The TAP-IN Blog

Increase in Community Health Centers - What about Free Clinics?

The NY Times ran an article about the increase in funding for community health centers - Expansion of Clinics Shapes a Bush Legacy

An interesting article, but one major piece missing is the impact of free clinics, with the model of locally-run, volunteer-based services to the uninsured.  The article does talk about the fact that, growth of health centers or not, there still is a shortage of primary care physicians that has to be solved.  That's where the TAP-IN model of re-engaging retired health care professionals via volunteering at free clinics comes in...

The other misconception is that, because these health centers take Medicare, all is well because Medicare takes care of everyone.  Fact is, Medicare covers but a small fraction of the uninsured, and is very limiting.  Just sorting through the rules of who is eligible can be daunting.

That's why we at TAP-IN believe working with free clinics and local communities, with the help of volunteer physicians, is the right approach.  While indeed one may accuse free clinics and other safety net providers of being a 'bandaid' and not the solution, until others smarter than me figure out the solution, the free clinics and others will continue on, TODAY, helping the uninsured.  Probably a wise move not to wait on the solution, since we've been hearing talk of solving this for well over 30 years now...

Retail Clinics - Are They a Solution to the Problems of the Uninsured?

Is there a convenient alternative to free clinics just down the block from where you live?

You may have seen them, or you may be making use of them. Retail clinics that take drop-in patients in drug stores and Wal-Marts were touted as an answer to the lack of affordable health care services for the uninsured and under-insured, but a recent study challenges the belief that they are filling those gaps.

As reported in the Wall Street Journal:

Despite the Hype, Patients’ Use of Retail Clinics Is ‘Modest’

The number of patients who’ve tried out retail clinics turns out to be modest, but that’s shouldn’t be all that surprising, some health wonks say.

The clinics are still young, and while they’ve spread rapidly (and then slowed down), they’re still not everywhere, note the authors of a study from the Center for Studying Health System Change.

Only 3.4 million American families, or 2.3%, had used a retail clinic as of 2007, according to survey results. More highlights:

• Among families that used retail clinics in the past year, 27% had at least one member who was uninsured.
• Families who’d said they’d either not gotten or had delays getting needed care over the past year were nearly 2.5 times as likely to have used retail clinics as families without such problems.
• Families with respondents age 18 to 34 were more than twice as likely as families with respondents aged 50 to 64 to have used a retail clinic.
• 48% of consumers using retail clinics said they’d done so for diagnosis and treatment of a new illness or symptom, and 47% said their visit had included a prescription renewal.

The study’s authors noted that retail clinics have turned out to be more complex and costly to operate than expected, and some doctors in traditional physician practices are responding by extending their own office hours and doing more same-day scheduling.

Another recent study of patients who visited retail clinics in chains that included Wal-Mart, CVS and Walgreen found roughly 90% of patients had one of 10 relatively simple treatments. The Top 10 list included ear infections, upper respiratory infections, immunizations and blood pressure checks. Insurance paid for 67% of visits. And most patients said they didn’t have a primary care provider.

North Carolina's Rising Rates of Uninsured

The trend is unmistakeable and the load on safety net resources continues to increase.

digtriad.com reports on the steady increase of uninsured citizens in the Greensboro, Highpoint and Winston-Salem region.

More People Turning To Clinics, Emergency Rooms After Losing Health Coverage

Greensboro, NC -- More people are turning to emergency rooms and free or low-cost health clinics for their medical needs as they lose their jobs and health insurance.

Last year, 250 new patients received care each month from HealthServe Community Health Clinic in Greensboro. That number went up 300 this year.

Of those, 74 percent have no insurance and 26 percent have Medicaid or Medicare.

That percentage is up from 69 percent uninsured last year and 63 percent uninsured in 2006.

A co-pay is required for some patients, but the clinic will treat people who can't afford to pay. The amount a patient pays depends on their federal poverty level. To see if you meet federal poverty guidelines, click here.

