Leaders of free clinics from across the nation gathered for three days last week at the Providence Biltmore for the third annual National Association of Free Clinics Summit, which focused on the clinics’ role in the health care system and the challenges they face.
Locally, the Rhode Island Free Clinic provides comprehensive health care, at no charge, for adults who have no insurance and cannot afford to pay for care. The providers all volunteer their services, offering acute and chronic medical care, preventive services, hospital care, health education and pharmacy.
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Dr. Bernard J. Mansheim, president of the Rhode Island Free Clinic’s board of directors, spoke with Providence Business News about the clinic and last week’s summit.
PBN: Tell us a bit about the Free Clinic. Whom do you serve?
MANSHEIM: Our clinic in South Providence serves between 500 and 1,000 patients. We serve adult men and non-pregnant women, no children – because poor mothers and children tend to qualify for RIte Care – who are below 150 percent of the federal poverty line. So basically they’re the working poor. In Rhode Island today, there are about 120,000 people who are uninsured, and the number is increasing because of the unemployment rate. We’re serving the lower end of that demographic, and we think there are about 35,000 adults that would qualify for enrollment in the clinic.
PBN: You’ve been looking at a new model to serve more people?
MANSHEIM: Historically, we have operated as a freestanding clinic … with primary care … and specialty clinics. It occurred to us as a board this year that it would make a lot more sense to bring the patients to the doctors rather than … depending on volunteer physicians who give their time, after working all day, to work at the clinic in the evening. We’re limited in our ability to recruit because it’s difficult for physicians to do that. And we also felt we could reach out to a lot more patients.
So that’s why we developed what I call a virtual clinic, a network of physicians around the state … we’re reaching out to every primary care physician in the state and asking them to consider taking between one and 50 uninsured patients into their practice, to provide them a medical home, and to see them for no reimbursement.
We will enroll patients who carry a Rhode Island Free Clinic card and align them with a physician near their home, and these people will have the dignity of knowing they have their own doctor. If a doctor needs to make a referral to a specialist, or to imaging, or a hospital, their office can call us and we will connect them. … So we’ve created a comprehensive system of care for patients. I think if we could get even 500 doctors to participate and take 20 patients, that’s 10,000 patients right there.
PBN: Where does that project stand?
MANSHEIM: We have the plan, we have buy-in and the endorsement of the three largest medical groups in the state as well as the American College of Physicians Rhode Island Chapter, which represents internal medicine doctors.
PBN: You’ve just spent a few days with free clinic leaders from across the country. How does what you’re doing compare with the approaches they are taking?
MANSHEIM: I think that the network structure that we’re doing … is unique in the United States. There may be one or two examples, but I’m not aware that anyone has been successful at this model or even given it the kind of effort that we have. I think that the fact that Rhode Island is a small state and that all the hospitals in the state are nonprofit, so they’re generous in providing care to the indigent without charge, makes it much more possible to do in Rhode Island all across the state. … We are also building a central supply pharmacy with all-generic drugs for our patients … who would otherwise not be able to afford their medications.
PBN: What are some of the biggest issues discussed at the National Association of Free Clinics summit?
MANSHEIM: Pharmacy is a big deal. People need to have access to prescription drugs. Another area that’s important is dentistry. As you can imagine, these people are in dire need of dental care. At the present time, we [in Rhode Island] don’t have a dental plan, but it’s certainly the next step in our program, because it’s a critical piece, and it turns out nationally to be one of the hardest pieces to put together. The other component is mental health, which we’re going to begin to actively work on.
The value of having the NAFC in Providence and getting to meet some of the medical directors and board members across the states is that we can reach out to them and they can reach out to us. Because as you can imagine, there are a lot of “best practices” across the country, and there’s no need to reinvent the wheel when you can learn from other people’s experiences. So that’s a real opportunity.
Founded in 2001, the National Association of Free Clinics focuses on the issues, needs and concerns of free clinics, their volunteer work force and their patients. For more information, go to www.freeclinics.us. For more information about the Rhode Island Free Clinic, go to www.rifreeclinic.org.
