the program will be funded at the same level as last year. Initially, that sum allowed them to provide four home visitors to 100 families without Medicaid. But without matching federal funds, she said the center has to downsize the program to two personnel, even as they have expanded into Wards 7 and 8.
“As we have broadened the base of who we can support, we find ourselves limited by decreased staffing and lack of funding stability,” Goldstein told the committee. That means fifty fewer families will receive at-home care from pre-natal to two years of age.
Unity Health Care, the District’s largest FQHC, told council member that they can only watch for reductions to Medicaid and Medicare that could hit the bulk of their covered customers, leaving those that are uninsured even more vulnerable as the clinic struggles to cover costs. There are fears that the FQHC will be overwhelmed by uninsured patients, or that without preventative care, more people will end up in emergency rooms, stressing hospitals.
However, neighborhoods on the east side of the river will meet that challenge with a new hospital and the relatively new medical services that have come to Wards 7 and 8 since the pandemic. It remains to be seen what affect budget challenges will have on the stability of the area’s medical care.
