FernCare Free Clinic, Inc.
2014 Clinic Review
459 E. Nine Mile Road
Ferndale, MI 48220
248-677-2273 – Appointments and Information
info@ferncare.org
www.ferncare.org
Amy Davisson, MS, PA-C Clinic Manager
Dr. G. Christopher Popp Medical Director
1
Introduction
This is our 5th Clinic Review. We collect the data
to better serve our patients
to assist considering in-house changes at the clinic
to review for cost efficiency
to gather data for grant proposals and presentations
The data is collected through information provided by clinic volunteers, clinic
team leaders, the Patient Satisfaction Surveys, calls to the
Appointment/Information line and money spent on services offered at the clinic.
The Clinic Review is part of our Annual Report which is issued at the
FernCare Annual Meeting in July. The 2013Clinic Review is on our website,
www.ferncare.org.
A yearly review to look at the clinic and services is one of the marks of Best
Practice the Board of Directors fully supports. This report along with open Board
Meetings and the information we put on our website regarding FernCare business
operations are parts of our commitment to being ethical and transparent
caretakers of the donations we receive to operate the clinic.
Clinic services are paid by individual donations, local fund raising and
grants. In 2014, Blue Cross Blue Shield Safety Net Program, The Jewish Fund,
Hitachi Motors, Michigan Department of Community Health, The Lennon
Foundation and the Croll Family Foundation helped fund clinic services as well as
11 local fund raising events that we coordinated or were held for us and of
course, always generous donations from members of the community.
The National Association of Free Clinics (2014) reported that free and
charitable clinics remain one of the only health care providers in the country to
provide essential health care services regardless of the patient’s ability to pay.
There are just over 1,200 free clinics in the US with over 5 million patient visits
each year. 83% of the individuals who receive health care at a free or charitable
clinic come from a working household. While 44% of the clinics have an operating
budget of less than $100,000, a minimum of $5.00 in services are provided to the
patients for every dollar donated.
2
Clinic Team
G. Christopher Popp, MD
Medical Director
Amy Davisson, MS, PA-C
Clinic Manager
Diane Dengate, RN-C, Chris Milosevich, RN
Head Nurses
Christine Rainey, PharmD, DSci
Pharmacy Manager
Peg Given
Lab Manager
Najette Jasey
Holistic Nutritionist
Brian Wahl
Benefits and Community Resources
Brian Wahl, Marsha Manning, Jewish Family Services
ACA Enrollment Assist
Lyle Ulinski
Appointment Desk, Reception
Amy Davisson, MS, PA-C
Counseling
Linda Baker
All round Assist
Geoff Blumenthal
IT Assist
John Ulinski
Michael Kruger
Purchasing Agent/ Building Maintenance
Statistician
The Clinical Manager reports to the Board of Directors monthly at the regularly
scheduled Board of Director meetings. The Clinic Team decides protocols, vets
new volunteers, sets clinic volunteer schedules, operates the clinic and handles all
patient issues between clinic sessions.
We have about 120 additional volunteers that work various sessions in various
capacities on a regular basis.
Anyone interested in working at the clinic can go to the website,
www.ferncare.org for the volunteer application.
3
Overview
We were open 9 hours/month as a medical clinic. Our hours in 2014 for the
medical clinic were 9 to noon on the 1st and 3rd Saturday and 6 – 8 pm on the 4th
Thursday of each month. We are also open twice a month, the 2nd and 4th Wednesday
evenings for mental health counseling. The clinic schedule is on our website. If there
are any date changes, the website schedule notes the change.
We are an appointment only clinic. After the Healthy Michigan program through
the Affordable Care Act opened we were able to eliminate our waiting list. We can now
offer people appointments within one or two weeks of their initial call.
We receive between 8 and 15 calls daily for either appointments or health
related information. All of the calls to the clinic are returned within 24 hours of the
initial call. This has not changed since August, 2010 when we opened the phone line.
The Resources pages on our website remain the most visited pages. Health
related resources are also in hard copy handouts. When we are part of Health Fairs or
Information Tables as various events, we take these handouts as well as specific
information about the clinic and patient criteria. The information on each handout is
reviewed and updated as needed but are always updated every 6 – 8 months.
