New Publications Address Impact of Reform on the Health Care Safety Net

As the 112th Congress launches a new round of national debate on health care reform, free clinics and charitable clinics across the country are continuing to assess the impact of a potential coverage expansion on their patients and communities. We at Free Clinic Solutions are constantly monitoring the literature on this topic, and periodically we will share our findings here for the benefit of clinic leaders, health care planners, policymakers, funders, and other interested parties. Recently several publications have emerged that not only highlight the impact of reform on the health care safety net but also contain specific conclusions and recommendations.

Just this month a very thoughtful article, written by Mark A. Hall, JD, and entitled Re-Thinking Safety Net Access for the Uninsured, appeared in the New England Journal of Medicine. Hall eloquently describes how safety net providers will need to "adapt to fit the future contours of the uninsured population." In particular, he says, this will involve 1) re-designing program eligibility to fit the major categories of people who are exempted from the insurance mandate, and 2) collecting fees from patients who are forced to remain uninsured because they will not get enough help to purchase private insurance but would have the ability to pay modest amounts for their care. The latter scenario, he acknowledges, could be "disruptive" to clinics that have heretofore been free and have benefitted from things like free government-provided malpractice protection for their volunteers. Some clinics around the country have already gone this route, choosing to move away from the term "free" in their name and policies. It will be interesting to see whether and to what extent this movement will continue in the future. I would encourage you to take a look at another very helpful article that was published last year by the Kaiser Permanente Institute for Health Policy. It is entitled The Implications of Health Reform on U.S. Charity Care Programs. This article presents a compelling case for why charity care programs can and must remain a vital part of the broader health safety net in terms of service provision.

Finally, a number of you have already seen or heard about the 65 page booklet I (Mark Cruise) wrote last fall for the Georgia Free Clinic Network, but it is worth mentioning again here. It is called A Guide to National Health Care Reform for America's Free and Charitable Clinics. This publication is equal parts policy brief and guidance document for free/charitable clinic executives and board members that want an easy-to-understand, valuable tool for making smart decisions in the health care reform era. We are grateful for all the positive reviews it has received, and GFCN and I look forward to writing and publishing periodic updates to it. To obtain a copy of the booklet, click here.

Each of the publications cited above would be useful reading and background material for a clinic's strategic planning process. We would be happy to come and give a presentation on this topic to your clinic or community health care roundtable. In the meantime, stay tuned for future blogs on this vast and ever-changing topic of health care reform and how safety net providers like free/charitable clinics are responding and adapting to it.

-- Mark R. Cruise

Article Published on America's Free Clinics

I am proud to report that a landmark study of America's Free Clinics, conducted by Julie Darnell, PhD, MHSA, has been published. The article appeared in the June issue of the Archives of Internal Medicine, a prestigious national medical journal. The University of Illinois at Chicago, where Julie now serves as an Assistant Professor in health policy and administration in the School of Public Health, issued a news release to announce the article. Julie is a member of the Free Clinic Solutions consulting team; she focuses on designing and managing research projects involving Free Clinics and Free Clinic Associations.

With this study Julie established herself as the nation's foremost researcher on the Free Clinic sector. Prior to her work, scarce scholarly research on Free Clinics nationally, let alone published articles, existed. She commented, "Like so many, I first became aware of free clinics as a volunteer. Because they exist below the radar, free clinics are a challenging subject to study. But I was determined to spread their incredible story of caring for people who are left out of the traditional health system."

Among her findings from the survey (which she distributed in 2005-2006), there were 1,007 Free Clinics operating in the U.S. These clinics provided 1.8 million patients with 3.1 million medical visits and 300,000 dental visits. For more information about the study results, contact Julie at jdarnell@uic.edu. Many people are asking how many Free Clinics exist today. Julie recently estimated there are approximately 1,300 Free Clinics serving somewhere between 2.5 and 4.7 million patients."