Representatives from some local health systems told WFMY News 2 that more people are turning to emergency rooms for care because, by law, ER doctors cannot turn anyone away.

Doctors at Moses Cone are not seeing that trend yet. In November at Wake Forest University Baptist Medical Center, doctors saw a decrease in patients. They said they feel that was due to the economic downturn and high cost of deductables and co-pays for patients.

Houston Janitors' Union to Open It's Own Clinic

Some of Houston's working poor may have found a solution.

From the Houston Chronicle Web site:

Janitors' dream coming true: a clinic of their own

Health benefits part of the package won by the service workers' union

Two years ago, Houston janitors who belong to the Service Employees International Union staged a monthlong strike to win higher pay and health benefits. The resulting three-year contract boosted hourly wages and promised a health clinic in 2009 exclusively for the union's 5,300 members, the first such facility in Houston.

On Wednesday, workers crammed into a small room inside a Midtown office building to christen the temporary Houston Service Workers Healthcare Clinic, which will open in early January. Organizers expect the clinic's permanent home will welcome its first patients in a still-undetermined medical setting on Feb. 1.

One in three Harris County residents under 65 has no health insurance. Many of the uninsured are low-wage workers, such as janitors and others in the service industry.

"Our clinic will, hopefully, become a model for how we can afford to provide health care for low-wage workers and will be a step forward for solving the health care crisis in Houston," SEIU Local 1 leader Susan Polouski said.

"When you don't have access to health care, you're taking sick days and waiting all day in a line at the emergency room just to get basic care. Now, people will have a clinic to go to, get their needs met and be able to get back to work."

The union clinic is modeled after similar facilities in other large cities. In Chicago, the concept began 50 years ago with one small SEIU clinic and has grown into a network of facilities across the metro area that serves 40,000 members.

Polouski said most of the Houston janitors have been getting basic health care in local emergency rooms.

"Reform of health care up in air as economy sinks" - USA Today

There's an article in USA Today this morning in which the Congressional Budget Office states that "...the number of uninsured could jump 20% in 10 years, up from about 45 million in 2009 to 54 million...".  Wow...the need for free clinics, and volunteer health care providers, is great and continues to grow.  While folks smarter than me figure out the ultimate solution to this problem, free clinics are out there NOW working to meet the needs of the uninsured.  However, they can't do it without the volunteers...without YOU.

Here's the story: http://www.usatoday.com/news/health/2008-12-18-health_N.htm

From Houston - Plan could revise rules on indigent health care

Here's an article from the Houston Chronicle.  Relates to our soon-to-be newest TAP-IN market.  Sounds like we're going to need even more volunteer health care providers:

Plan could revise rules on indigent health care: Idea to use 'assets test' might limit Gold Card eligibility, critics say

Liz Austin Peterson
Dec 15, 2008 (Houston Chronicle - McClatchy-Tribune Information Services via COMTEX) --

The Harris County Hospital District soon may begin including the value of patients' assets, rather than just their incomes, as they evaluate applications for free- and reduced-cost health care.

Chief Financial Officer Ferdinand Gaenzel told the hospital district's board of managers earlier this month that officials are considering implementing an "assets test" for the Gold Card program to ensure people with substantial savings do not take advantage of the discount program. The district currently bases eligibility decisions solely on applicants' incomes.

Some advocates worry that such a move could limit access to treatment at a time when more people are losing their jobs and health insurance.

"We have some real concerns about that," said Dr. Rebecca Wills, a retired family practitioner who works on health care issues for The Metropolitan Organization, a Houston-area network of churches and groups working to improve access to health care for the poor.

Wills said she fears some needy applicants may not qualify because their family has two cars even if both parents need one to get to work. Even people who still qualify may have trouble gathering all the paperwork to meet the new requirements, she added.

"It's like it's placing another barrier," she said.

Gaenzel mentioned the assets test proposal while describing several changes the hospital district is making in an effort to make it easier for poor residents to get the treatment they need.

