Patient Access Monthly Journal Source: The Academy of Healthcare Revenue
Volunteer Clinic Reduces Costs, Patient Volume for Area Providers
The steady growth in the uninsured patient population has
placed acute strain on both urban and rural hospitals
nationwide. A recent report from the U.S. Census Bureau
found that the number of uninsured individuals grew from
44.8 million in 2005 (15.3 percent of the U.S. population) to
47 million in 2006 (15.8 percent). The increase in the uninsured
population also included growth in the number of
uninsured children, growing from 8 million (10.9 percent of
all U.S. children) to 8.7 million (11.7 percent) in the same
time period.
In response to the continuing growth in the uninsured
population, healthcare leaders have focused increased
attention on effectively collecting patients’ out-of-pocket
financial responsibilities, screening patients for financial
assistance eligibility, and optimizing other revenue cycle
processes to reduce inefficiencies. Some healthcare
providers have also taken a proactive role in addressing
the issue of the uninsured by re-evaluating their charity
care policies and expanding uninsured discounts, as well
as opening hospital-affiliated community clinics to serve
vulnerable patient groups.
Although opening a community clinic can be beneficial
for hospitals, leaders must not overlook existing resources
in the community to assist uninsured patients in obtaining
the care they need. For instance, in Hilton Head, South
Carolina, Volunteers in Medicine (VIM) is a community
clinic that has been in operation since February 1993. In
the thirteen years that the clinic has been in operation, it
has expanded its services from being able to handle simple
patient visits for routine illnesses to managing care for
patients with chronic conditions.
Margie Maxwell, the Director of Development and
Public Relations at the VIM clinic, explained the capabilities
of the clinic and VIM’s overall goal. “We have five disease
management programs and 22 medical specialties.
Our goal is to not only take care of walk-in patients who
wake up in the morning and don’t feel good, but also to
teach them and make them well, and keep them well in
such critical areas as hypertension, diabetes, obesity, children
with behavioral problems, and asthma.” The volunteer
clinic is staffed by more than 200 retired physicians in
the community and 220 volunteer staff members.
The VIM clinic serves residents of Hilton Head Island
and neighboring Daufuskie Islands, as well as patients
crossing over from the neighboring town of Bluffton. In
order to qualify for services at VIM clinic, patients must establish proof of residency of at least three months, have
annual incomes below 200 percent of the federal poverty
guidelines, and be uninsured. Maxwell further explains,
“Where one family member qualifies…and if it is a head of
household, or an adult…the entire family qualifies. And
our rule is, if in doubt, decide eligibility on the side of compassion
and cure the patient, and get the hard data later
for the next visit.”
On Hilton Head Island, there is one acute-care facility,
Hilton Head Regional Medical Center, a 93-bed for-profit
hospital. Leaders at Hilton Head Regional have recognized
the vital contribution of the VIM clinic in providing
patient care to the region’s uninsured residents, and its
impact on the hospital’s revenue. Thus, hospital administrators
have worked with VIM’s leaders to ensure that
uninsured patients are directed to the clinic for necessary
follow-up care and other services.
For instance, Hilton Head Regional will routinely refer
patients who receive treatment in the ED to the VIM clinic
to receive necessary follow-up care (e.g., suture removal).
In addition to referring uninsured patients to the VIM clinic,
Hilton Head Regional also provides vital services that
the clinic cannot perform. “They’re a for-profit organization,
but they do many mammograms for us, about 15 per
month at their facility. They charge us their cost for a
mammogram, which is almost nothing,” Maxwell said,
“They also provide us with…two to three procedures a
month that cannot be done within the walls of the clinic.”
In addition to providing ongoing care to uninsured
patients, VIM clinic administrative staff also screen
patients for eligibility for public assistance. However,
many uninsured patients visiting the clinic do not qualify
for public assistance programs due to their income status.
Maxwell explains, “If there is an opportunity for Medicare
or Medicaid, we make sure that happens and help them
with the paperwork. But as a whole, Medicaid requires
almost indigence, and 70 percent of our patients are
employed. Another 20 percent above that are kids, who
can’t be employed yet. So there’s only a true 10 percent of
our patients who are unemployed, indigent, or not working
for whatever reason.”
According to Maxwell, the impact of the volunteer clinic
on the healthcare providers in the region, primarily
Hilton Head Regional, is approximately $6 million per year
in reduced uncompensated care costs. The VIM clinic
has become very well known as a resource where
uninsured patients throughout the region can obtain
vital ongoing care. The success of the VIM clinic in
reaching vulnerable uninsured patient groups illustrates
how healthcare providers can work with volunteer organizations in their communities to provide essential
patient care, while also reducing uncompensated care
costs often incurred from patients arriving to the ED for
primary care. Furthermore, by working closely with
volunteer organizations, providers can create a positive
reputation in the community for their efforts to enhance
patient health.
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Media Contact Andrea Morrill
Research Director
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