Proposal for a Viroqua Area Free Clinic November/December 2008 Executive Summary Viroqua and Vernon County Wisconsin, despite being poor and rural, are blessed with outstanding health care. However, a niche exists for simple, ambulatory health care provided without any charge to the patient. Office space exists in the Viroqua Public Market for such a free clinic. The Free Clinic's legal identity would be a registered 501(c)3, ideally as a joint venture with Vernon Memorial Healthcare (VMH) or other organization. Volunteer provider coverage by area health care professionals would be feasible if the hours of operation were limited. The Free Clinic would operate as a country doctor on a house call might. That is, no medications dispensed, minimal or no procedures, no labs, and no compensation. Providers acting as volunteers are also exempt from medical malpractice per state statute. Value of a Free Clinic The need for a free clinic option seems obvious. Though the area clinics and VMH offer exemplary care and reasonable prices, the sad fact remains that many patients have no insurance coverage or high deductibles and cannot easily afford even an $80 office visit. For simple, straightforward concerns, health maintenance, disease prevention, advice, and many other low complexity patient issues, all that is really required is a comfortable room, an empathetic ear, skilled hands and no demand for compensation. Having a free clinic option also demonstrates this community's continued commitment to providing world-class health care at all levels. This would be one of the only free clinics in the area and one of only a handful in the State of Wisconsin. The closest free clinic, the fifteen year-old St Claire Health Mission of La Crosse, is only open two days per week and not really a feasible option for patients here in Vernon County.
The St. Claire clinic exclusively sees patients without any coverage, who live below 150% of the US poverty standards. They do this because they must; there is simply an excess of patients and not enough capability to see more than those with the greatest need. St. Claire caps each day at 35 patients and often has over 50 that request care.
Free clinics can refer patients to services they may not be aware of, such as those patients who qualify for disability coverage, not yet in the system.
Finally, because of the minimal barriers to care, a free clinic will inevitably capture patients who otherwise might not seek care until it is too late.
Basic Operational Philosophy The Viroqua Area Free Clinic would be based entirely and exclusively on ultra-straightforward, low complexity, ambulatory patient concerns covering both disease and disease prevention. Any patient issue not clearly appropriate for the free clinic would be referred to the proper clinic, hospital or, if necessary, to the emergency department (ED). Clinic volunteers would have a responsibility to make patient appointments when able, ideally while with the patient.
The Free Clinic would be analogous to an old fashioned county doctor's home office. When practicing in this manner, the everyday barriers to the doctor-patient relationship are all but eliminated. It's hard to imagine in today's environment being virtually free of paperwork, government regulations, med-mal risk, insurance carriers, and most importantly, the influences of profit. Providers are free to simply, "do the right thing" for the patient.
The clinic shall not stock any prescription medications or provide any on-site laboratory services. Thus, regulations such as CLIA would not apply to the free clinic. Providers shall not write or refill any controlled substances. Writing of complicated or dangerous medications with a low therapeutic to harm ratio is discouraged. Should patients need laboratory, radiographic studies or other medical needs they are to be referred the VMH. Should the free clinic have a surplus of capital, a fund to subsidizes these costs could be established.
The clinic would refer patients to existing services and programs as appropriate. These would include CouleeCap, BadgerCare, Well Woman, Children & Family Svc, needymeds.com, government disability, Walmart's $4 drug program, etc.
Location Free clinics are located everywhere from hospitals to church basements. The proposed location of the Viroqua Area Free Clinic is a vacant small office space inside the Viroqua Public Market. The space is approximately 30 square feet, private, locked and adjacent to public lavatories. There is ample room for a desk, patient and provider seating, a file cabinet, shelving and small clinic supplies. The interior design would be homey and warm, perhaps more like a country doctor's office than a modern clinic.
The downtown central location would be convenient for patients. The St. Claire Clinic has no choice but make patients wait outside. Patients waiting for the Viroqua Area Free Clinic could wait comfortably by the indoor fountain in public seating, sit in the adjacent cafe, or stroll the market.
