After an unexpected $250,000 loss in funding, The Greenville Free Medical Clinic is looking for other ways to help fund care for the 3,600 uninsured Greenville County residents it sees each year.
The money, which represents about 20% of the clinic’s budget, came from Prisma Health-Upstate, formerly Greenville Health System.
Prisma, in turn, got the money from the state Department of Health and Human Services via the Healthy Outcomes Plan or HOP, a program that supports hospitals coordinating care for chronically ill and uninsured patients outside high-cost ERs.
But when HOP funding was cut to Prisma, they cut funding to the clinic.
“The revenue goes down and … something’s got to give,” said Suzie Foley, executive director of the free clinic. “Unfortunately, we were it.”
Jennifer Snow, director of accountable communities for the hospital, said that supporting local safety-net providers like the free clinic is important to Prisma, and that HOP funds enhanced their ability to do that.
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But HOP funding to Prisma dropped from $1.04 million in fiscal 2014 when the program launched to $580,000 for fiscal 2019, reducing the amount that the hospital system had to staff and operate the program across four counties, including to the free clinic, she said.
So its allocation declined from $250,000 in fiscal 2017 to $75,000 in fiscal 2018 to zero in fiscal 2019, Foley and Snow said.
“As one of the state’s highest target enrollments when HOP started, Greenville Memorial Hospital initially received a higher allotment and was able to share some of those funds with its partners, including (the clinic),” Snow said.
“But as the program has evolved … HOP funding was reduced, which in turn reduced the amount of funding that health systems and safety-net providers receive.”
Controlling health care costs
HOP began in 2013 as a way to get targeted patients who are frequent ER users into the appropriate care setting, DHHS said in an emailed statement after declining an interview request. Frequent users are defined as having five or more visits a year.
Funds are provided to hospitals and other partners to help control health care costs by reducing preventable ER and inpatient visits.
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And DHHS says it’s produced significant results statewide:
- A 36% decrease in ER visits
- A 31% drop in ER costs
- A 41% reduction in inpatient stays and costs
As the HOP matured, DHHS requested less direct funding for the program from the General Assembly, according to the statement. That resulted in reduced allocations to Prisma.
But DHHS said that while it reduced the HOP funding by $1.4 million between fiscal 2016 and fiscal 2018, it increased the rate for hospital Medicaid claims by 2.75% and increased funding for other safety-net programs, including about $30 million through the Disproportionate Share Hospital funds, which typically covers uncompensated care, in support of HOP. Its funding to safety net providers also includes $46 million to spur innovative strategies in fiscal 2020.
“While decisions about individual investments are made at the local level, (DHHS) has consistently broadened the scope and increased financial support for innovative care delivery models for the state’s hospitals over the past three years,” Director Josh Baker said in the statement.
“SCDHHS will continue to work with the General Assembly and the state’s hospital systems to continue to support care delivery systems that provide the best care at the best value to the taxpayer.”
A variety of support
Snow said Prisma Health-Upstate’s HOP funding supports 2,194 patients at 14 community partners across four counties, including the Greenville Free Medical Clinic, Taylors Free Medical Clinic, New Horizon Family Health Services and Greater Greenville Mental Health.
It pays for social work care managers and community health workers plus transportation and medication assistance, she said.
In addition to the HOP-funded support, Prisma Health provides additional services as well, such as volunteer staffing and diagnostic support, she said. Prisma also provided $442.8 million in charity care, community partnerships, Medicare shortfall and bad debt in 2018, plus more than $19 million in grants over past two years through its Healthy Greenville program, Snow said.
“We’re proud of the work we do with a range of diverse partners,” she said. “Together, we work to improve access to care and resources for those who need it the most.”
Greenville Free Clinic tightens its belt
Before HOP, the free clinic was funded solely by philanthropy, said Matt Utecht, a member of its board and immediate past chair.
“Our ongoing challenge is how do we maintain the level and quality of the services we’ve been providing with reduced resources,” he said. “I think continued reliance on philanthropic dollars as the sole or primary source of revenue is not sustainable.”
The clinic logs about 12,000 visits a year on its $1.3 million budget which is largely funded through individual and foundation donations, Foley said. Area health care providers volunteer their services and drug companies donate medicines.
So far, no services have been cut as a result of the lost funding, Foley said. But the clinic’s planned expansion has been scaled back along with discretionary expenses as it tightens its belt.
“We have a pretty mean and lean budget anyway,” she said. “But I had to sharpen my pencil even more … as well as making sure we were maximizing any potential revenue sources.”
So the clinic sought and received approval from the Greenville Health Authority to use money it got from its Healthy Greenville grant to offset the loss, Foley said.
That $596,000 three-year grant was designed to expand clinic services from one or two days a week to three or four days a week at its three satellite locations in the Northwest Crescent, Greer and the Golden Strip by partnering with Clemson University’s nurse practitioner program to care for additional patients, she said.
That has been put off indefinitely, she said
Diagnostics and other in-kind services
The free clinic provides almost $10 worth of care for every $1 it gets, Foley said.
Though the $250,000 loss will be deeply felt, she said the clinic is grateful for the other in-kind services it gets from both hospitals, including diagnostic services valued at about $3 million a year from Prisma and about $750,000 a year from Bon Secours St. Francis Health System.
In addition, at least 75 Prisma physicians regularly volunteer at the clinic, she said, while three Prisma residents staff an evening clinic two nights a month. Another 35 St. Francis doctors volunteer as well, she said, for an estimated value of $1.2 million a year for all donated physician services.
“Both hospital systems recognize the value of what we’re providing to patients,” she said. “They know these 3,600 patients would be incurring even higher cost ER visits and inpatient stays if they did not have access to services here.”
A growing need for help
But as a charitable organization, the free clinic is subject to the fluctuating economy, meaning that demand for services increases as donations decline, Foley said.
Utecht said the clinic hopes to partner with hospitals to reduce the overall cost of caring for these patients by improving outcomes and then sharing in the savings.
So patients with asthma get regular care at the clinic instead of the ER from repeat attacks, he said, while the cost of the case manager seeing those patients could be borne by the hospital that would otherwise have to absorb the ER costs.
But that’s a long-term solution, Utecht said. Short term, the clinic will continue to pursue grants and reach out to other potential donors.
“We would love for our dedicated and committed donors and volunteers to continue what they’re doing and if they’re able, to increase their support. We need them now as much as we ever have,” he said.
“But just as important, we need to reach those people who may not know exactly what we’re doing and how beneficial it is.”
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“We’re on an economic roller coaster,” added Foley. “We are too critical to the health care safety net of this community to be that vulnerable to the ups and down of philanthropy.”
The Greenville Free Medical Clinic will hold its annual fundraiser on Oct. 24 from 6-9 p.m. Learn more at greenvillefreeclinic.org.