Presentation on theme: "How to Start and Maintain a Free Health Care Clinic"— 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 Need Identified and Researched Reality TestingSharing the Idea with ConfidantesSpouseProfessional colleague and friendPastorHospital Foundation AdministratorSociety of St. Vincent de Paul Administrator and two Board Members
5 Need Identified and Researched Getting Facts and Figures with ResearchPrairie Clinic, S.C. - the local primary family practice group (and my former group practice)Sauk Prairie Memorial Hospital & Clinics - the community hospitalSociety of St. Vincent de Paul - a very active social service force in the communityCounty Public Health Nurses - Sauk, Dane (Northwest), Columbia and IowaStatistical PublicationsFederal Poverty GuidelinesHealth Policy Center, The Urban Institute, Washington, DCWisconsin Family Health Survey, Center for Health StatisticsDivision of Health, Dept. of Health and Family Services
6 Need Identified and Researched How are Free Clinics Started?National Free Clinic Foundation of America1240 Third Street, S.W.Roanoke, VAPhone: (540)Web:Jane E. Zwiers, RN, Convenor Free Clinics of the Great Lakes Region 321 West South StreetKalamazoo, MIPhone: (616)Fax: (616)Web:Volunteers in Health Care (VIH)Memorial Hospital of Rhode Island111 Brewster StreetPawtucket, RIToll Free: (877)Web:Jill Collier FNP, Wisconsin State Coordinator (Wisconsin Free Clinics)Living Healthy Communicty Clinic800 Algoma BlvdOshkosh, WIPhone: (920)Fax: (920)John Vick, Administrator, Volunteer Health Care ProgramBureau of State Risk ManagementPO Box 77008Madison, WIPhone: (608)
7 How to Start and Maintain a Free Health Care Clinic A Need was Identified and ResearchedAn Informed Community was Marshaled
8 An Informed Community was Marshaled Spreading the WordA Public Forum was announced through the local newspapers and byIndividual Invitations for the presentation of plans for a free health care clinicA Noon Meeting was hosted by St. John’s Church in the fellowship hall and Lunch was Catered by the HospitalA Slide Presentation was given and Volunteer Forms were available
9 An Essential Ingredient An Informed Community was MarshaledAn Essential IngredientThe concept of a free health clinic has the unanimous support of the Sauk Prairie Memorial Hospital Medical Staff
10 An Informed Community was Marshaled Need Assessment for a Free Clinic: The “Economically Poor” Federal Poverty Guidelines (FPG), April 1998Source: Wisconsin Primary Health Care Association
11 Percent of County Population Below FPG - 1995 Estimates An Informed Community was MarshaledPercent of County Population Below FPG EstimatesSource: Wisconsin Primary Health Care Association
12 Percent of County Population Uninsured - 1994 An Informed Community was MarshaledPercent of County Population UninsuredSource: The Urban Institute, Washington, D.C.
13 Percent of Wisconsin Non-Metropolitan Population Underinsured - 1996 An Informed Community was MarshaledPercent of Wisconsin Non-Metropolitan Population UnderinsuredNo 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
14 An Informed Community was Marshaled What is a Free Clinic?AccessAn easily accessible facility which provides quality, comprehensive medical care with the same dignity and confidentiality afforded to the private sector.Confidentiality and QualityA 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.
15 An Informed Community was Marshaled What is a Free Clinic?GovernanceA private, non-profit, autonomous facility governed by a board of directors.OperationsA 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 SupportA well organized facility which must have the support of the medical community as well as the community-at-large.