We also are a “no longer used” medical equipment and medication
collection site for anyone in the community to drop off unused medical equipment and
medications. People usually drop these items off during clinic hours. Medical equipment
and medications within date go to World Medical Relief and out-of-date medications to
the drop off at the Royal Oak Police station. Unfortunately, we cannot offer this service
to medical clinics, home health care businesses or medical offices. The work involved to
prep the equipment and medication makes it impossible for us to accept their large
quantities.
Through collaboration with SE Oakland Coalition, a group that works with families
and substance abuse issues, we partner yearly to be a collection site for the nation-wide
DEA Drug Take Back Day. In 2014, 47 lbs. of medications were dropped off on that one
day to be incinerated safely.
4
Scope of Service – Medical Clinic
FernCare most closely resembles a traditional family practice clinic in terms
of provided services.
We dispense generic and over the counter medications whenever possible
as prescribed by our volunteer practitioners. We have a Prescription Assistance
Program available for those patients that require medications that we do not
provide and are within the PAP income guidelines.
We do most lab testing. Some tests are in-house and the rest are sent out for
evaluation.
We offer benefits counseling, social worker counseling, nutrition counseling
and Affordable Care Act Insurance Exchange and Healthy Michigan (ACA/HM)
enrollment assistance during clinic sessions and on the first Wednesday evening
of each month.
We also offer an in-depth Counseling Program and a Diabetic Support
Group outside of medical clinic hours.
We do NOT provide
a. Obstetric or gynecological services
b. Mental health care that is beyond a patient/family physician realm.
c. Sexually transmitted Infection testing or counseling.
d. Dental care
e. Anything deemed “emergency” by staff.
f. Anything requiring a specialty (podiatry, neurology, etc.) These are
referred out to specialists who have a specific agreement with FernCare
regarding treatment of FernCare patients.
g. Imaging (x-ray, MRI, etc.). We have an agreement with Basha Imaging
that allows our patients to pay a greatly reduced cost for these services.
h. Surgery including incisions and drainage.
i. OR dispense psychotropic medications, narcotics, medical marijuana,
opiates or any addictive or controlled substance medication.
Pain medications are NOT considered by our physicians until the 3rd patient visit.
Please note again that we keep an updated Clinic page on our website,
www.ferncare.org that addresses the services that we currently do and not
provide.
5
Volunteers
Currently, except for the Clinic Manager, ALL of the clinic staff are
volunteers including the Medical Director. Our clinic volunteers volunteered just
over 4101.25 hours to the clinic in 2014. Using the IRS lowest volunteer rate of
$23.07/hour, the dollar value of their time is just under $94,616.
ALL of the medical volunteers are licensed or certified as required by the
state of Michigan. Also both our dispensing pharmacy and our lab are state
licensed.
We have between 13 and 15 volunteers at each session - reception area,
practitioners, nurses, medical aides, social worker, benefits counselor, holistic
nutritionist, lab staff, pharmacist and pharmacy techs and cleaning staff.
As stated earlier, we have about 120 volunteers in all who work various clinic
sessions. We have not had to close the clinic for any session because we did not
have adequate volunteer coverage. We are very fortunate and value our
volunteers.
We also are able to incorporate a few students from the local community
colleges and universities. We can only work with a few at a time because we have
limited physical space. The comments from these students and sending staff are
very complimentary. Hopefully once they are fully accredited this experience will
encourage them to continue volunteering their skills.
Staff comment
“Volunteering at FernCare is the highlight of my week! I look forward to spending
time with such talented and good-hearted people every time I volunteer. My
experiences here have been essential in my growth as an EMT and medical
professional.”
“Volunteering at FernCare reminds me why I chose to go into medicine. I love
spending time with our patients!”
6
Patients
Patient Criteria
Prospective patients
 must be between the ages of 19 through 64
 have no health insurance or any kind
 have no primary care provider
 provide a photo ID
At the clinic, patients are required to fill out a Patient Information form, a Health
History and sign a Patient Contract. If a patient becomes part of the Prescription
Assistance Program or is sent to a referral outside of the clinic, there may be
additional documents required.
