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How to Start and Maintain a Free Health Care Clinic Presented by: Haakon Carlson, M.D.

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Presentation on theme: "How to Start and Maintain a Free Health Care Clinic Presented by: Haakon Carlson, M.D."— Presentation transcript:

1 How to Start and Maintain a Free Health Care Clinic Presented by: Haakon Carlson, M.D.

2 How to Start and Maintain a Free Health Care Clinic A Need was Identified and Researched

3 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?

4 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

5 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

6 National Free Clinic Foundation of America 1240 Third Street, S.W. Roanoke, VA Phone: (540) Web: How are Free Clinics Started? Volunteers in Health Care (VIH) Memorial Hospital of Rhode Island 111 Brewster Street Pawtucket, RI Toll Free: (877) Web: Jill Collier FNP, Wisconsin State Coordinator (Wisconsin Free Clinics) Living Healthy Communicty Clinic 800 Algoma Blvd Oshkosh, WI Phone: (920) Fax: (920) Jane E. Zwiers, RN, Convenor Free Clinics of the Great Lakes Region 321 West South Street Kalamazoo, MI Phone: (616) Fax: (616) Web: John Vick, Administrator, Volunteer Health Care Program Bureau of State Risk Management PO Box Madison, WI Phone: (608) Need Identified and Researched

7 How to Start and Maintain a Free Health Care Clinic A Need was Identified and Researched An Informed Community was Marshaled

8 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. Johns 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

9 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

10 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

11 Percent of County Population Below FPG Estimates Source: Wisconsin Primary Health Care Association An Informed Community was Marshaled

12 Percent of County Population Uninsured Source: The Urban Institute, Washington, D.C. An Informed Community was Marshaled

13 Percent of Wisconsin Non-Metropolitan Population Underinsured 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

14 What is a Free Clinic? Access An easily accessible facility which provides quality, comprehensive medical care with the same dignity and confidentiality afforded to the private sector. Confidentiality and 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

15 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

16 Who Does a Free Clinic Serve? Patients referred from physicians, hospitals, schools, social workers, home health RNs, 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

17 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

18 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

19 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

20 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

21 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

22 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 An Informed Community was Marshaled

23 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

24 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. Johns Church) That became, in large part the Board of Directors, was formed from the returned volunteer forms An Organization was Formed

25 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. Johns 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 (MDs, RNs, 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

26 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 An Organization was Formed

27 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 its a beginning. Oscar Romero

28

29 James Walton, DO & Adam Chabira, MHA 3A Determining Cost Savings to Hospitals

30 Jim Walton, DO Adam Chabira, MHA Baylor Health Care System – Dallas, TX Charity Clinic Outcomes: Determining Impact on Hospitals

31 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

32 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

33 Data Collection: Metrics vs. Impact/Outcomes Metrics –Quantitative –Answer the Questions: How many? How much? –Examples: # of visits # of unduplicated pts. # of Rxs 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

34 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 youre impacting lives –How youre impacting the community

35 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

36 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

37 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?

38 Project Access Dallas

39 Before & After Analysis

40 Before & After Analysis (cont.) = +50% = -74% = -22%

41 Before & After Analysis (cont.)

42 = -58% = -2% = -63%

43 Central Dallas Ministries Community Health Services

44 Two Population Comparison 48%

45 Two Population Comparison (cont.) 29%

46 Two Population Comparison (cont.) 20%

47 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

48 Data Collection Tips Ask for summary data without patient identifying information Be prepared to produce patient consent to share health-related information

49 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

50 Analytical Tips Comparison population should be as similar to your population as possible –Uninsured –Demographically –Geographically –Same time period

51 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

52 Brent Hafele, MA Executive Director Chippewa Valley Free Clinic 421 Graham Avenue Eau Claire, WI


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