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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?

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how to start and maintain a free health care clinic2
How to Start and Maintain a Free Health Care Clinic
  • A Need was Identified and Researched
need 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?

slide4

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 researched5
Need Identified and Researched
  • 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

Getting Facts and Figures with Research

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 researched6

How are Free Clinics Started?

Need Identified and Researched

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: fpchc@iserv.net

Web: www.fcglr.org

National Free Clinic Foundation of America

1240 Third Street, S.W.

Roanoke, VA 24016

Phone: (540) 344-8242

Email: Foundation@freeclinic.net

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: info@volunteersinhealthcare.org

Web: www.volunteersinheatlhcare.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: collierj@vaxa.cis.uwosh.edu

John Vick, Administrator, Volunteer Health Care Program

Bureau of State Risk Management

PO Box 77008

Madison, WI 53707-7008

Phone: (608) 261-6638

how to start and maintain a free health care clinic7
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
An Informed Community was Marshaled
  • A Public Forum was announced through the local newspapers and by

Spreading the Word

  • 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

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

need assessment for a free clinic the economically poor federal poverty guidelines fpg april 1998

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

percent of wisconsin non metropolitan population underinsured 1996

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

what is a free clinic

An easily accessible facility which provides quality, comprehensive medical care with the same dignity and confidentiality afforded to the private sector.

Access

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.

Confidentiality and Quality

An Informed Community was Marshaled

What is a Free Clinic?
what is a free clinic15

A private, non-profit, autonomous facility governed by a board of directors.

Governance

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.

Operations

A well organized facility which must have the support of the medical community as well as the community-at-large.

Community Support

An Informed Community was Marshaled

What is a Free Clinic?
who does a free clinic serve

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
who are the providers in a free clinic

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
what are the services offered

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
what providers of a free clinic do not do

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
where is a free clinic housed what are the hours

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

how will the free clinic be financed

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
where do we go from here

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 clinic23
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
An Organization was Formed

That became, in large part the Board of Directors, was formed from the returned volunteer forms

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)
an organization was formed25
An Organization was Formed
  • The Name: The Goodneighbor Clinic of Sauk Prairie, Inc. (Incorporation of a tax exempt, not-for-profit, 501 (c) (3) corporation

The Clinic Became a Reality

  • 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 formed26
An Organization was Formed
  • Publicity: An Ongoing Effort

The Clinic Became a Reality

  • 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
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

slide29

3A Determining Cost Savings to Hospitals

James Walton, DO &

Adam Chabira, MHA

charity clinic outcomes determining impact on hospitals

Charity Clinic Outcomes:Determining Impact on Hospitals

Jim Walton, DO

Adam Chabira, MHA

Baylor Health Care System – Dallas, TX

introductions
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
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

Data Collection:Metrics vs. Impact/Outcomes
the importance of impact outcomes
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
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
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 hospitals37
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
before after analysis cont
Before & After Analysis (cont.)

∆ = -22%

∆ = +50%

∆ = -74%

before after analysis cont42
Before & After Analysis (cont.)

∆ = -58%

∆ = -63%

∆ = -2%

data collection
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
Data Collection Tips
  • Ask for summary data without patient identifying information
  • Be prepared to produce patient consent to share health-related information
analytical tips
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 tips50
Analytical Tips

Comparison population should be as similar to your population as possible

  • Uninsured
  • Demographically
  • Geographically
  • Same time period
summary
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
slide52
Brent Hafele, MA

Executive Director

Chippewa Valley Free Clinic

421 Graham Avenue

Eau Claire, WI 54702

715-839-8477

Brent@cvfreeclinic.org