Clinic Evaluations from Patients
ALL of the patients that filled out the Patient Satisfaction Survey felt their visits
were “very helpful” which was the top value on a 1 – 5 scale.
Comment from the Patient Satisfaction Surveys:
“I am extremely grateful for the exception service you continue to provide each
and every time I visit. The awesome staffs of volunteers that make up FernCare,
thank you!”
“Everyone here is very nice and helpful.”
“Everyone here is very helpful and full of smiles!”
7
PATIENT DEMOGRAPHICS 2014
AGE
19 – 29
30 – 39
40 – 49
50 - 59
60 – 64
GENDER
12.4%
17.8%
19.1%
39%
11.6%
Male
Female
RACE/ETHNICITY
White
African-American
Hispanic
Asian
American Indian
39.4%
60.6%
MARITAL STATUS
50.0%
45.7%
1.7%
1.7%
0.9 %
Single
Married
Partnered
Divorced
Widowed
58%
20.7%
2.9%
17%
0.4%
EMPLOYMENT STATUS
INCOME
Full time
21%
Part time
32.3%
Not employed
46.6%
Note: 7.5% did not give information
under $15,000 71%
over $15,000 29%
TOP 6 CITIES OF PATIENT RESIDENCE
Ferndale
Detroit
Hazel Park
Southfield
Madison Heights
Royal Oak
Note: 10% did not give information
33 cities were represented
22.0%
17.0%
11.2%
8.3%
5.0%
5.0%
60.6% of our patients are from south Oakland County using 14 Mile Road as the north/south divider.
This is a small decrease from 2013.
67.6% of all of our patients are from Oakland County. This is a 2.4 decrease from 2013. In addition to the
above Oakland County cities we have patients from Berkley, Birmingham, Bloomfield Hills, Clawson, Farmington,
Farmington Hills, Lathrup Village, Novi, Oak Park, Pontiac and Troy.
21.6% of our patients are from Wayne County with 17% of our patients from Detroit. This is a decrease
of 1.2% from all of Wayne County and a 2.4% increase in the number of patients from Detroit.
10% of our patients are from Macomb County. This is a 1.1 % increase from 2013.
We also had one patient from Holland, Michigan.
8
Clinic Statistics
We served 241 unique patients in 2014. This is a decrease of 59.6% from
2013.There were 621 patient appointments in 2014. This is a decrease of 8.4%
from 2013.
The majority of our patients were seen from 2 – 5 times during that period with a
very small number registering 10 – 14 visits in the year.
We saw an average of 26 patients per clinic session.
Diagnosis (16 DIAGNOSIS CATAGORIES)
63.7 % of the patients have more than one diagnosis. The mean number of
diagnoses per patient is 2.1.
Hypertension
35.7%
Pain other than back
28.2%
High Cholesterol
22.0%
Depression
17.0%
Any infection/fever
16.2%
Diabetes
15.8%
Digestive/intestinal
14.5%
The other categories are allergy (12.4%), anxiety/insomnia (11.6%)
arthritis (5.4%), asthma/respiratory (10.8%), back pain (10.4%),
heart problems (4.6%) hyperthyroidism (4.6%), any infection/fever (15.8%),
obesity (9.5%), need physical (2.5%).
Weight
Mean average weight for our female patients is 198.84 lbs. (Range 95-388) and
for our male patients it is 206.36 lbs. (Range 127-353)
AGE
Mean age for all patients is 46.1 (20-64). For female patients it is 47.4 (30-64) and
for male patients it is 44.2 (20-64)
9
Laboratory
We requested 639 separate tests from Detroit Biomedical Laboratories and
completed about 60 HgB-AIC and urinalysis tests in our lab for a total of 699 tests
in 2014. This is a 9.2% decrease in the number of tests done in 2013.
Most patients have 2 – 3 tests done per visit.
