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Dr. Kim with a patient at Beacon Christian Community Health Center
Najlah Feanny/Genesis
Dr. Kim with a patient at Beacon Christian Community Health Center

Calling the shots

Charity | Independent Christian clinics may soon have to decide whether to accept government funding. Is the price of federal money too high?

Issue: "Dead heat," Sept. 22, 2012

In 1999 Dr. David Kim surveyed the medical landscape in Staten Island, N.Y., and noted a presence and an absence. Present: high rates of diabetes, obesity, heart disease, and asthma. Absent: Christianity. Kim decided to open a clinic but knew he could not do so with private contributions. In 2006 he founded Beacon Christian Community Health Center, a nonprofit clinic he hoped would become a federally qualified health center (FQHC) and receive grants from Washington.

The process of applying for nonprofit status under the state health department began with securing a site, an empty warehouse-but then Kim learned he could not renovate it until the health department received his plans and approved them, which took months. When the renovation was complete, the state had to sign off on it. The entire process took two years. During that time he housed the clinic in a temporary space above the local post office. Ill or elderly patients would say, "Dr. Kim, it's really good to see you, but those 17 steps. …"

Next, Kim and his staff had to prove they could provide primary and preventative care, have a paid core staff, and maintain accessible hours. Kim waded through the extensive application process and overcame considerable political opposition. At one point a bureaucrat told him to join a different community health center where he would not be allowed to put his Christian beliefs into practice.

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Later, a New York health department staffer couldn't even imagine how faith and medicine could work together. He called to ask, "Do you do exorcisms? Do you use holy water? Do you immerse people in it?" But Kim's perseverance paid off, and Beacon became the first federal and state licensed faith-based clinic in New York state.

Beacon is not the only explicitly Christian FQHC: so is Lawndale in Chicago, Esperanza in Philadelphia, and Christ Community in Memphis. They serve in poor, medically underserved areas, which is one requirement for becoming an FQHC. Federal grants help these clinics provide care to the uninsured, and higher Medicaid and Medicare reimbursements make it economically feasible to care for the poor. Kim says the grants "are a bit of a bureaucratic nightmare. If there is something we can fund with patient revenue, we do so to avoid tight regulation."

In return for a steady funding stream, FQHCs must offer comprehensive medical care, including mental health and substance abuse treatment. They must report statistics about patients and procedures: Doctors generally see 15-20 patients per day. Clinic patients must form a majority of an FQHC's governing board. (The Beacon board includes a Sri Lankan, a Nigerian, a firefighter, and a retired church secretary: Kim and his staff joke that they have the diversity of the entire UN sitting in their waiting room.) About 1,100 FQHCs exist nationwide. Since each one can have multiple locations, that means about 8,000 total sites.

Volunteers at privately funded clinics speak often about the joy of practicing medicine without worrying about paperwork and complicated billing codes for Medicaid and insurance reimbursements. They bemoan the business of medicine, which results in doctors having to deal with many different insurance companies, each with its own rules, and with government directives.

Many Christian clinics, like Bethesda in Tyler, Texas, maintain their freedom by relying entirely on private funds. Executive director John English says, "As a Christian clinic we didn't want to have anything that would limit what we do. We didn't want to be dependent on any one resource." Bethesda relies on support from churches, individuals, and foundations, as well as a small patient co-pay, to meet its annual $1.2 million budget.

Pat White, executive director of the West Virginia Health Right clinic, expressed bluntly the view of many charity clinic supporters: "I don't like jumping through hoops." She sees charity clinics as bottom-up organizations, while FQHCs are "very top-down." She says the 200 doctors and dentists who volunteer at her clinic don't like Medicaid: "They fight Medicaid in their private practice. They don't want to do it when they volunteer." She gives an example of how her clinic works: "This afternoon we have a cardiologist. He'll see 16 patients that other doctors have referred. We don't have to get any Medicaid approvals. We just schedule them. It's a different practice type: patient-focused rather than payment-focused."

Charity clinics don't have billing systems. They either suggest nominal fees or accept donations - but they don't bill patients who can't pay. It's an honor system. White says patients appreciate the doctors who volunteer, and the doctors enjoy having patients say, "Thank you." She says many "impoverished people on Medicaid have to jump through so many hoops, they feel I'm entitled. …"

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