The nation's Free Clinics are very fortunate to have a researcher of Julie's calibre studying the sector and presenting her findings. She has given numerous presentations at state and national Free Clinic conferences, and continues to be a great resource for anyone trying to understand the "big picture" of Free Clinics. "I have no doubt that there will be a need for free clinics after comprehensive health care reform," said Julie, "because it is estimated that 23 million people may still be uninsured. We can anticipate that people will have problems accessing primary care, especially given the workforce shortages that we are likely to encounter in primary care."

If your Free Clinic or Free Clinic Association is interested in doing an evaluation or some other kind of research, email me at mark@freeclinicsolutions.com and we'll set up a free, no-obligation telephone call to learn more about your needs and goals.

-- Mark R. Cruise

Individual Giving in the U.S. Declines Only 0.4% in 2009

According to data released by Giving USA last month, charitable contributions from individuals decreased by a mere 0.4% in 2009. This runs contrary to the speculation of many that 2009 would show marked declines in individual giving. However, rising stock market indices and greater media coverage of the needs of nonprofit organizations helped fuel increased giving in the last quarter of 2009. Total charitable giving - comprised of giving by individuals (including bequests), foundations, and corporations - dropped only 3.6% overall, from $315 billion in 2008 to a little under $304 billion in 2009. Corporations contributed just under 5% of all charitable donations, foundation grants represented about 7%, and individuals made up nearly 89% of all giving (when bequests and family trust giving are included)!

What does all this mean for Free Clinics and Charitable Clinics? Let me answer that with a question - if 89% of all charitable giving in this country originates from individuals, how many clinics are building their mailing lists and conducting annual campaigns to solicit charitable donations directly from individuals? We at Free Clinic Solutions observe it to be surprisingly few. Many nonprofits, health clinics included, get caught up in the fundraising "treadmill" of endless grant applications and tiresome, self-operated fundraising events, and they fail to adequately pursue direct individual contributions. As many as 85% of all U.S. households make charitable contributions, and the average annual giving per household is $1,620. How are they being solicited? While online giving is increasing, in 2009 only 5% of contributions were made online; nevertheless, we strongly encourage clinics to incorporate online giving tools on their websites. However, the fundraising research indicates that direct mail is still, far and away, the preferred method by which individuals wish to be solicited.

Free Clinic Solutions has presented on this topic for some time now and received favorable reviews. In our presentation we provide practical tools and strategies for building a successful direct mail campaign that can be carried out at two critical times of the year, and bolstered by effective, efficient marketing and communications with existing and prospective donors. Contact us today and we'll show you how your clinic can begin raising a larger amount of your annual operating budget from individual gifts. Doing so will help you build a strong foundation for soliciting major gifts and planned gifts, as well as achieving success in a future capital campaign. The newly-released data from Giving USA should be ample reason to get started down this path today! I welcome your comments and questions, as always.

-- Mark R. Cruise

Florida's Free Clinics meet to develop strategic plan for state association

On June 4th history was made as the first ever statewide gathering of Florida's Free Clinics took place in Orlando. For years Free Clinic leaders throughout Florida (including Marisel Losa, Michael Daily, Jeannie Shapiro, and others) have been interested in forming a state association. Florida has a large number of Free Clinics - perhaps the most of any state in the country. It is one of the last frontiers of Free Clinic Association development in a state like Florida that has a critical mass of clinics.

The meeting, sponsored by the Health Council of South Florida, was part of a strategic planning initiative to accelerate the development of the Florida Association of Free Clinics. The Health Council, now under the leadership of Marisel Losa (formerly executive director of St. John Bosco Clinic in Miami), has been providing administrative support over the past year to help "incubate" the Association . With funds from a planning grant awarded by the Allegany Franciscan Ministries in early 2010, Free Clinic Solutions was engaged to help organize and facilitate a strategic planning process, which included indepth interviews with clinics statewide, facilitation of the statewide gathering, and drafting of a 2010-2012 Strategic Plan.

