By RENEE STOVSKY
Dr. Richard Hansen, 62, medical director for Emory Specialty Associates Primary Care Division, describes himself as having been educated at George Washington University medical school, trained at Emory University Hospital, and reeducated at Mercy Care, a clinic system that operates Atlanta's only health care for the homeless program.
That's because 20 years ago, when he first began volunteering at Mercy Care as a Saint Joseph's Hospital internist, he says he thought of the homeless as "mainly crazy, disheveled, unkempt people who had been released too soon from psychiatric facilities." But that was before he treated a homeless man who wore a tool belt when he slept in shelters.
A patient at Mercy Care's North clinic walks with the helping hands of medical assistant Nerzi Tarantine, left, while Dr. Latasha Bogues, a pediatrician, looks on.
"I do woodworking as a hobby, so I knew that guy had about $2,000 worth of new tools there that he wouldn't let out of his sight," recalls Hansen. "Once we started talking, I found out he was actually a carpenter by trade, down on his luck after a broken marriage and recent job loss."
That one encounter, Hansen says, served as "a clarification of how close people are to being one paycheck away from homelessness.
"We all have a tendency to look at things and segment them. In the case of the homeless, we see them and think, 'That would never happen to me.' But my work at Mercy Care has taught me, among many things, that they are we, and vice versa," he says.
Gift of giving
That kind of knowledge has served as inspiration for many of the volunteers and staff at Mercy Care, says its Vice President of Mission Sr. Angela Marie Ebberwein, RSM. "One way to explain the generosity and dedication of those who are involved is to understand that the work is a gift of reciprocity," she says. "Those who give of themselves also benefit enormously from their giving."
That "gift of reciprocity" is the foundation upon which Mercy Care was formally founded in 1985. It actually traces its roots to 1978, when Saint Joseph's Hospital — the oldest in Atlanta — moved from its downtown location to Sandy Springs, Ga., a suburban area. Soon after, a handful of staff doctors and nurses, realizing they were losing touch with poor and homeless patients they had treated, started a volunteer effort to return downtown with tackle boxes full of medical supplies to care for the people who had come regularly to the hospital at its previous location.
Seven years later, the Sisters of Mercy, who founded Saint Joseph's Hospital in 1880, decided to formalize that volunteer mission by incorporating Saint Joseph's Mercy Care Services. The sisters designated $1 million from the sale of the downtown property to establish a foundation to continue the work.
Patients line up outside of Mercy Care's medical coach for a community screening event in August during National Health Centers Week.
Mercy Care was designated as a federally qualified health center in 1986, with a specific focus on the homeless population, and it grew rapidly after that. It now consists of five main, full-time clinics, four part-time satellite clinics, and five additional locations — churches and homeless shelters — serviced by mobile clinics.
But, as part of Saint Joseph's Hospital, "Mercy Care was the best kept secret in town — it didn't have an identity of its own," says Tom Andrews, president of Mercy Care and president and chief executive of Saint Joseph's Health System. That changed when Saint Joseph's Hospital merged with Emory Healthcare in January 2012, and became Emory Saint Joseph's Hospital. Mercy Care — along with Mercy Care Rome and the Mercy Care Foundation — remained part of Atlanta-based Saint Joseph's Health System. Together, Mercy Care; Mercy Care Rome, which serves vulnerable elderly clients; and Mercy Care Foundation, continue to focus on the neediest populations in Atlanta and Rome, Ga.
In addition to providing primary care, Mercy Care's almost 200 employees — including seven physicians, four dentists, 13 nurse practitioners and support staff — offer primary medical care, dental care, optometry, behavioral health and social services for adults and children, including the elderly and disabled. More than 95 percent of Mercy Care's patients are uninsured, and 83 percent live at or below the poverty level.
How has Mercy Care managed to keep its mission alive and well?
"We now have a $14 million annual budget, and 65 percent of that is covered by federal, state, local and foundation grants," Andrews says. "The rest comes from interest earned from our investment asset base, which has grown to more than $70 million, and from fundraising efforts. It's not a good business model, but it works because of the thoughtful approach of our board."
Mercy Care's fundraising campaigns, he adds, have been strongly supported over the years by grateful Saint Joseph's patients who want to give back. "We educate patients so they understand the importance of mission, and connect them through formal structure to help fund us," says Andrews. "When people realize that the proceeds of our annual golf tournament and ball are to support mission, not to fund a new hospital wing, it resonates with them."
Mercy Care's strong volunteer program is a plus as well. "We've found that millennials, in particular, want to get involved in organizations they are supporting financially, and there's plenty of opportunity for that here," he says.
Another huge factor — "the ace in the hole," says Andrews — that helps secure Mercy Care financially is its status as a federally qualified health center. As such it can recruit new medical school graduates from Emory University to work at Mercy Care where they not only earn salaries but can repay loans through the National Health Service Corps, which is now funded at a higher level under the Affordable Care Act.
Mercy Care also is hoping to join a Medicare supported, accountable care organization with two other providers — Grady Memorial Hospital and Morehouse School of Medicine — which will be funded by monthly per capita payments, rather than fee for service, to care for patient populations. That type of reimbursement, Andrews says, could reap an extra $3 million to $4 million that Mercy Care could use to hire more doctors and provide more care.
Mercy Care Street Medicine team members check on a resident of a tent city under the Interstate Highway 20 overpass in downtown Atlanta during night rounds in January of 2014. From left are Kathy Schaaf, a Mercy Care registered nurse; Dr. Michelle Adler, a volunteer who is an infectious disease specialist for the Centers for Disease Control and Prevention; an unidentified volunteer; and Ricky Alexander, a Mercy Care behavioral health outreach specialist.
The road ahead
Craig McCoy, departing chief executive of Emory Saint Joseph's Hospital, believes Mercy Care's independent status ultimately may work to its advantage financially. "While we still have a close working partnership, Mercy Care can now utilize some huge corporate entities for support, instead of relying completely on hospital funding," he says. "Businesses are realizing that strong health care is tied to strong education and strong infrastructure in the community. Deeper pockets, and an awareness of social issues, can drive the critical changes that are needed to impact the lives and well-being of the poor and vulnerable."
Sr. Ebberwein points to the evolving services Mercy Care has been able to offer over the years as proof of its expanding footprint in the community: English as a second language classes for its large Hispanic population, as well as prenatal and parenting education for Spanish speakers; obesity and diabetes management programs; adult day health services; in-home and support services for Alzheimer's patients; and most importantly, mental health treatment, substance abuse counselors, a recuperative care program for homeless hospital patients, and supportive or transitional housing for those without shelter.
"Last year, we served 13,000 clinic patients and in excess of 20,000 people, including our street medicine, HIV prevention and case management services," says Andrews. "Atlanta is a magnet in the South for the homeless — on any given day there are more than 7,000 — so there is plenty for Mercy Care to do."
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