Transcript How to Start and Maintain a Free Health Care Clinic

How to Start and Maintain a
Free Health Care Clinic
Presented by:
Haakon Carlson, M.D.
How to Start and Maintain a Free
Health Care Clinic

A Need was Identified and Researched
Need Identified and Researched
The need for free health care is almost a given
. . . But where to start?
Free health care in Haiti or Here at Home?
Need Identified and Researched
Reality Testing






Sharing the Idea with Confidantes
Spouse
Professional colleague and friend
Pastor
Hospital Foundation Administrator
Society of St. Vincent de Paul Administrator and
two Board Members
Need Identified and Researched
Getting Facts and Figures with Research

Prairie Clinic, S.C. - the local primary family practice group
(and my former group practice)

Sauk Prairie Memorial Hospital & Clinics - the community
hospital

Society of St. Vincent de Paul - a very active social service
force in the community

County Public Health Nurses - Sauk, Dane (Northwest),
Columbia and Iowa

Statistical Publications
•
•
•
•
Federal Poverty Guidelines
Health Policy Center, The Urban Institute, Washington, DC
Wisconsin Family Health Survey, Center for Health Statistics
Division of Health, Dept. of Health and Family Services
Need Identified and Researched
How are Free Clinics Started?
National Free Clinic Foundation of
America
1240 Third Street, S.W.
Roanoke, VA 24016
Phone: (540) 344-8242
Email: [email protected]
Web: www.freeclinic.net
Volunteers in Health Care (VIH)
Memorial Hospital of Rhode Island
111 Brewster Street
Pawtucket, RI 02860
Toll Free: (877) 844-8442
Email: [email protected]
Web: www.volunteersinheatlhcare.org
John Vick, Administrator, Volunteer
Health Care Program
Bureau of State Risk Management
PO Box 77008
Madison, WI 53707-7008
Phone: (608) 261-6638
Jane E. Zwiers, RN, Convenor Free
Clinics of the Great Lakes Region
321 West South Street
Kalamazoo, MI 49007
Phone: (616) 344-3751
Fax: (616) 353-4186
Email: [email protected]
Web: www.fcglr.org
Jill Collier FNP, Wisconsin State
Coordinator (Wisconsin Free Clinics)
Living Healthy Communicty Clinic
800 Algoma Blvd
Oshkosh, WI 54901
Phone: (920) 424-1242
Fax: (920) 424-0123
Email: [email protected]
How to Start and Maintain a Free
Health Care Clinic
A Need was Identified and Researched
An Informed Community was Marshaled
An Informed Community was Marshaled
Spreading the Word

A Public Forum was announced through the local
newspapers and by

Individual Invitations for the presentation of plans
for a free health care clinic

A Noon Meeting was hosted by St. John’s Church
in the fellowship hall and Lunch was Catered by the
Hospital

A Slide Presentation was given and Volunteer
Forms were available
An Informed Community was Marshaled
An Essential Ingredient
The concept of a free health clinic has the
unanimous support of the Sauk Prairie
Memorial Hospital Medical Staff
An Informed Community was Marshaled
Need Assessment for a Free Clinic: The
“Economically Poor”
Federal Poverty Guidelines (FPG), April 1998
Source: Wisconsin Primary Health Care Association
An Informed Community was Marshaled
Percent of County Population
Below FPG - 1995 Estimates
Source: Wisconsin Primary Health Care Association
An Informed Community was Marshaled
Percent of County Population
Uninsured - 1994
Source: The Urban Institute, Washington, D.C.
An Informed Community was Marshaled
Percent of Wisconsin Non-Metropolitan
Population Underinsured - 1996
• No insurance for part of the year - 6%
• No insurance for the entire year - 7%
• In 1996, 7-13% of the non-metropolitan
population in Wisconsin was without
adequate insurance.
Source: Wisconsin Department of Health and Family Services
An Informed Community was Marshaled
What is a Free Clinic?
Access
Confidentiality
and Quality
An easily accessible facility which provides
quality, comprehensive medical care with the
same dignity and confidentiality afforded to the
private sector.
A clinic would serve people who are trying to
improve their lives but do not have medical
insurance or the ability to pay for medical care.
It would be an evening, walk-in health facility
where working people can seek medical care
without having to take time off from work
during the day without pay.
An Informed Community was Marshaled
What is a Free Clinic?
Governance
A private, non-profit, autonomous facility
governed by a board of directors.
Operations
A relatively cost efficient facility relying on
private contributions for the majority of the
operating expenses and professional volunteers
to deliver medical care. A small, dedicated staff
is necessary to coordinate the daily operations
of the facility.
Community
Support
A well organized facility which must have the
support of the medical community as well as the
community-at-large.
An Informed Community was Marshaled
Who Does a Free Clinic Serve?
• Patients referred from physicians, hospitals, schools, social
workers, home health RN’s, clergy and others.
• Those in financial need
• Minimum wage workers
• People between jobs
• Single parent families
• People who are trying to get on their feet
• Those who are working two or three jobs
• Senior citizens who cannot afford medications
• Those who do not have any third party coverage
• Those who cannot afford private care
An Informed Community was Marshaled
Who are the Providers in a Free Clinic?
•
•
•
•
Volunteer health care workers
Management and office staff
“People” people
Other professionals
An Informed Community was Marshaled
What are the Services Offered?
• Evaluation and treatment of acute/chronic
health care problems
• Health maintenance and education
• Assistance for people requiring eligible
health care from other providers
• Eye care
• Dental services
• Other services
An Informed Community was Marshaled
What providers of a free clinic DO NOT do:
•
•
•
•
•
•
•
Admit to the hospital
Obstetrics
Encourage emergency care
Surgery
Provide second opinions
Duplicate services
Other
An Informed Community was Marshaled
Where is a Free Clinic Housed?
What are the Hours?
•
•
•
•
•
Accessible site
Hospital and professional clinics
Churches
Free standing buildings
Service organizations (St. Vincent DePaul, Salvation Army)
Hours based on need - possibly starting with one evening per week
An Informed Community was Marshaled
How Will the Free Clinic be Financed?
• Local Support
–
–
–
–
–
–
Hospitals & professionals
Churches
Service organizations
Private donations
Local governments
Token co-pays from those who can afford it
• Grants
• State and Federal aid
An Informed Community was Marshaled
Where Do We Go From Here?
• Informal, temporary steering committee
selects an acting board of directors:
 Made up of a small number of qualified people
 Establish an executive committee with skills in
organizational planning, budgeting, marketing, etc.
 Appoint a medical director, head nurse, office manager
How to Start and Maintain a Free
Health Care Clinic
A Need was Identified and Researched
An Informed Community was Marshaled
An Organization was Formed
An Organization was Formed
A Steering Committee
That became, in large part the Board of Directors, was formed
from the returned volunteer forms