The most frequently requested tests were
Lipid panel – measures cholesterol
CBC differential – red/white blood cell count, iron, platelets
Comprehensive metabolic panel – diagnose/monitor diabetes, liver,
blood sugar, electrolytes, kidney function
Basic metabolic panel - diagnose/monitor diabetes, blood sugar,
electrolytes, kidney function
TSH – thyroid function
Electrolytes – electrolytes, fluid balance
This year the lab was supported by Blue Cross/ Blue Shield Safety Net grant
and The Jewish Fund. This is the second grant we have received from BCBS Safety
Net. We are in the middle of a three year grant from The Jewish Fund. Both
organizations have long supported health care.
Detroit Bio Medical Laboratories has worked with us since we opened.
DBML also had done specific tests for our patients that we do not offer at a
greatly discounted rate. They have been a great clinic partner. By the way, this is
the same thing I said in the 2013 report. They still remain a great partner!
Peg Given has administrated the lab since the clinic opened and she has
managed the lab for the last 2 years. The Lab Team is made up of 3 licensed
phlebotomists and 5 Medical/Lab Technologists.
10
Pharmacy
We filled 2785 prescriptions in 2014. This is a 13.4% increase over 2013.
Our largest script count was in February with 384 prescriptions filled.
Meds (# of pills used annually), 2014
Blood pressure
Diabetes
Cholesterol
NSAID
Thyroid
Antidepressant
Cardiac
Asthma
Allergy
Anti-infective
GI
Other
Anti-inflam-steroid
Analgesic
Gout
Ophthalmic
Topical
TOTAL
38,381
14,102
8,299
8,136
4929
4788
3311
2340
196
1,754
1308
1061
631
430
573
8
15
92030
% of total
41.7
15.3
9.0
8.8
5.4
5.2
3.6
2.5
2.1
1.9
1.4
1.2
0.7
0.5%
0.6%
0.0%
0.0%
In addition: from the Pharmacy, we distributed 620 packets of insulin
(including PAP insulin), 170 packets of syringes (including PAP pen needles, 7
packages of lancets and 1 package of alcohol swabs and 17 boxes of test strips to
our patients with diabetes. We also distributed 969 inhalers (includes 887 free
Xopenex inhalers received from AmeriCares), 12 Ventolin inhalers and 19
packages of nebulizer solutions. It should be noted that FernCare did not
purchase insulins, syringes, lancets, alcohol swabs inhalers or nebulizer solutions,
and these were donated. Once again, we and our patients are so fortunate.
We order our medications from Anda Pharmaceuticals. There is some
discount in cost because we are part of the National Association of Free Clinics
and Free Clinics of Michigan and are a non-profit corporation. We also have an
11
independent pharmacy and Medical Supply Corporation (Paul Collum) providing
pharmaceuticals at a much discounted cost.
We receive some free medications from both AmeriCares and Direct Relief (nonprofit organizations that provide access to medications and medical assists) as
well as over the counter products and health assists for our patients. For two
years now, we have received free flu vaccine. In 2014 we received products from
AmeriCares worth $45,079 retail and Direct Relief worth $2162.19 retail.
Christine Rainey, Pharmacy Team Manager also supervises students from
Wayne State University, School of Pharmacy. This experience is invaluable for the
students. A community organized, self-funded, volunteer led clinic and its
pharmacy is a completely different experience than a hospital, retail chain drug
store or an independent pharmacy. The students love coming to the clinic and
have frequently told us that they wish Christine was an instructor at WSU!
We were also very fortunate to receive a $7000 gift from Judy Jones to
enlarge and renovate the Pharmacy. She is the mother of a past volunteer Mel
Jones who worked with us as an RN and then Interim Clinical Manager and the
mother-in-law of Shawna Ivancic. Shawna began volunteering in the Pharmacy
when she had just entered U of M Pharmacy School and stayed with us until she
graduated last June. She has successfully passed her Boards and is now proudly;
Shawna Ivancic, PharmD.
Patient Assistance Program
We enrolled 7 patients in the Patient Assistance Program coordinated by
Needy Meds (an online medication distribution non-profit organization). This is a
decrease from 2013. With the introduction of the Affordable Care Act Insurance
Exchange and then in April, 2014, Healthy Michigan this program is getting
smaller because PAP does not fund medications for people who are eligible for
either health insurance program.
