BY: VIRGINIA PEARSON
Ms. Pearson is a consultant for the Baton Rouge Health Forum, Baton Rouge,
LA, and a member of the board of the Baton Rouge Community Clinic.
Physicians and Dentists Have Pooled Their Skills to Provide Care for the
Area's Working Poor
For years, Americans have talked about helping the "working poor," people
who, although they hold down jobs, do not have health insurance. On one hand,
they are too young for Medicare and earn too much to qualify for Medicaid. But,
on the other hand, they don't earn enough to cover the cost of even the most
basic of health prevention services.
In Baton Rouge, LA, a group of health care providers decided in 2000 that
they would attempt something untried (as far as they knew) in any other part
of the country: They would establish a "virtual clinic" to help the local working
poor. The Greater Bat¥n Rouge Community Clinic was launched in January 2000.
Today more than 400 physicians and dentists, working in partnership, have made
the virtual clinic a reality.
Getting Started
During the project's initial planning, William Cassidy, MD, the president of
the board of the East Baton Rouge Parish Medical Society approached the members
of the Greater Baton Rouge Health Forum (GBRHF) looking for help. The medical
society is a member of the GBRHF, a partnership composed of all the hospitals
in a five-parish area.* Cassidy is a talented community organizer with whom
GBRHF members had worked on previous projects.
* For the Greater Baton Rouge Health Forum, see Virginia Pearson,
"Five Years of Collaboration," Health Progress, January-February
1999, pp. 28-29.
Cassidy's initial request to the forum was for funding with which the medical
society's board could hire an executive director whose primary task would be
bringing the virtual clinic project to life. GBRHF members approved a grant
of $25,000, the director's salary for six months. During that half-year, the
executive director would, first, determine whether the project could attract
a sufficient number of volunteer physicians and dentists, and, assuming that
it could, write applications for grants that would give it financial stability.
Doctors and Dentists
Today more than 300 physicians and some 130 dentists have volunteered to attend
to "clinic" patients. Every six months, they make a commitment as to how many
patients they will be able to see in the half-year to come. Each physician and
dentist determines for himself or herself what the number will be. In one case,
it might be a single "clinic" patient; in another, it might be 20. During this
six-month period, the assigned number of patients are seen in the doctor's or
dentist's own office and treated by him or her with the aid of his or her own
equipment and staff.
The executive director, who has three part-time assistants, is the Greater
Baton Rouge Community Clinic's only full-time employee. In 1999, during its
developmental period, a bit more than $31,000 was raised for it. In 2002 grants
brought in more than $46,000, while special events added another $28,000. Annual
operating expenses remain under $100,000.
Thus the "virtual" clinic. This arrangement makes it possible for area physicians
and dentists to give something back to the community without leaving their own
offices. Their participation in the program gives them great satisfaction, they
say. Office staff members express pride in working for professionals who care
enough to share their medical expertise with those who need it most. Increased
employee satisfaction was not one of the project's original goals, but it is
certainly an added bonus.
Because they do not work in a single location, the virtual clinic concept
does require continuous communication among volunteers. The executive director
is responsible for visiting and orienting the staff of each participating provider
before any patients are assigned to that provider. Ongoing recruitment is necessary
to maintain all specialties. The executive also works continually to educate
the public about the services available through the "clinic." This is necessary
because the working poor are not generally used to looking for or receiving
assistance.
Hospitals
"From the start, we recognized the need for a creative solution to help the
uninsured working people in our service area," said Alison Walker, vice president,
Our Lady of the Lake Regional Medical Center, a member of the Franciscan Missionaries
of Our Lady Health System, both of which are based in Baton Rouge. Our Lady
of the Lake participates in the GBRHF. "We work in a lot of partnership efforts
and know that a lot can be done if everyone uses his or her own talents in achieving
a solution," Walker said. "Certainly the work we were already doing through
the GBRHF had proven this to be true."
