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

Presented by:

Haakon Carlson, M.D.


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


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


National Free Clinic Foundation of America1240 Third Street, S.W.Roanoke, VA 24016Phone: (540) 344-8242Email: [email protected]: 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: [email protected]: 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: [email protected]

Jane E. Zwiers, RN, Convenor Free Clinics of the Great Lakes Region 321 West South StreetKalamazoo, MI 49007Phone: (616) 344-3751Fax: (616) 353-4186Email: [email protected]: www.fcglr.org

John Vick, Administrator, Volunteer Health Care ProgramBureau of State Risk ManagementPO Box 77008Madison, WI 53707-7008Phone: (608) 261-6638




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 Essential Ingredient

The concept of a free health clinic has the unanimous support of the Sauk Prairie

Memorial Hospital Medical Staff


Need Assessment for a Free Clinic: The “Economically Poor”

Federal Poverty Guidelines (FPG), April 1998

Source: Wisconsin Primary Health Care Association


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


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.


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


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.


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.


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


Who are the Providers in a Free Clinic?

• Volunteer health care workers

• Management and office staff

• “People” people

• Other professionals


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


What providers of a free clinic DO NOT do:

• Admit to the hospital

• Obstetrics

• Encourage emergency care

• Surgery

• Provide second opinions

• Duplicate services

• Other


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


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


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 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


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


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


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

http://www.goodneighborclinic.org/

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


ED-Related Utilization (n=87)


∆ = +50%

∆ = -74%

∆ = -22%


$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


ED-Related Costs (n=87)



$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


ED-Related Costs (n=87)


∆ = -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


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)


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

[email protected]

how to start and maintain a free health care clinic presented by: haakon carlson, m.d

Documents

free health clinic

free health care clinic

marshaled slide

informed community

researched slide

medical community

wisconsin department

slide presentation