Issue link: https://viewer.e-digitaledition.com/i/674833
Called to Serve THOUGH IMPLEMENTATION OF the HITECH Act and the ACA has placed additional time constraints and pressures on physicians, the number of medical volunteers who spend time at free and charitable clinics has remained about the same at the Greenville Free Medical Clinic in Greenville, South Carolina, and the Lake County Free Clinic in Painesville, Ohio. The pool of physician volunteers at the Good Samaritan Health Center of Gwinnett in Lawrenceville, Georgia, has increased 200 percent in the past 24 months. "Whether you can offer fi ve hours a month or 40 hours a month, we are happy to have you," says Nicole Lamoureux, Chief Executive Offi cer of the National Association of Free & Charitable Clinics. "... The more people who give time, the bigger impact we can have on the community." A SHIFTING PATIENT POPULATION Free and charitable clinics predominantly care for uninsured Americans — and for the most part, that hasn't changed. However, clinics in many states, especially states that have expanded Medicaid, are seeing a new type of patient: people who have insurance through Medicaid or Health Insurance Marketplace-sponsored private plans but either can't fi nd a Medicaid-approved provider or can't a– ord the high deductibles associated with their bronze-level plans. Johanna Henz, Executive Director of the Lake County Free Clinic in Painesville, Ohio — a state that expanded Medicaid in 2014 — noted that the number of uninsured patients who access free care at the clinic has dropped from 90 percent of the patient base to roughly 80 to 85 percent, while the number of people with insurance who visit the clinic is increasing. Gregory E. Lang, PhD, Executive Director of the Good Samaritan Health Center of Gwinnett in Lawrenceville, Georgia, has observed similar changes. Georgia opted out of Medicaid expansion, but the clinic has seen more patients with private plans. "Recently, a woman came into the clinic seeking services and complaining of her 'worthless' insurance," Lang says. "She had a $6,300 deductible. If one requires a subsidy to a– ord a monthly premium, how could that individual be expected to pay 100 percent of the fi rst $6,300, potentially after a single episode of care?" To keep up with demand from insured but underserved patients, the Good Samaritan Health Center of Gwinnett has adjusted its business model. The clinic traditionally provided care only to uninsured individuals but now sees uninsured patients and those with individual deductibles higher than $3,000, with service prices averaging roughly 55 percent of market cost. FILLING TRADITIONAL CARE GAPS Despite the ACA's e– orts to provide insurance to all Americans, many people still lack basic coverage. The Greenville Free Medical Clinic in Greenville, South Carolina, provides free medical care to uninsured adults between ages 18 and 65 and has seen a stable annual average of roughly 4,000 patients in recent years. In addition to providing basic primary and dental care, the clinic specializes in the management of chronic conditions and o– ers patient education, free prescriptions and behavioral health services. Since the ACA took e– ect, the clinic has partnered with two local healthcare systems to provide a medical home for uninsured patients with diabetes, hypertension and other chronic illnesses. According to Suzie Foley, Executive Director of the Greenville Free Medical Clinic, results from the partnerships are positive. Those with chronic ailments who seek care at the clinic have fewer emergency department visits and preventable hospital stays. AN ONGOING NEED Although care models and the types of patients served at free and charitable clinics may vary, Lamoureux, Henz, Lang and Foley all agree on one thing: There will likely continue to be a signifi cant need for free and charitable care. "There are always going to be people who fall through the cracks," Henz says. "... Despite [any government program], there are always going to be people that it doesn't work for." ■ M D N E W S .C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N n M AY/J U N E 2 016 3 5