Free Healthcare Clinic Experiences

imanubee · Apr 6, 2009

Hi CareerThree,

What you are describing is a "Community Health Center". Healthcare centers such as these offer services at typical costs as well as a "sliding fee scale" for those who qualify based on income. Many times, the fees are waived depending on where the patient falls on the poverty scale. Documentation of income is essential to maintain. The center would set the fees and decide on the sliding fee scale.

Another option for CHCs is FQHC certification---Federally Qualified Health Center. This is a federal certfication/designation that offers "enhanced reimbursement" to centers from Medicaid and Medicare on the order of 115-200% of the usual reimbursement. The rationale being that the center is a "safety net" provider and the additional $ will offset discounted and free services. Also paramount is a very aggressive strategy to maximize funding streams, as the center would have to demonstrate an ability to maintain financial viability to receive any kind of federal assistance. This can be accomplished via grants, fundraising, participation in managed care contracts, corporate sponsors, etc. Also, obtaining FQHC status qualifies the center to receive annual subsidies that can vary from 100-400K (depends on the center and many other factors) to help offset start-up costs and hire staff/providers.

The center must operate as a non-profit with a Board of Directors that are active "users" (fed lingo) of the clinic. and must be in a "medically underserved or rural area" to qualify as an FQHC For more info, google "community health center" and "FQHC". Also, HRSA and NACHC (nat'l assoc of community health centers) are excellent places to start and obtain more info. HRSA is the fed branch that oversees these type of centers. This is a complex undertaking with many regulations and legalities, but very doable. rewarding and necessary.

Hope this info helps some. Feel free to pm me if you have any questions.

Cheers!

CareerThree · Apr 7, 2009

Dear Imanubee,

Thanks for your extensive reply.

Thinking about this situation, have you or anyone reading this had experience with a clinic that does not take Government support and thereby avoids Government regulations? I recognize that some rules come with charging any fee for healthcare services. What if no fee was charged?

I'm trying to explore all possibilities.

Thanks!

R,

CareerThree

imanubee · Apr 7, 2009

It is theoretically possible to offer "free" services, but in reality, something that is very difficult to accomplish. I have worked in agencies that have provided charity care to some patients, but not across the board for everyone.

The most immediate problems that comes to mind with providing free services to patients is that many times, medical conditions are not "diagnosable" without studies such as lab work, x-rays, ultrasounds, mri's, cts, angiograms, etc. Now you are in a situation where a medical provider may suspect a condition, but there is an issue of payment for such diagnostic exams. And there are also medical liability issues involved if you suspect a serious condition but do not have the resources or referral arrangements to ensure the follow up and management of the patient. There is also the issue of treatment. How/who will pay for medications that the patient may need on a continued basis? If this is a clinic that is going to treat minor aches, URIs or something that requires a week's worth of antibiotics, its not such a big deal. But if there is a more extensive problem, its a tough position to be in.

I worked for several yrs at a CHC, but prior to that I worked for several years in a cardiology transplant group. Frequently patients came in that needed transpantation or evaluation for such, but they were uninsured and financially challenged. It was a bad situation in that we were happy to provide the medical visits for free, but the costs of a heart cath, pul testing, echos, etc were out of reach as these involved procedures @ the hospital and w/ other specialists. On top of that, medications were unaffordable, the transplant itself approached 1 million dollars, plus the costs of immunosuppressives, and ongoing care put such an option out of reach.

Also, if you provide free services, services have to free for everyone. If a pt is medicare/medicaid insured, you CAN NOT collect payment from them, even if the pt wants to pay and even if you are not participating in federal programs. The exceptions to this are in traditional medical models or CHCs as in my previous reply.

This is all probably way more info than you wanted, but hopefully something in my reply has helped or given you food for thought.

Cheers!