President
Vice-president
Secretary/Publicist
Treasurer
Medical Director
Clinic Director
Board Member (Attorney)
Board Member (Member of Society of St. Vincent de Paul Board)
Board Member (Pastor Don Wendt, St. John’s Church)
An Organization was Formed
The Clinic Became a Reality

The Name: The Goodneighbor Clinic of Sauk Prairie, Inc.
(Incorporation of a tax exempt, not-for-profit, 501 (c) (3)
corporation

The Site: The Educational Unit of St. John’s Lutheran
Church

Hours of Operation: One Day per Week (Monday) 1:00 7:00 pm

Equipment: Donated by the hospital, St. Vincent de Paul and Prairie
Clinic

Staffing: All volunteer professional (MD’s, RN’s, Pharmacists,
Dentists, and Optometrists) and numerous “non-medical” personnel

Support Services: Diagnostic tests (lab and imaging) and various
support needs are donated by the hospital and Prairie Clinic
An Organization was Formed
The Clinic Became a Reality

Publicity: An Ongoing Effort

Financial Support: Comes From the Community
 Individuals
 Service Clubs
 Churches
 Community Banks
 The community United Way
 School Children
 Grants

Future Growth:
 New Location - St. Vincent Service Center
 Open two days a week
A Quote . . .
It helps, now and then, to step back and take the long view . .
We plant the seed that one day will grow . . .
We lay foundation that will need further development . . .
We cannot do everything, and there is a sense of liberation in
realizing that.
This enables us to do something, and do it very well.
It may be incomplete, but it’s a beginning.
Oscar Romero
• www.goodneighborclinic.org
3A Determining Cost
Savings to Hospitals
James Walton, DO &
Adam Chabira, MHA
Charity Clinic Outcomes:
Determining Impact on Hospitals
Jim Walton, DO
Adam Chabira, MHA
Baylor Health Care System – Dallas, TX
Introductions
Jim Walton, DO
– VP and Chief Health Equity Officer
– Baylor Health Care System – Dallas, TX
Adam Chabira, MHA
– Program Manager
– Office of Health Equity
– Baylor Health Care System
Purpose of Presentation
• Discuss the importance of outcomes
reporting
• Present analysis methodologies for
hospital impact
– Key indicators/variables
• Present examples of hospital impact
analyses
• Discuss strategies for collecting and
analyzing hospital data
Data Collection:
Metrics vs. Impact/Outcomes
• Metrics
– Quantitative
– Answer the Questions:
• How many?
• How much?
– Examples:
• # of visits
• # of unduplicated pts.
• # of Rx’s dispensed
• Impact/Outcomes
– Qualitative or
Quantitative
– Answer the Questions:
• What difference are we
making?
• How are we impacting
our community?
– Examples:
• Improved health of pts.
• Reduction in
unnecessary hospital
use
The Importance of
Impact/Outcomes
Outcomes are important to:
– Your Boss/Board of Directors
– Funders
– Potential Partners
– Policy Makers
They tell the story of your work
– How you’re impacting lives
– How you’re impacting the community
Charity Clinic Impact on
Hospitals
Fundamental Principles:
– Providing primary and preventive care
to patients will reduce dependence on
hospitals for obtaining care
– When patients do require hospitalization
the severity/complexity of their
conditions will be lower because they
are receiving primary care
How do we Demonstrate Impact on
Hospitals?
Show a reduction in the following Key Indicators:
• Utilization
–
–
–
–
ED Visits
Admissions
Outpatient Visits
Average Length of
Stay (ALOS)
• Costs
– Total Costs
– Direct Costs
– Indirect Costs
How do we Demonstrate Impact on
Hospitals?
Two methodologies:
– Before & After Analysis – compares
hospital utilization and costs before and
after enrollment in an intervention