The facility is only two blocks to the area clinics, hospital and emergency department and is literally across the street from EMS. The space would contain: a computer with high-speed Internet connection for references and a simple electronic medical record Basic medical supplies - tongue depressors, gloves, etc Simple equipment such as BP cuff, otoscope, headlamp, etc Patient advice print-outs and medical references. - Automatic defibrillator
Hours of Operations Tuesday - Thursday noon - 3pm {exact days, hours to be determined} Workflow & Patient Scheduling
The clinic would operate as a walk-in type clinic. During the days of operation, patients would present on a first-come first serve basis. A patient list would be generated each day by non-medical volunteers. Patient scheduling could start in advance of the clinic opening.
Each patient is then assigned a number based on this list. The list would cap at a number to be determined, approximately 4 patients per hour per provider, or ~12 per day to start with. The provider or assistant would call for the next patient by their roster number.
The Public Market staff could be utilized to take this information and generate the patient roster if necessary.
Staffing & Staff Scheduling With approximately fourteen three hour shifts to cover a month, it should be fairly easy to staff the free clinic. The free clinic would be staffed by volunteer providers operating under their own licenses. We envision all levels of provider participation including MD/DO, RN, dietitians, PT/OT, etc. Non-medical volunteers will assist with scheduling, record keeping, grant writing, patient assistance, etc.
The Schedule would be published with provider type using the Public Google Calenders, showing only dates, times and provider type. A private Google Calender would be used and shared between providers, showing the actually provider schedule. See example below... Example of Free Clinic Public Schedule - Google Calender Patient Population The Free Clinic would be open to all with no restrictions. Both insured and uninsured patients would be welcome. Patient Payment The Free Clinic will not accept any form of payment for services rendered. Should patients or benefactors wish to donate money, they may make charitable donations to the 501(c)3 general fund. Financials & Funding The start-up costs for such a Free Clinic as proposed here would be nominal, probably a few hundred dollars mostly related to the creation of the 501(c)3. On-going operational expenses would also be minimal: rent $25 to $200/mo - to be negotiated Utilities: $40 - telephone, Internet. Heat & electrical is gifted by the Public Market proprietors. Medical Supplies: $20 Misc office: $20
We would seek start-up and on-going capital through donations. VMH will be approached to fund these nominal costs. Record-keeping Medical records will be kept in a secure fashion for all patients seen. This will likely take the form of a secure, password protected simple electronic medical record or basic hand written chart. Patients will be assigned a consecutive medical record number, referenced to with an index of alphabetical names.
Anonymous patient demographics will be documented for statistical analysis, grant writing, annual reports, etc.
Partnership with Existing Entities The Free Clinic will seek collaboration from all area health care organizations, for referrals, staffing, assistance, resources, etc. Particularly, the Free Clinic hopes to form a joint venture with VMH. Though this proposed joint venture, VMH if it so chooses, could associate it's identity branding with the Free Clinic in a win-win partnership.
Legal & Regulatory According to a conversation with the head of the Department of Health Services, free clinics are not regulated in any way by the State of Wisconsin. No licence is necessary. providers simply practice as volunteers, under their own individual medical licences.
The free clinic would operate as a 501(c)3 or in formal partnership with an existing volunteer agency. It would registered under the Department of Administration along with a notarized roster all volunteer providers (thus satisfying the statutory requirement for exemption from medical malpractice liability).
Again, the Free Clinic would have no lab or pharmacy services on-site.
The clinic would be HIPPA compliant. Each patient would sign a HIPPA form.
Regarding "counseling" or mental health services, because these actions may prompt official scrutiny from regulatory bodies, even if provided without contract of compensation, the free clinic will expressly not offer or refer to any form of "counseling". Instead, as the St. Claire Free Clinic does, the Viroqua Area Free Clinic with provide only "referral and conversations" to patients.
Malpractice Liability
Under Wisconsin statute Chapter 146.89 (1)(r) - Healthcare providers who provide care without receiving income are exempt for malpractice liability. The volunteer entity (the 501(c)3 and provider must register with the Dept. of Administration).
Per a search of the case law and through discussions with council, Wisconsin has had only one suit filed involving a free clinic. This case was subsequently dropped and no action was taken.
Timeline
The Viroqua Area Free Clinic shall launch in the first part of 2009. ____________________________  Self Portrait  Discovering the Heart Of Love be blessed Macastat www.macaSTAT.com
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