As of Dec. 8, applicants no longer have to provide identification documents for family members when they are the only person in the household seeking care.

The district also plans to shorten the application form from three pages to one in the coming months and train the clerks who register patients to help them with the eligibility process so patients do not have to wait in multiple lines.

The TMO and other groups long have complained that the application process for the hospital district's Gold Card program is unnecessarily long and confusing, often requiring multiple trips to eligibility centers to provide additional documentation.

Adriana Guzman would welcome such a change. Guzman had to visit a district eligibility center every day for eight days in August -- sometimes twice a day -- before she was able to get approval for her mother's uterine cancer treatment at Ben Taub General Hospital. Each time she thought she'd found the last required document, the clerks told her something else was missing.

"I'm telling you, it was devastating for me to come home with my mom waiting for me to say yes or no," said Guzman, a youth minister at Holy Name Catholic Church. "To her, this was life and death."

About 30 percent of Harris County's 3.8 million residents lack health insurance, and the district's three hospitals, 12 community health centers and numerous clinics serve as their primary safety net. The Gold Card's discount programs offer assistance to impoverished adults who cannot qualify for Medicaid because they are not disabled, have no dependent children or have children, but are not on welfare.

Through the Gold Card program, the hospital district offers discounts on a sliding scale to patients whose income is less than 250 percent of the federal poverty level, or $53,000 a year for a family of four.

Hospital district spokesman Bryan McLeod said officials are considering an assets test because they want to make sure taxpayers are not subsidizing care for people who could afford to pay full price.

He said it was too early to say how the test would be structured but added officials are leaning toward the Medicaid model, which generally bars recipients from having assets worth more than $2,000, not counting their homes or their family's first car. That standard would have to be tweaked to mesh with the hospital district's sliding-scale system.

Dallas County does not include patients' assets in eligibility decisions for its charity care program unless the person receives Medicare, said Lynsey Purl, spokeswoman for Parkland Health & Hospital System.

Anne Dunkelberg, a health care policy expert with the Austin-based Center for Public Policy Priorities, said almost every state but Texas has discarded asset tests for government insurance programs because they generally are not worth the time and effort.

While Gaenzel told the board the district wanted to avoid helping someone with a small income but $200,000 in the bank, Dunkelberg said such a scenario is "unbelievably rare."

"The bottom line is, asset tests are seen as really antiquated and almost an excuse to deny people benefits," she said.

But Karin Dunn of Gateway to Care, a nonprofit that helps uninsured people in the Houston area navigate the health care system, said she believes few of her clients would have enough in the bank to be affected by an assets test.

"I'm not going to say, 'Oh yeah, there's not going to be any problems with the district putting in an assets test,' but at the same time, until we see some details, we can't say that there will be," she said. "So, we just have to wait."

liz.peterson@chron.com

To see more of the Houston Chronicle, or to subscribe to the newspaper, go to

http://www.HoustonChronicle.com. Copyright (c) 2008, Houston Chronicle

Distributed by McClatchy-Tribune Information Services. For reprints, email

tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax

to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave.,

Suite 303, Glenview, IL 60025, USA.

Copyright (C) 2008, Houston Chronicle
News Provided by

 

 

TAP-IN in Cleveland

Here's a short article about TAP-IN's launch in Cleveland:

http://www.cleveland.com/sunsentinel/communitylife/index.ssf?/base/features-0/12283997384790.xml&coll=4

America's Health Rankings - Texas Drops 9 Places in One Year

Every year, the United Health Foundation performs a study of health care in the United States and releases a report in early December that assesses the overall status of national health care and provides a state-by-state ranking for health care delivery, standards and status.

On the web site America's Health Rankings, the general and detailed results for 2008 can be found. After an initial 15 years of almost steady year-to-year improvement in our national situation, over the last four years the curve has flattened, even showing a hint of regression this past year.

Key factors contributing to these results included unprecedented levels of obesity, an increasing number of uninsured people, and the persistence of risky health behaviors, particularly tobacco use.