– Comparison of 2 populations –
compares the hospital utilization and
costs between a population receiving an
intervention and a similar population not
receiving the intervention
Project Access Dallas
Before & After Analysis
Project Access Dallas Impact
Baylor University Medical Center
ED-Related Utilization (n=87)
120
100
80
60
105
82
66
61
44
40
20
16
0
Total EDRelated Visits
ED Visits
1 Year Before Enrollment in PAD
ED Admits
1 Year After Enrollment in PAD
Before & After Analysis
(cont.)
Project Access Dallas Impact
Baylor University Medical Center
ED-Related Utilization (n=87)
∆ = -22%
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
1.21
∆ = +50%
∆ = -74%
0.94
0.76
0.70
0.51
0.18
Total ED-Related
Visits per Patient
ED Visits per
Patient
1 Year Before Enrollment in PAD
ED Admits per
Patient
1 Year After Enrollment in PAD
Before & After Analysis
(cont.)
Project Access Dallas Impact
Baylor University Medical Center
ED-Related Costs (n=87)
$600,000
$579,270
$530,939
$500,000
$400,000
$300,000
$200,000
$243,282
$196,061
$48,331 $47,221
$100,000
$0
Total EDRelated Costs
ED Visit Costs
1 Year Before Enrollment in PAD
ED Admit Costs
1 Year After Enrollment in PAD
Before & After Analysis
(cont.)
Project Access Dallas Impact
Baylor University Medical Center
ED-Related Costs (n=87)
$8,000
$6,000
$4,000
$2,000
$6,658
∆ = -58%
$6,103
∆ = -63%
∆ = -2%
$2,796
$2,254
$556$543
$0
Total ED- ED Costs perED Admit Costs
Related Costs
Patient
per Patient
per Patient
1 Year Before Enrollment in PAD
1 Year After Enrollment in PAD
Central Dallas Ministries
Community Health Services
Two Population
Comparison
Admission Rate (per 1,000)
Baylor University Medical Center
CDM Study Population vs. 12 Zip Code Region
35
(per 1,000)
30
33
48%
25
20
15
19
17
10
5
0
FY2005
CDM Study Population
FY2006
12 Zip Code Region
Two Population
Comparison (cont.)
Average Cost per Admission
Baylor University Medical Center
CDM Study Population vs. 12 Zip Code Region
$12,000
$10,000
$9,599
$9,130
$8,000
$6,484
$6,000
$4,000
$2,000
$0
FY2005
CDM Study Population
FY2006
12 Zip Code Region
29%
Two Population
Comparison (cont.)
Average Length of Stay
Baylor University Medical Center
CDM Study Population vs. 12 Zip Code Region
ALOS (Days)
7
6
5.82
5.69
4.62
5
4
3
2
1
0
FY2005
CDM Study Population
FY2006
12 Zip Code Region
20%
Data Collection
• Provided hospital decision support staff
with a roster of patients enrolled in an
intervention. We provided enrollment
dates for Before & After analysis.
• Requested utilization and costs for these
patients for a given timeframe
• Results were returned in summary format
without patient identifying information
Data Collection Tips
• Ask for summary data without patient
identifying information
• Be prepared to produce patient
consent to share health-related
information
Analytical Tips
• Provide data in tabular & graphic
formats
• Provide aggregate data and per
patient data (total costs/# of patients)
• Use a static timeframe for Before &
After analyses (1 yr. before/1 yr. after)
• Calculate percent change
– (After Costs-Before Costs)/Before Costs
Analytical Tips
Comparison population should be as
similar to your population as possible
– Uninsured
– Demographically
– Geographically
– Same time period
Summary
• Impact on Hospitals can be
measured by showing changes in
utilization & costs
• 2 primary methodologies:
– Before & After analysis
– Comparison of 2 populations
• Next steps: documenting preventive
health care services
Brent Hafele, MA
Executive Director
Chippewa Valley Free Clinic
421 Graham Avenue
Eau Claire, WI 54702
715-839-8477
[email protected]