In 2010, 15.7 percent of Virginians didn’t have health-care insurance, according to the commonwealth’s Virginia Performs website, making Virginia 25th among all states. So who fills the gap in providing health care?
In Rappahannock, it’s the Free Clinic, a satellite office of the Fauquier Free Clinic in Warrenton. In interviews, all those involved with the clinic talked about the excellent care it provides, often better than that provided through health insurance.
“I’m getting better care than if I were paying for it,” says 22-year-old Rappahannock native Amber Thomas, who has been treated for severe type II diabetes by the clinic since she aged out of coverage under her grandmother’s Medicaid at 19.
Currently unemployed, Thomas says the American health-care system is “just too expensive.” She says she figures she’d be paying more than $50 a month for her prescribed medications alone if she wasn’t getting them from the free clinic, so when it comes to health care, “It’s this or nothing for me.” Physician and patient care coordinator Carmen Cioceanu confirms that even cancer patients get the best of care.
The Rappahannock satellite office, commonly referred to as the “Rappahannock free clinic,” opened in 2000. (For more insight into the clinic see one of our other stories.) County residents Jennifer Matthews, Jean Lillard, Philip Strange and Judy Tole were instrumental in its founding, says Fauquier Free Clinic executive director Rob Marino.
“We have vulnerable populations that did not have adequate access to health care,” says Matthews, who is a registered nurse and nursing professor, about why she and the other Rappahannock residents wanted to get a free clinic started here.
“They’ve fallen through the cracks,” she says. “They’re not eligible for Medicare or Medicaid but most are working in low-paying positions for someone who doesn’t offer health insurance.” Marino concurs and adds that Medicaid is not an option for many because in Virginia it is “mostly restricted to children, pregnant women, and people with disabilities and is not available to our patients.”
According to Marino, the two clinics, combined, provided more than $1.6 million in health care last year, including physician care, dental, medications and diagnostic services. “Almost all of that was performed by volunteers in one of the clinic sites, specialist doctors seeing our patients in their own offices or services donated by Fauquier Health,” Marino says.
According to Marino, the Fauquier Free Clinic’s budget is $390,000 per year in expenses, with the biggest costs being “medications, staff, and medical and diabetic supplies.” Cioceanu adds that, for every dollar donated, the clinic provides $6 worth of health care. Without the free clinic, many of its patients would likely end up in the emergency room of Fauquier Hospital (part of the Fauquier Health System), which would add to the hospital’s cost burden, she says.
Services are offered twice a month at the Rappahannock office, on the first and third Wednesdays, with four sessions each year that focus on diabetes care. Most of the care is delivered by local primary-care doctors, including Jerry Martin, Brooke Miller, Franklin Brosgol and Patty Daly (an endocrinologist); nurse practitioners, such as Anne Miller; and registered nurses, such as Joanne Tepper and Matthews. Lay volunteers, who help with reception and administrative chores, are usually organized into four rotating teams of three each.
While much of the data for the clinic’s two locations is combined, Marino did have recent statistics on the number of patient visits to the Rappahannock clinic: 205 in 2009, which fell to 158 in 2010, then rebounded to 249 last year, “the most ever.” And the trend is upward, he says, projecting about 275 for 2012.
The recession has “led to a big increase in the overall program,” says Marino, which is echoed by statewide statistics on the website of the Virginia Health Care Foundation, a nonprofit organization that helps the uninsured find medical care: Virginia’s 2010 rate represents a 10-percent increase over 2009.
The economic situation has been “particularly tough” on those working in housing construction, Marino says, so the clinic has seen a lot of new patients this year who have lost jobs in that industry. To ensure Rappahannock residents know about services at the satellite office, Marino says the free clinic has been sending out letters and making other efforts to get the word out, which “has started to show up in the numbers.”
To be eligible to receive services, someone must be a resident of Fauquier or Rappahannock County, who is not privately insured or covered under Medicare and Medicaid, and whose income does not exceed 150 percent of the U.S. poverty rate. For a single person, that rate is currently $11,170 and, for a family of four, $23,050. Eligibility must be reestablished every six months.
No new patient is turned away from the clinic, says Cioceanu, who explains that patients have one month to prove their eligibility. If they can’t but still can’t afford insurance, the clinic tries to find health care providers to help them on a volunteer basis.
Marino says the clinic does not ask patients to pay for care, although it does accept a $2 donation in return for medications they receive. Health care providers within the clinic’s network chip in with some drug samples, says Cioceanu. Pharmaceutical companies provide some medications directly through medical-assistance programs, and patients buy some medications directly at Wal-Mart at reduced prices through an agreement with the company.
The free clinic has no funds to pay for medical care patients receive outside of the clinic, Cioceanu says, but the first visit to other providers within the clinic’s network is always free. After that, it’s up to the providers, who often continue to see the patient “many, many times.”
For patients needing extensive diagnostic services or treatment, such as surgery, at Fauquier Hospital, the hospital will develop a payment plan based on the patient’s financial situation. Much of the routine diagnostic services, such as lab work or mammograms, are free.
The Rappahannock clinic uses the county health-department’s building in Washington, which offers a large shelving unit for the clinic’s patient records and medications, a waiting room and reception area, two examination rooms and a triage room. Matthews says the clinic has a “warm and friendly” relationship with the health department nurses, who have been extremely helpful.
Money for both clinics is raised from local donations, grant programs and fundraising events, including registration fees for the Rappahannock Rough Ride on September 15.
“The local community has always been very generous to our program and our patients, and I hope that will never change,” says Marino. “Going forward we will need financial support and new volunteers to help us keep growing and make sure no local citizen goes without care.” Matthews adds that one of the biggest problems for many patients is lack of transportation to medical appointments.
Those involved with health care delivery at the clinic who were interviewed say they are there because they believe what they’re doing is important. Cioceanu, whom Matthews says is “extremely knowledgeable,” was a doctor of internal medicine and family practice in her native Romania. She volunteered at the Fauquier Free Clinic when she came to this area instead of pursuing licensing here. Rather than taking more lucrative work in research or hospital administration, she says, she became the clinic’s patient care coordinator because she finds that job “more rewarding.”
Barbara Dennis, who has been volunteering since the early days of the clinic and serves as the leader of her team of lay volunteers, says she joined the effort because she finds the clinic interesting and “it seemed like a worthwhile thing to do.”
For more information about the free clinic go to www.fauquierfreeclinic.org or call (540) 347-0394. To learn about other options for medical help for the uninsured, go to the Virginia Health Care Foundation’s website, www.vhcf.org, or call (804) 828-5804.