As the virtual clinic project took shape, the GBRHF's member hospitals again
stepped in, committing themselves to provide an annual number of laboratory
studies of the type that cannot be performed in physicians' offices. Louisiana
State University (LSU)–Earl K. Long Medical Center, Baton Rouge, the local community
hospital, agreed to provide needed surgeries. Other GBRHF facilities promised
to provide specialty surgical procedures, should a need for them occur. Baton
Rouge physicians have historically provided services for which they received
no payment, but they were hindered from making (and then treating) certain diagnoses
because the patient couldn't afford the specialty tests needed to establish
the diagnosis. Now, however, the "clinic" has established agreements with GBRHF
member hospitals outlining the tests a particular hospital has available, as
well as the contact persons, financial reporting processes, and special procedure
requests involved.
Applicants and the Process
In Louisiana, a state with one of the nation's highest poverty levels, health
care needs are always great. In planning the virtual clinic, organizers discussed
the various local populations that seemed to need help in obtaining care. The
organizers decided that, to give the program its best chance for success, they
would need to focus on one particular group.
In the end, they decided to focus on adults who were working at jobs that
either provided no health care benefits or provided benefits the worker could
not afford. The organizers established two screening sites—one at the Bishop
Ott Shelter, operated by the St. Vincent de Paul Society, and the other at Family
Road, a local resource center. At these sites, program applicants are asked
to provide proof of total family employment (an income tax statement from the
previous year, paycheck stubs, or a letter from their employer if the employment
data differs from the tax information), a photo identification card, and proof
of residency (a utility bill or other official document).
Applicants can earn up to 150 percent of the federal poverty guidelines, which
amount to a maximum of $27,100 for a family of four. Applicants must be currently
employed, have worked 10 of the past 12 months, and reside within the current
service area, which now comprises nine parishes (an expansion from the original
one, East Baton Rouge Parish).
Once an applicant has been approved, he or she is issued an identification
card that is valid for six months. If still eligible, the patient can be recertified
for a second six months of medical services. He or she can receive only one
six-month period of dental services, however, because the "clinic" has a long
waiting list of people with oral health needs. Applicants are assigned to physicians
or dentists whose offices are geographically close to either their home or place
of employment. Since most applicants have jobs and can therefore pay for it,
transportation to and from the "clinic" is not the major problem it is for some
other programs.
An applicant accepted into the virtual clinic program is responsible for scheduling
an introductory visit with the primary care physician or general dentist listed
on his or her ID card. He or she is encouraged to phone the physician or dentist
as soon as possible to secure an appointment. "Clinic" patients are treated
by the physician's or dentist's staff s with the same respect and dignity as
private-pay patients. Medications prescribed can be filled at the St. Vincent
de Paul Society's Free Community Pharmacy (another program that has received
support from GBRHF members). Patients can be seen for emergency care and surgical
services at LSU–Earl K. Long Hospital.
Genuine Collaboration
As word has spread about this partnership of area physicians, dentists, and
hospitals, the number of applicants has steadily grown. Currently, about 75
percent of the applicants come seeking dental help. Finding affordable dental
care has always been difficult in the greater Baton Rouge area. General dentists
are needed to serve as initial providers. Even so, because patients are a marginalized
population that tends to neglect its oral health, every one of the "clinic"'s
dental specialties is over utilized.
Surveys have shown that people in Louisiana have a history of accessing their
medical care through emergency rooms of the statewide "charity hospital" system
(community hospitals, including LSU–Earl K. Long, under the direction of the
LSU Medical School). The virtual clinic is working to change those patterns
by encouraging people to go to primary care physicians for preventive and educational
health care. Program organizers know that people who have regular medical care
are less likely to ignore symptoms until they become so severe that they require
a trip to the emergency room.
