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Swedish opens new specialty clinic for low-income and uninsured

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Examination Room at Swedish Community Health Specialty Clinic

Examination Room

Swedish Medical Center has opened a new clinic to provide surgical and specialty medical care to low-income patients who lack the insurance needed to pay for such high-cost care.

Surgeons and medical specialists from Swedish and other participating physician groups will provide their care at no charge to clinic patients.

The clinic, housed in a newly remodeled 4,000-square-foot facility next to Swedish’s main hospital building on Broadway, will offer general surgery, dermatology, orthopedics, hand surgery and podiatric surgery services onsite.

Clinic Coordinator Stacy Block and Director Tom Gibbon

Other specialty care, such as cardiology, gynecology, neurology and urology services, will be coordinated by the new clinic but will be provided off-site in the offices of the participating volunteer specialists.

“The goal is to provide the same quality and aesthetics of care that you find in our other clinics,” says Clinic Director Tom Gibbon.

The site will begin offering dental specialty care next year, Gibbon said.

The new facility, called the Swedish Community Specialty Clinic, brings together services previously provided by two other Swedish clinics for low-income patients, the Mother Joseph Clinic and the Glaser Surgical Clinic.

Origins

The new facility grew out of an effort launched eight years ago to take care of patients who came to the emergency room at the Swedish’s Cherry Hill Campus who could not get orthopedic care, says Dr. Rayburn Lewis, who was medical director the Cherry Hill Campus at the time and is now executive and medical director of Swedish/Ballard.

“Patients who came through the emergency department who were uninsured or on Medicaid couldn’t get into an orthopedic clinic because very few doctors took Medicaid and the cost of care out-of-pocket was too high,” says Dr. Lewis. “If you didn’t have money, you were out of luck.”

Many of these patients had no choice but to return to the emergency room seeking help, says Dr. Lewis, but the emergency room staff could not provide the specialty care they needed.

Rayburn Lewis, M.D.

Dr. Rayburn Lewis

So, in 2002, Dr. Lewis helped establish a follow-up clinic behind the emergency department, where patients needing specialist orthopedic treatment could get care.

The clinic consisted of just a single room with curtains separating the gurneys.  In 2003, the clinic was named the Mother Joseph Clinic.

Over time, however, the tiny clinic outgrew its space as it began to offer additional services, such as dermatology and podiatry care, says Dr. Jay Fathi, new clinic’s medical director and Swedish’s medical director of Primary Care and Community Health.

But, says Dr. Fathi, providing more space and a better facility was just one reason for opening the new clinic–another was to improve the coordination and quality of charity care provided by Swedish.

As a nonprofit, Swedish is required to provide care for those who cannot pay, and Swedish estimates that it provides nearly $25 million a year in community health services and direct charity care and as well as another $29 million in subsidized care for Medicaid patients .

But much of the Swedish charity work has been inefficiently “scattered” through the medical center’s system, says Dr. Fathi, and a goal of the new clinic is to help bring the center’s charity care under one roof.

This will not only improve the quality of care, Fathi says, it should also make the the job of delivering that care easier for the the volunteer providers, Fathi said.

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Philip Jenny

Over eight years, Philip Jenny’s right ankle got progressively worse. He didn’t know it at the time, but he was developing a degenerative condition that would destroy the cartilage in his ankle and foot. He soon couldn’t keep up with his warehouse job and went on disability. Finally, he went in to a Seattle Public Health clinic, which sent him to Swedish’s Mother Joseph Clinic for care. The surgeons found that the damage was so bad, Jenny says, “it’d gotten to the point were it was fix it or lose the foot.”  But two surgeries later, Jenny says he hopes to be walking again by Christmas–albeit with a limp–and hopes to be getting back to work. “I can’t say enough good stuff about these guys.”

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Making it easier for specialists to donate their time

Fathi says the work of the clinic’s partner, King County Project Access, has been “crucial” to the success of Swedish’s community specialty care clinics.

Project Access is a local nonprofit that was founded four and half years ago to build a network of specialists in the county who would be willing to provide care to low-income and uninsured patients.

Sallie Neillie, founder and executive director of King County Project Access (KCPA), says that many specialists want to donate their services but often find it too difficult and too expensive to provide care to this population of patients.

Logo for King County Project AccessMost of the patients KCPA serves are working poor earning below 200 percent of the Federal Poverty Level–about $44,100 for a family of four–and many do not have primary care physicians who can provide follow-up care, don’t have a way to get to their appointments, and often don’t speak English.

“When we started we brought together specialists from a number of systems and asked them what it would take for them to say ‘yes’ to joining the program,” says Neillie.

“They said, ‘We want patients to show up, we want them to be on time, we don’t want to have to pay out-of-pocket for interpreters . . . ,” Neillie recalls — and they did not want to be exposed to medical malpractice lawsuits for providing charity care.

So KCPA set out to address those issues, “slowly taking them off the table,” says Neillie.

When, for example, the KCPA enrolls the patient it first links connects them with a provider at one of the local community health clinics or free clinics, who manage the patient’s primary care so that the specialist can concentrate on providing specialty care.

The KCPA staff also makes sure that all the necessary tests have been done and x-rays taken before they go to see the specialist. This streamlines care and is much less expensive than having such tests done through a specialist clinic.

“And we work with the patients to make sure they are prepared,” says Neillie. “We help them think about transportation, about arranging childcare, … and make sure there’s an interpreter.”

As a result of this sort of preparation, KCPA patients have a no-show rate of only 4%, which compares favorably with rates seen in the general population, says Neillie.

After the patient has been seen but the specialist or surgeon, Neillie’s staff makes sure the specialist’s report and treatment recommendations get back to the patient’s primary provider and that follow up appointments and tests are arranged as needed.

To address the specialists’ malpractice concerns, KCPA also helped get legislation passed that expanded the state’s “Good Samaritan” law, which helps protect health providers who give care in an emergency from malpractice lawsuits, to cover clinicians working in volunteer programs like the Swedish community specialty clinics.

Neillie says that since KCPA has been able to address the concerns the specialists raised when the project began, she has been “stunned by the willingness of physicans to provide this care.”

“When we started four and half years ago, we had a couple of doctors at Swedish and a couple at PacMed. Now we have 600 doctors from all the major multi-specialty groups and in six of the 11 health systems,” she says.

The new Swedish Community Specialty Clinic expects to see more than 2,000 patients this year.

Disclosure: Michael McCarthy has provided editorial services to Swedish Medical Center.

To learn more:

  • Visit the King County Project Access website at www.kcprojectaccess.org where you can learn how to receive care through the Swedish and other clinics and medical groups participating in the program or call the King County Project Access at 206-788-4202.
  • Call the Swedish Community Specialty Clinic at 206-860-6656.
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