PAP provides medications free of charge to patients who qualify. There is a
very, very small cost to the clinic for providing this service.
Donna Reeves, RN has been coordinating this program since its inception.
Patient Appointments/Information line/Health Resources
This is our most used clinic service and has been since we opened. We
received just over 2650 calls on our two lines in 2014. Amy Davisson, Clinic
12
Manager, heads the team that arranges appointments and takes all of the calls.
We use a Magic Jack phone system so that the appointment and information
volunteers can work from home. This team also volunteers as the
Reception/Front Desk volunteers any time we have clinic sessions.
Patient Referrals
Our patients can see a Benefits Counselor if they so choose or if medical
staff has suggested that it may be helpful. The requests are split about 2/3 for
additional medically based referrals including information or enroll assist in either
the Insurance Exchange or Healthy Michigan and the other 1/3 for non-medical
concerns or for referrals for family members who are not FernCare patients.
Information most requested: dental care resources, prescription resources,
mental health resources and women’s health in that order. Brian Wahl heads this
team and has done so since clinic opening in 2010.
Patient Referrals – medical team generated
It must be noted that Medical staff also make referrals for the patients
regarding a medical issue. In 2014, most referrals were for podiatry, gynecology,
imaging in that order. We are continually building our list of physicians and
services that will see our patients either pro bono or at minimal cost to the
patient. If we have no referral name for a particular issue, the patient is directed
to Benefits.
Mental Health Counseling
The counseling sessions are twice a month with a 12 session limit unless the
patient and the therapist decide additional sessions would be helpful. We saw 14
patients in 113 visits in 2014.
We have three therapists and will probably expand this program in 2015.
Amy Davisson oversees this program with Sara Abrin coordinating appointments
and therapist schedules.
The costs for this program come from our overhead budget.
Affordable Care Act enrollment assistance
This began in November, 2013 and will continue as long as we operate a
medical clinic and/or as long as one or both programs are available in Michigan.
We have successfully enrolled 68 patients with other patients self-enrolling.
About 28% of our patients are successfully enrolled. We have applied for a grant
13
to create an ACA unit within the clinic to make sure that every patient is apprised
of the program and is assisted directly with enrollment if needed.
When a patient has successfully enrolled, the patient continues with us for
60 days to ensure a smooth transition to a new provider and lessens greatly the
chance of any treatment or medication not being continued in a timely manner.
One issue that the Board is very interested in is the number of patients who
are not eligible for either program or the reasons why enrollment is not possible.
This is the population who may in the near future be the bulk of our patients. We
are not the only group looking at this population. We communicate regularly with
other free clinics, the Michigan Department of Community Health and advocacy
organizations on this issue.
14
Looking Forward
Like all health care agencies, clinics and hospitals, we are impacted by the ACA
and Healthy Michigan health care insurance programs. There is a lot of
administrative work associated with the program: not only adding enrollment
assistance to clinic sessions and an independent session; keeping track of where
the patients are in terms of sign up or not; making sure that we have the most
current information for our patients, but also completing the paperwork involved
as patients transition to new providers. Like everyone else, so many questions:
Will our patient count level off? Who exactly will be our patients in 6 months, a
year, three years? Will there be impact on the ACA and HM with the Supreme
Court decision in June? Will there be an impact with the elections in 2016?
As we ended 2014, it was clear to the Board of Directors that we are not going to
close anytime soon. They continue to see, as does the Clinic Staff, a place for a
medical clinic. Expanding our role in local community’s health programs: working
more closely with the Oakland County Health Department and Covenant Care
Clinic in Royal Oak, the closest Federally Qualified Health Clinic, creating specialty
programs (food choices, Wellness, for instance) for both our patients and the
community are all possible. We work in collaboration with other organizations
now and this will only increase as we expand our work beyond simply providing a
medical clinic for those without health insurance.
We are still very upbeat about our future. We see a role for FernCare in quality of
health issues for people in Ferndale and surrounding communities for quite some
time.
15
16