Today, for the first time in their lives, thanks to the Greater Baton Rouge
Community Clinic, many area residents have charts on file in physicians' and
dentists' offices. Because they do, they are able to seek medical and dental
care without the loss of income that often occurs when one is forced to take
time to seek treatment. Preventive care is now a reality for them.
"Collaboration" is a word that gets thrown around a lot these days, but in
the Baton Rouge area it has real meaning. The Greater Baton Rouge Community
Clinic is a case of good people helping good people.
A "Virtual Clinic" Christmas Story
Christmas 2000 had special meaning for "Alexis." Not only was she going to
get her "two front teeth"; she would have all of her upper teeth replaced. As
the first patient seen by volunteers with the Greater Baton Rouge Community
Clinic, she couldn't have been more excited.
After almost a decade of working in factories and at domestic and other service-type
jobs, Alexis had, she said, "just enough to go to school, have transportation,
and take care of the bills." Having recently graduated from a medical assistant
training program, she began a job search.
It was the beginning of a new career and one that, Alexis felt, would fulfill
her desire to help others. Her ultimate goal was to be a physician's assistant.
While going to school, she worked as many as six part-time jobs just to make
ends meet. Alexis, who has never received public assistance, is proud of the
fact that she has always been able to find part-time jobs to get her through.
After months of searching for a job as a medical assistant (including many
job interviews), Alexis was told by an interviewer that he could not hire her
because her teeth were so bad; the job was one in which she would be required
to interact with the public.
Meanwhile, however, one of Alexis's instructors had watched her work her way
through school and was impressed by her determination. After making several
phone calls on her behalf, the instructor directed her to the newly launched
Greater Baton Rouge Community Clinic.
Alexis was the first person to go through the screening process at the "virtual
clinic." She was also the first to qualify for its help. She was seen by Glenn
Kidder, DDS, a "clinic" founder and one of the first dentists to volunteer for
this new concept. Fifteen of Alexis's teeth had to be extracted. But that didn't
dampen her enthusiasm for the help she was receiving. "When you wake up and
have a cup of coffee without anything hurting, it's a wonderful feeling," she
said.
By the time Alexis's treatment had been completed, Kidder, Scott Pecue, DDS,
and her oral surgeon, Tooley Towns, DDS, had among them donated more than $2,500
in services. Christmas 2000 was indeed magical. Alexis's smile proves that.
Oh, and by the way, she also found the job she wanted. Wishes can come true.
Physicians Like the Program, Too
One in five Louisiana residents has no health insurance coverage. The state ranks third highest in the nation in uninsured populations.
At the Greater Baton Rouge Community Clinic, "the typical patient seen by our physicians is a single parent, usually female, who works outside the home but either has no insurance offered through her employer or cannot afford the copay required to access the insurance when it is offered," said Curtis Chastain, MD. Chastain is medical director of Lake Primary Care Physicians at Our Lady of the Lake Regional Medical Center and one of the "virtual clinic's" volunteer physicians.
The typical patient "puts off getting medical and dental care until the problems get too difficult to ignore," Chastain continued. "She will make sure that her children's needs are taken care of first. Our physicians like the concept of the virtual clinic because it allows them to see patients who really need their care, who have gone through an approved screening to qualify for the care; and it is a program that allows the physician to take care of these needs in their own offices using their own staff and equipment."
Volunteer physicians also like the fact that they are able to get "clinic" patients' laboratory studies, X rays, and other tests taken care of by the local hospitals, which means that the patient can receive the full amount of care needed and not be stopped short by access problems.
In only three years of operation, the nation's only virtual clinic has already provided more than 5,800 medical and dental procedures. services worth more than $480,000. "Our Lady of the Lake Regional Medical Center and our physicians are pleased to be a part of this total community effort," Chastain said. "This concept enhances the mission of the hospital as well as that of the Franciscan Missionaries of Our Lady and reminds us physicians of the real reasons we went into the medical profession."
Copyright © 2003 by the Catholic Health Association of the United States
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