16 Who Does a Free Clinic Serve? An Informed Community was MarshaledWho Does a Free Clinic Serve?Patients referred from physicians, hospitals, schools, social workers, home health RN’s, clergy and others.Those in financial needMinimum wage workersPeople between jobsSingle parent familiesPeople who are trying to get on their feetThose who are working two or three jobsSenior citizens who cannot afford medicationsThose who do not have any third party coverageThose who cannot afford private care
17 Who are the Providers in a Free Clinic? An Informed Community was MarshaledWho are the Providers in a Free Clinic?Volunteer health care workersManagement and office staff“People” peopleOther professionals
18 What are the Services Offered? An Informed Community was MarshaledWhat are the Services Offered?Evaluation and treatment of acute/chronic health care problemsHealth maintenance and educationAssistance for people requiring eligible health care from other providersEye careDental servicesOther services
19 What providers of a free clinic DO NOT do: An Informed Community was MarshaledWhat providers of a free clinic DO NOT do:Admit to the hospitalObstetricsEncourage emergency careSurgeryProvide second opinionsDuplicate servicesOther
20 Where is a Free Clinic Housed? What are the Hours? An Informed Community was MarshaledWhere is a Free Clinic Housed? What are the Hours?Accessible siteHospital and professional clinicsChurchesFree standing buildingsService organizations (St. Vincent DePaul, Salvation Army)Hours based on need - possibly starting with one evening per week
21 How Will the Free Clinic be Financed? An Informed Community was MarshaledHow Will the Free Clinic be Financed?Local SupportHospitals & professionalsChurchesService organizationsPrivate donationsLocal governmentsToken co-pays from those who can afford itGrantsState and Federal aid
22 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
23 How to Start and Maintain a Free Health Care Clinic A Need was Identified and ResearchedAn Informed Community was MarshaledAn Organization was Formed
24 An Organization was Formed A Steering CommitteeThat became, in large part the Board of Directors, was formed from the returned volunteer formsPresidentVice-presidentSecretary/PublicistTreasurerMedical DirectorClinic DirectorBoard Member (Attorney)Board Member (Member of Society of St. Vincent de Paul Board)Board Member (Pastor Don Wendt, St. John’s Church)
25 An Organization was Formed The Clinic Became a RealityThe Name: The Goodneighbor Clinic of Sauk Prairie, Inc. (Incorporation of a tax exempt, not-for-profit, 501 (c) (3) corporationThe Site: The Educational Unit of St. John’s Lutheran ChurchHours of Operation: One Day per Week (Monday) 1:00 - 7:00 pmEquipment: Donated by the hospital, St. Vincent de Paul and Prairie ClinicStaffing: All volunteer professional (MD’s, RN’s, Pharmacists, Dentists, and Optometrists) and numerous “non-medical” personnelSupport Services: Diagnostic tests (lab and imaging) and various support needs are donated by the hospital and Prairie Clinic
26 An Organization was Formed The Clinic Became a RealityPublicity: An Ongoing EffortFinancial Support: Comes From the CommunityIndividualsService ClubsChurchesCommunity BanksThe community United WaySchool ChildrenGrantsFuture Growth:New Location - St. Vincent Service CenterOpen two days a week
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 it’s a beginning.Oscar Romero
29 3A Determining Cost Savings to Hospitals James Walton, DO &Adam Chabira, MHA
30 Charity Clinic Outcomes: Determining Impact on Hospitals Jim Walton, DOAdam Chabira, MHABaylor Health Care System – Dallas, TX
31 Introductions Jim Walton, DO Adam Chabira, MHA VP and Chief Health Equity OfficerBaylor Health Care System – Dallas, TXAdam Chabira, MHAProgram ManagerOffice of Health EquityBaylor Health Care System
32 Purpose of Presentation Discuss the importance of outcomes reportingPresent analysis methodologies for hospital impactKey indicators/variablesPresent examples of hospital impact analysesDiscuss strategies for collecting and analyzing hospital data
33 Data Collection: Metrics vs. Impact/Outcomes QuantitativeAnswer the Questions:How many?How much?Examples:# of visits# of unduplicated pts.# of Rx’s dispensedImpact/OutcomesQualitative or QuantitativeAnswer 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 DirectorsFundersPotential PartnersPolicy MakersThey tell the story of your workHow you’re impacting livesHow you’re 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 careWhen 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:UtilizationED VisitsAdmissionsOutpatient VisitsAverage Length of Stay (ALOS)CostsTotal CostsDirect CostsIndirect Costs
37 How do we Demonstrate Impact on Hospitals? Two methodologies:Before & After Analysis – compares hospital utilization and costs before and after enrollment in an interventionComparison of 2 populations – compares the hospital utilization and costs between a population receiving an intervention and a similar population not receiving the intervention
47 Data CollectionProvided 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 timeframeResults were returned in summary format without patient identifying information
48 Data Collection TipsAsk for summary data without patient identifying informationBe 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 TipsComparison population should be as similar to your population as possibleUninsuredDemographicallyGeographicallySame time period
51 SummaryImpact on Hospitals can be measured by showing changes in utilization & costs2 primary methodologies:Before & After analysisComparison of 2 populationsNext steps: documenting preventive health care services
52 Chippewa Valley Free Clinic Brent Hafele, MAExecutive DirectorChippewa Valley Free Clinic421 Graham AvenueEau Claire, WI
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