Attended by 54 people representing 34 Free Clinics, the meeting provided real confirmation that clinics not only want their own state association, but they have ambitious goals for the association. The energy and enthusiasm in the room that day was palpable. For many this was a dream come true - being able to meet and network with their counterparts throughout the state, share stories and successful strategies, and discuss common issues and needs that a state association could help meet was cathartic. With my background and experience in Free Clinic Association development, I am pleased to be working with these fine folks in Florida and offering advice and counsel where appropriate. They have a bright future ahead of them!

-- Mark R. Cruise

Great time at the CCHF Annual Conference!

Last week I attended and participated in the Christian Community Health Fellowship annual conference in Nashville. It was a great meeting! I had an opportunity to lead a session on fundraising, meet lots of folks from around the country, and introduce people to Free Clinic Solutions. CCHF describes itself as a nationwide network of health providers, administrators, teachers and students who are living out the gospel of Christ by providing health care to the poor. In recent months, CCHF’s Executive Director, Steve Noblett, and I have gotten to know each other better and begun to explore ways to work together to support CCHF’s work. I am excited at the prospect, not just because Steve is a great guy and fellow believer, but because CCHF is onto something very special in my opinion.

As a seminary graduate and former pastor, I have had a career-long interest in the intersection of the church and healthcare. Christ taught, He preached, and He healed. He called his followers to do the same, but the church particularly over the last century has abdicated its calling to be an agent of healing and healthcare, instead choosing to allow other institutions to take on that responsibility. However, that has been changing lately. According to research done by our own Dr. Julie Darnell, faith-based clinics are the fastest growing segment of the free and charitable clinic sector. I have had the opportunity to witness this phenomenon firsthand, working with dozens of churches and faith-based groups working together to develop and grow healthcare clinics. Among other things, CCHF has assumed the mantle of “national association for Christian health clinics.” This is a timely and important development. CCHF is well-positioned to play a vital role in supporting, representing, and advocating for the interests of the growing faith-based health clinic sector.

If you are a Christian healthcare provider or leader of a free or charitable clinic or health center, I encourage you to join CCHF. You will find an exciting and vibrant organization opening its arms to you, teaching and inspiring you to do great things, and providing fellowship and community along the way.

-- Mark R. Cruise

Welcome to the Free Clinic Solutions Blogsite

Welcome to the first post on the Free Clinic Solutions blogsite! As founder and principal of Free Clinic Solutions, I am delighted to be launching this blog that I hope will advance awareness, knowledge, strategies, and practices of the free and charitable clinic sector in the U.S.

Since its inception in October 2006, Free Clinic Solutions has become a trusted advisor and valuable resource to free and charitable (i.e. low-cost) clinics across the country, along with their associations, partners, and suppliers. Prior to starting this limited liability company, I served as executive director of the Virginia Association of Free Clinics from 1997-2006 and as executive director of the Free Clinic of the New River Valley (VA) from 1995-1997. Free Clinic Solutions is a full-service firm that provides consulting, coaching, training, and other support services, using a team of consultants with experience in free/charitable clinics and subject matter expertise in various disciplines. You can reach us by clicking on the "Contact Mark Cruise" link in the right margin or by calling me at (804) 306-3975.

The purpose of this blog is provide information, advice, and commentary on topics of interest to free and charitable clinics, and those that support them. We will cover subjects as big as healthcare reform and as small as developing an effective gift acceptance policy. If a free or charitable clinic is interested in a topic, we will write on it. In addition to myself, other members of our consulting team will write blogs for posting here. I invite readers to post comments, ask questions, and provide feedback. Disagreements are acceptable as long as they are written with courtesy and respect! I also invite you to sign up to receive email from Free Clinic Solutions (click on this in the right margin), which will alert you when there are new blog posts.

Thank you for your time and interest. And again, welcome to our blogsite!

-- Mark R. Cruise