Aug. 7–He’s not a doctor. He’s a former high school football coach and pharmaceuticals salesman. But that didn’t stop Ed Cota, with his wife, Tracey, from building a chain of for-profit OB-GYN clinics.
Cota is targeting the patients that hospitals complain are sinking emergency rooms with financial losses: poor, often illiterate, mostly uninsured immigrants — many of them in the United States illegally.
Cota, though, is convinced it’s a lucrative and underserved niche.
The Cotas began with one clinic in 1998 and now own five, each called Clinica de la Mama, served by a total of nine doctors.
All the clinics are in metro Atlanta, but the Cotas plan to open three elsewhere in Georgia in the next year and are considering other states.
Their clinic on Jimmy Carter Boulevard occupies a former Po’ Folks restaurant, with the clinic’s lab in what had been the part of the kitchen. In the parking lot, a Volkswagen is wrapped in an advertisement for the couple’s latest venture — an eye care service at the clinics.
Mothers-to-be who come in for prenatal care are charged a straight fee, Cota says. It’s $1,700 — payable on a monthly basis — for doctors’ fees, ultrasounds and lab work until, but not including, delivery. The fee also covers picking up patients for appointments at the clinic. There’s a 24-hour call-in service — in Spanish — for patients who have questions. And patients are given a sort of ID card with their photographs and basic information about their prenatal care and lab results.
Ed Cota estimates that 96 percent of the clinic’s patients have no medical insurance to cover prenatal care and that the majority are in the United States illegally. Still, Tracey Cota, who serves as a sort of chief operating officer for the business, estimates that 95 percent of patients pay their bills in full.
QUESTION: Tell me about the clinics.
ANSWER: Ed: We are providing a real conduit between a population that no one knows how to deal with. Before, everyone went to the ER. … The misconception was that Hispanics didn’t like prenatal care. That wasn’t it. They didn’t have access to it. …
Prior to us, they didn’t have prenatal care as a whole. They showed up at the last minute at the hospital. They walk in. They don’t speak (English). You assume they’ve had no prenatal care, so the hospital has to treat them as a brand new (patient), which causes the costs to go up.
Q: Tracey, what is your background?
A: Tracey: My interest has always been international markets. There are three very large international markets here — Hispanic, Asian and Russian. … Hispanic was the demographic that was young, child-bearing women.
They were exploding in growth much faster than other markets. …
This is where you look for OB. You want the child-bearing years.
A: Ed: The fastest-growing minority in the U.S. — that’s the Hispanic population. I speak Spanish. Obviously, I’m a Hispanic. We said, let’s set up an OB practice with the guys we know, friends of ours, the OBs, and provide a prenatal package for this population that no one wants to do, no one cares to do and they don’t understand. … But it has to be seen, regardless of the anti-immigration sentiments that are going on.
Q: What do you do, Ed, vs. Tracey?
A: Tracey: He markets. He is the king of marketing.
A: Ed: I bring in the patients, bring in the contracts, deal with the docs, set up the new companies. She’s the person who runs it all.
Tracey: I’m much more of a micro person. … I enjoy dealing with the patients, the operational issues.
Q: What was the biggest mistake you made as far as the business?
A: Ed: Probably not being ready for the volume of people that showed up. We underestimated the market.
A: Tracey: We had to play catch-up.
A: Ed: The computer system wasn’t set up to follow and track every patient. We should have been computerized from day one. … The ability to provide transportation: We thought we were going to transport 40 people in a week. We were transporting 40 people in a day.
Q: What happened? Did you end up losing a lot of customers?
A: Ed: No. What happened is we had to work every day, 12 hours a day.
Every day. … We thought we were going to open a practice that would go five days a week, 40 hours.
A: Tracey: We didn’t lose a lot of people. Yeah, people got upset. But we had a very hands-on relationship. We still do with our patients.
… I think little mistakes are forgiven.
Q: Why did you think it would be a good business to aim at low-income people who don’t have health insurance?
A: Ed: Volume. Volume drives everything.
A: Tracey: It’s an extremely large group of people.
Q: What percentage of your customer base is in the country illegally, and does that pose any special challenges for your business?
A: Ed: Sixty percent undocumented. It doesn’t place any issues to us because no one is going to stop this undocumented immigration.
They are going to keep coming whether you like it, whether I like it. We have to deal with it. We know that the more undocumented people come in, they need care.
Q: Do you have to treat them differently? Are they more or less likely to pay?
A: Ed: They are more compliant. The Hispanic community as a whole is very compliant. Besides their religion and their family, I think the next most important is probably medical. They hold it in very high regard. … You give them care with respect and dignity and, let me tell you what, our volume will always increase at 30-40 percent a year. …
Once you have good business with one of them, you’ve made a friend.
They will always come to you, and they will tell everybody.
Q: Are there any disadvantages to serving this community?
A: Tracey: This is a transient community. They move a lot. … Your attrition rate is higher than a normal practice. It’s above 15 percent.
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