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Physicians’ Forum
done for the patient on an outpatient basis, which
is less costly than on an inpatient basis, I try to do
that. The bottom line, though, is that physicians
are in the business of caring for patients, caring
with a capital “C.”
TH: Unfortunately, they do print a patient’s insurance
information on the super bill. Patients will tell
me, “I don’t have coverage” or “I don’t have this or
that,” but I’ll tell them not to ever let that be an
issue. My issue is “how can we care for you?” I’ll
work with whatever plan they’re working within.
In what ways has this impacted you and/or your
practice?
MH: My practice probably hasn’t been impacted a
great deal. We have about 30,000 patients in my
practice, and I would say that, of those, less than 2
percent have no intermediary in place to pay for the
services they receive. If they don’t, we work with
them. In addition, each physician here at the hospital
has a case manager and access to a social worker.
That coordination occurs on day one for a patient; as
soon as a patient is admitted, if a problem is recognized,
the case manager and social worker work with
me as team members to see how the patient’s needs
can be met. Most often finances are on every
patient’s mind.
TH: I still practice privately, and I don’t think there’s
been much impact on my private practice. The clinic
is free-standing and self-supporting. Early on, I
told them we needed to be inclusive, not exclusive,
and to look into how we could broaden the program.
Two years ago, I was able to rotate off as president of
the clinic board—I’m obsolete, and that’s wonderful!
I wanted it to be that way; we don’t want to depend
on one person to run the clinic. We want it to keep
working long after we’re gone. I still see patients in
the free clinic, but if you let physicians know that
they don’t have to be there every day or every week
to make a difference, you broaden the philanthropy
in the community and you don’t burn out the physicians.
In the free clinic, we’re just working to serve;
being able to see people being cared for for free—
that’s incredible and also incredibly generous on the
part of everyone involved.
Has your patient base changed in the last five
years and, if so, how?
MH: Absolutely. More than 50 percent of my
patients now are over 60 years of age; of course,
many of these people have Medicare. What I see as
a major issue for these patients is their inability to
afford pharmaceuticals. Fortunately, a lot of companies
in the pharmaceutical industry are coming
together to address this problem. In particular,
there’s a program called Share RX where eight to 10
major pharmaceutical companies got together to
offer options for about a hundred different medications,
typically the most popular on the formulary.
In this program, for example, if a patient qualifies to
participate, a medication that could cost a couple of
hundred dollars for a one-month supply can be purchased
for $15. I lean heavily on these types of programs.
In addition, we have a local community
action group and also three volunteers in our office
who come in one day a week and spend the whole
day completing paperwork to enroll our patients in
various assistance programs. We also have at least
four churches that provide food, assistance, and
other available aid to our citizens when needed.
TH: I don’t think my patient base has really
changed. The reason I say that is because I made it
clear up front that patients couldn’t just be
“unloaded” into the Community Free Clinic. The
free clinic was established to capture the community
population who aren’t receiving care because
they don’t have insurance or the funds necessary to
pay for their treatment. In addition, I’m not going
to see patients in the free clinic if they’re already my
patients in my private practice. That was not the
idea of the free clinic; it is for those people who
have not sought medical help because they’re uninsured
and know they would encounter a bill immediately
upon entering a medical office.
How does indigent care affect hospitals and clinics
in your area?
MH: From an absolute numbers standpoint, Cullman
Regional Medical Center spends approximately $10
million a year on indigent care. That’s a big piece of the
pie; they do their best to budget for it, but the costs
change from year to year and are difficult to predict.
TH: Hopefully, if we take care of indigent patients’
primary-care needs—diabetes, hypertension, and
the like and keep them preventatively under control—these
patients will be less likely to be seen in
area hospitals and clinics. We’ve had incredible support
from local hospitals, labs, X-ray facilities, and
physicians—almost 100 of the hospital’s physicians
were involved last year. That tells you that we care
about our people and meeting their needs. Both
area hospitals and their ancillary services have been
very open to providing staff and volunteers, and a
lot of times they either lower their costs or write
them off entirely. It’s been incredible. Logically
thinking, if we do things right, in the long-term
we’ll decrease the numbers of people in the emergency
rooms for routine care. Physicians want to
help people—that’s the bottom line.
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Do you have any ideas or suggestions for improving
the current state of indigent care in Alabama?
MH: Again, I would encourage local communities
to get involved, not just physicians. Indigents are
people who work beside you every day—you live
with them, you play with them, you go to church
with them, you go to school with them. A community-based
holistic approach to helping them is
what I would suggest—everyone benefits from it. I
think community leaders need to spearhead it, get it
in motion, and local physicians will come on board.
I don’t think I know any physician who would say
“no” to donating time to care for patients who need
it. For instance, we have 85 physicians here; if you
spread their care out over time and everyone
becomes involved, it doesn’t require a huge amount
of time for each person, but it provides an excellent
service that is morally and ethically correct and one
whose benefits outweigh the costs.
TH: I think counties need to tell their folks, “Hey,
look, this is your deal, you can do this.” It’s important
that we, as physicians, take care of the folks “at
home,” and it’s just a matter of getting physicians
involved; let them see there’s a need and formulate a
plan; they don’t need to reinvent the wheel. A great
starting point would be the free guidebook available
from the Bradley Free Clinic—anyone can request a
copy. If we get enough physicians in the state of
Alabama on board with the idea of establishing free
community clinics, what a model we could be for the
rest of the nation. We could say, “Hey, we take care of
our own—we’re not dependent on another government-run
program to help our communities.” And I
think physicians need to know that they can make a
difference—know that it’s just a matter of persistence,
and it doesn’t take a huge group of people to start the
ball rolling. One or two folks can be the catalysts to
ask, “Where can we do this?” Don’t be afraid to try.
I believe that health care is a privilege and not a
right; there are people in this population who work
their tails off and have earned that privilege, but
can’t get the insurance or the medical care that they
deserve. Community free clinics are one way to get
these folks the care and treatment they need.
The second part of this Physicians’ Forum topic will appear
in the Summer 2004 issue of the Alabama Medical Alumni
Bulletin. In that issue, we will look at indigent care in the
state’s larger metropolitan areas.
Editor’s Note: If you are interested in the guidebook “How
to Start a Free Clinic,” published by the Bradley Free Clinic,
it is available online at [http://medkind.com/scripts/medkind/X30.idc?code=1004&index=35413].
In addition,
you can contact the Bradley Free Clinic at (540) 344-5156,
or by mail at 1240 3rd St. SW, Roanoke, VA 24016, for
more information.