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Patti Price puts away food in the Food Pantry at Hope Clinic in Ypsilanti, Mich.
Stephen McGee/Genesis
Patti Price puts away food in the Food Pantry at Hope Clinic in Ypsilanti, Mich.

Networks of care

Charity | Formal and informal groups of healthcare providers are keeping the poor from missing the safety net

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

Carol cradles her right foot in her hand, taking off her black Croc sandal and white sock. The callus on her heel is so hard it has worn a hole in the shoe. She could live with that, but up higher, on the fleshy part of her foot, sits a large, soft tissue growth. Every time she walks on it, pain shoots through her leg. Just walking to the bathroom is painful.

Michelle Carr, a nurse at Shelter Health Services in Charlotte, tells Carol she has an appointment with a well-known dermatologist: "They agree to see you Thursday morning, but I need to know if you can make it. … If you take the appointment, but then don't show up, they will never allow us to do this again."

Carol has lived with the growth for two years but found it difficult to work. Doctors were mystified and a podiatrist refused to work on it because he was afraid of making it worse. The homeless shelter clinic has worked to get her an appointment with the specialist, who agreed to charge only $20, which the clinic will pay. The appointment could change Carol's life - if she shows up.

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She does. The morning of her appointment she calls to verify that she will see Dr. Libby Edwards at Mid-Charlotte Dermatology & Research. Edwards biopsies the growth and diagnoses a cyst. She refers Carol to Dr. Hazem El-Gamal from Charlotte Dermatology, who operates and removes the cyst, charging a $20 co-pay, which the clinic pays. Carol can soon walk without pain.

Carr summarizes the problem: "There has always been a safety net for the poor. They just don't know how to access it. But we do, and we connect them." Many charity clinics do the same: They provide primary and preventive care, and when a patient needs surgery, cancer treatment, or dialysis, they rely on formal and informal networks to provide those services.

For example, Shepherd's Clinic in Baltimore partners with Union Memorial Hospital (UMH) to provide care for people like Levan, 61, a mechanic with a heart condition that has put him in the hospital three times. When Levan recently had gall stones and lower back pain, he went to Shepherd's rather than the Union Memorial emergency room for treatment.

The partnership began when Dr. William Finney, retired UMH chief of staff, became the clinic's first volunteer medical director and forged the reciprocal relationship. For more than 20 years, the hospital emergency department has sent its non-emergency, uninsured patients to Shepherd's for primary care. The clinic, in turn, refers patients to the hospital for diagnostic procedures, specialty consultations, and surgical procedures, which it performs as part of its charity care. Last year the clinic made more than 2,200 referrals back to the hospital.

The Project Access referral model began in Buncombe County, N.C., in 1996 (Asheville is the county seat). Project Access successfully recruited specialists and general doctors into a network to provide medical care to the uninsured. Specialists who volunteer through Project Access provide healthcare within their specialties, and the organization makes sure that patients get necessary lab work, X-rays, and follow-up care, including surgery and hospitalization.

The Buncombe County Project Access today involves more than 600 doctors, home healthcare groups, and local hospitals, providing care to 3,000 uninsured patients each year. The model is simple: Patients go to primary doctors or a charity or sliding scale clinic for a referral. Project Access screens patients to make sure they are county residents, have no insurance, and fit within income guidelines (currently 200 percent of the federal poverty line). Project Access then refers patients to a specialist, who sees them in his own office.

Since Buncombe County's Project Access saw its first patients in 1996, the model has spread to more than 50 cities, including Portland, Seattle, and Wichita, giving doctors across the country another avenue for volunteering. In some places, funding for administration comes from county government, foundations, or local medical societies. Other clinics also rely on informal doctor-to-doctor networks to secure treatment for patients.

Uninsured people also need help getting affordable prescriptions. Pharmaceutical companies have programs to provide free and low-cost medications to uninsured people who earn less than 200 percent of the federal poverty level, and receive tax benefits in return. The process varies from state to state. In North Carolina, MedAssistNC acts as a mail order pharmacy for the working poor: It receives free medications from drug companies and dispenses them to qualified individuals and clinics. The average client has three prescriptions, with help for diabetes, hypertension, and heart disease most common. Last year, MedAssist dispensed 160,000 medications worth $19 million wholesale, with drug companies donating 90 percent of that.

With reporting by Tiffany Owens and Christina Darnell

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