Of all the states, Texas showed the most year-to-year decline in rankings from 2007 to 2008. Vermont, for the second year in a row, was ranked #1.

The Upside - the Good That Two Free Clinics Can Do

In North Carolina, these two clinics - the Community Care Clinic and the Good Shepherd Clinic - demonstrate the services that local people can't find anywhere else.

Franklin Downs of China Grove saw a dentist Wednesday for the first time in 30 years, thanks to the Community Care Clinic of Rowan County.

A friend told him about the Salisbury clinic, where people who qualify can get free medical and dental care. 

What would Downs be doing with his toothache if the Community Care Clinic and Dr. Jim Mitchell were not there to help him?

"Probably pulling my teeth myself, like I used to," Downs says.

Downs, 57, is part of a growing stream of people flowing into free clinics like the Community Care Clinic on Mocksville Avenue and the Good Shepherd Clinic on South Fulton Street. Both are nonprofit organizations that rely on donations, grants and volunteers to keep the doors open.

Tracking Financial Pain in Atlanta's Health Care

We  are all members of this American society - a society facing many tough choices, but one that we at Tap-In believe is basically good and compassionate. What happens in a place like Atlanta has an impact on the rest of us and is certainly happening in other regions of the nation. When Tap-In began, we knew the health care system was in trouble. Today, that trouble is a fast-expanding crisis, driven by the combination of job layoffs, rising costs, reduced numbers of practicing health care professionals and financial distress across most health care facilities.

The faltering economy and payment crunch have hurt the state’s 170-plus hospitals, industry officials said.

“Elective procedures are decreasing rapidly,” said Kevin Bloye of the Georgia Hospital Association. “For a lot of hospitals, it’s their bread and butter —- hernia repairs, knee replacements, bariatric procedures.”

Hospitals are delaying equipment purchases and renovations, Bloye said. The credit crunch has raised their costs of borrowing money.

A recent American Hospital Association survey of 736 hospitals found about half have experienced an uptick in the proportion of patients unable to pay for care, which is putting pressure on hospitals’ financial health. Many hospitals, including some in Georgia, have cut administrative costs, staff and services.

Across the state, rural hospitals’ percentage of patients who have no insurance has climbed to 20 percent from 12 percent to 14 percent, said Jimmy Lewis of HomeTown Health, an organization of rural hospitals in Georgia.

As so many of the posts on this blog have described, the escalating problem is simple to describe.

1. If people don't have health insurance or cannot afford it, they will tend to not seek treatment.
2. They put off preventative treatment or diagnosis until they absolutely have to get taken care of.
3. If they have a free clinic nearby, they will arrange for an appointment.
4. If they can't wait for that appointment, they will go to the nearest hospital emergency room that will accept them.
5. The same lack of money that caused them to delay treatment will prevent them from paying their hospital bills.
6. The accumulation of thousands of unpaid bills burdens the hospital, often forcing the closure of ERs to the uninsured.

Free clinics are the last resort for a rising tide of our fellow Americans. We can hope for some kind of universal health care solution, but we dare not reduce our efforts to care for those who have not other options. One way or another, we all pay the costs for those of us who can't afford to maintain their health.

Among other medical trends amid the poor economy:

> The number of prescriptions filled in the United States fell 0.5 percent in the first quarter and 1.97 percent in the second, compared with the same periods in 2007 —- the first negative quarters in at least 10 years, research firm IMS Health said.

> A drug industry program called Partnership for Prescription Assistance —- offering free or reduced-cost drugs to low-income people —- has seen a major increase in applicants nationally, with the number of Georgians seeking this aid jumping from 4,000 in September to 7,000 in October.

> A flood of uninsured patients have recently sought services at Georgia’s network of “free” medical clinics. “A lot of them are new patients,” said Donna Looper of the Georgia Free Clinic Network. “I talked to people who have lost their jobs and have no health insurance.”