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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?
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
National Free Clinic Foundation of America1240 Third Street, S.W.Roanoke, VA 24016Phone: (540) 344-8242Email: Foundation@freeclinic.netWeb: www.freeclinic.net
How are Free Clinics Started?
Volunteers in Health Care (VIH) Memorial Hospital of Rhode Island111 Brewster StreetPawtucket, RI 02860Toll Free: (877) 844-8442Email: info@volunteersinhealthcare.orgWeb: www.volunteersinheatlhcare.org
Jill Collier FNP, Wisconsin State Coordinator (Wisconsin Free Clinics)Living Healthy Communicty Clinic800 Algoma BlvdOshkosh, WI 54901Phone: (920) 424-1242Fax: (920) 424-0123Email: collierj@vaxa.cis.uwosh.edu
Jane E. Zwiers, RN, Convenor Free Clinics of the Great Lakes Region 321 West South StreetKalamazoo, MI 49007Phone: (616) 344-3751Fax: (616) 353-4186Email: fpchc@iserv.netWeb: www.fcglr.org
John Vick, Administrator, Volunteer Health Care ProgramBureau of State Risk ManagementPO Box 77008Madison, WI 53707-7008Phone: (608) 261-6638
Need Identified and Researched
How to Start and Maintain a Free Health Care Clinic
A Need was Identified and Researched
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
% OF POPULATION % OF POPULATION
COUNTY BELOW 100% OF FPG BELOW 200% OF FPG
SAUK 9.5 30.4COLUMBIA 7.3 25.2DANE 10.0 22.7IOWA 9.9 32.9AVERAGE 9.2 27.8
Source: Wisconsin Primary Health Care Association
An Informed Community was Marshaled
Percent of County Population Uninsured - 1994
PERCENT NUMBER
COUNTY UNINSURED UNINSURED
SAUK 6.6 3,315COLUMBIA 8.0 3,869IOWA - NO FIGURES AVAILABLE-DANE 6.5 23,367
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?
AccessAccess
An easily accessible facility which provides quality, comprehensive medical care with the same dignity and confidentiality afforded to the private sector.
Confidentiality Confidentiality and Qualityand Quality
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?
GovernanceGovernanceA private, non-profit, autonomous facility governed by a board of directors.
OperationsOperations
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 Community SupportSupport
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 peopleEstablish an executive committee with skills in
organizational planning, budgeting, marketing, etc.
Appoint a medical director, head nurse, office manager
An Informed Community was Marshaled
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
A Steering Committee
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)
That became, in large part the Board of Directors, was formed from the returned volunteer forms
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 CommunityIndividualsService ClubsChurchesCommunity BanksThe community United WaySchool ChildrenGrants
Future Growth: New Location - St. Vincent Service CenterOpen two days a week
An Organization was Formed
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
James Walton, DO & Adam Chabira, MHA
3A Determining Cost Savings to Hospitals
Jim Walton, DO
Adam Chabira, MHABaylor Health Care System – Dallas, TX
Charity Clinic Outcomes:Determining Impact on Hospitals
IntroductionsJim 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
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
How do we Demonstrate Impact on Hospitals?
Project Access Dallas
Before & After Analysis
105
82
44
66 61
160
20
40
60
80
100
120
Total ED-Related Visits
ED Visits ED Admits
Project Access Dallas ImpactBaylor University Medical Center
ED-Related Utilization (n=87)
1 Year Before Enrollment in PAD 1 Year After Enrollment in PAD
Before & After Analysis (cont.)
1.21
0.94
0.51
0.76 0.70
0.180.000.200.40
0.600.801.001.201.40
Total ED-RelatedVisits per Patient
ED Visits perPatient
ED Admits perPatient
Project Access Dallas ImpactBaylor University Medical Center
ED-Related Utilization (n=87)
1 Year Before Enrollment in PAD 1 Year After Enrollment in PAD
∆ = +50%
∆ = -74%
∆ = -22%
Before & After Analysis (cont.)
$579,270
$243,282
$48,331 $47,221
$530,939
$196,061
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
Total ED-Related Costs
ED Visit Costs ED Admit Costs
Project Access Dallas ImpactBaylor University Medical Center
ED-Related Costs (n=87)
1 Year Before Enrollment in PAD 1 Year After Enrollment in PAD
Before & After Analysis (cont.)
$6,658
$2,796
$556$543
$6,103
$2,254
$0
$2,000
$4,000
$6,000
$8,000
Total ED-Related Costs
per Patient
ED Costs perPatient
ED Admit Costsper Patient
Project Access Dallas ImpactBaylor University Medical Center
ED-Related Costs (n=87)
1 Year Before Enrollment in PAD 1 Year After Enrollment in PAD
∆ = -58%
∆ = -2%
∆ = -63%
Central Dallas MinistriesCommunity Health Services
Two Population ComparisonAdmission Rate (per 1,000)
Baylor University Medical CenterCDM Study Population vs. 12 Zip Code Region
19 17
33
0
5
10
15
20
25
30
35
FY2005 FY2006
(per
1,0
00)
CDM Study Population 12 Zip Code Region
48%
Two Population Comparison (cont.)
Average Cost per AdmissionBaylor University Medical Center
CDM Study Population vs. 12 Zip Code Region
$9,130$9,599
$6,484
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
FY2005 FY2006
CDM Study Population 12 Zip Code Region
29%
Average Length of StayBaylor University Medical Center
CDM Study Population vs. 12 Zip Code Region
5.82
4.625.69
0
1
2
3
4
5
6
7
FY2005 FY2006
ALO
S (D
ays)
CDM Study Population 12 Zip Code Region
Two Population Comparison (cont.)
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, MAExecutive Director
Chippewa Valley Free Clinic
421 Graham Avenue
Eau Claire, WI 54702
715-839-8477
Brent@cvfreeclinic.org
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