Three years ago Grady Memorial, which still struggles to serve the city’s more than 65,000 uninsured and underinsured residents as Atlanta’s primary provider of uncompensated care, was in deep financial trouble and at risk of closing its doors. As the only level one trauma center within 100 miles of Atlanta and the city’s only safety-net hospital, Grady is an indispensible part of the city’s healthcare community; the prospect of its loss was unthinkable. The community rallied around Grady and the institution prevailed, currently providing over 850,000 outpatient and 30,000 inpatient visits per year.
While Grady is chartered to serve uninsured and under insured patients, the financial implications of doing so continue to tax the hospital. Of the more than 100,000 patients who visit Grady’s emergency room during the year, 70 percent are qualified as self-pay, charity or bad debt. And, as with most hospital emergency rooms, a significant population that is non-emergent is treated in Grady’s ER — the costliest site of care. Leon Haley, Jr., MD, chief of emergency medicine for the Grady Health System, says about 20 percent of Grady’s ER patient population, approximately 20,000 patients a year, require primary care and are considered non-emergent.
The Healing Community Center, the latest joint venture launched at the site of City of Refuge, a faith-based organization serving the homeless in Atlanta, will certainly not be able to absorb that kind of population, but at an average cost of $1,500 per emergency room visit, the cost savings to Grady from referrals to the clinic will certainly add up.
“Getting patients out of the ED who could get their care in a clinic-like setting like [the Healing Clinic] would not just be a tremendous cost savings but would facilitate the through-put and the quality care that the patients who are still here and have to be here for other reasons would be getting,” Curtis Lewis, MD, chief of staff at Grady Memorial Health System, explained. “Large urban hospital EDs tend to get a lot of patients who are just using the ED as their primary care facility because they don’t have one, but that’’s not the best use of an ED, so moving those patients back to the clinic setting is going to be a win for all.”
In 2009, Charles Moore, MD, director of the Healing Community Center and an ENT surgeon from Emory University who practices at Grady, started seeing patients in a converted storage room at City of Refuge. In 2010, City of Refuge started fundraising for the Healing Community Center, raising enough public and private funds in about a six month period to begin construction on phase one of the clinic.
Phase one of the new clinic includes 8,000 square feet used to provide primary care, mental health, dental, minor emergency care and specialty care. The facility includes eight examination rooms, two surgical units, six dental chairs, a mental health center and offices for physicians and nurses. Services will be donated by the local healthcare community.
In the spring of 2012, the venture will begin construction on a 26-bed recuperative center where homeless women who need ongoing inpatient care can be transferred from hospitals like Grady.
Tony Johns, director of community involvement at City of Refuge, sees the clinic as an integral part of the organization’s objective of caring for the whole individual. “The new clinic means that the people we serve at City of Refuge now have access to quality free comprehensive healthcare — including specialty care, dental and mental health services,” Johns said. “As a vital piece of our holistic approach, this ensures that, as they seek to secure the vital resources of education or training, employment and housing, they can do it without the fear that their health will fail due to lack of available healthcare.”
Unlike the existing overtaxed indigent care facilities, the Healing Community Center is unique in its ability to accommodate referral patients, usually on the same day, Jim Hammons, social work manager at Grady, says. Grady has instituted a formal referral process with the center “The difference in the referral process with the Healing Community Center is that the homeless, the working poor, the folks who are in distress without insurance aren’t put through a series of hoops to jump,” he said. “When they get there, their name is on the appointment list, and they take them back and treat them with dignity, as you would be if you walked in to your primary care physician with insurance. It’s a warm environment.”
An important feature of the clinic is that it can become a medical home for its patients, something that the uninsured have no access to when they primarily rely on emergency rooms for their care.
How many Healing clinics would it take to help meet the needs of the vulnerable population of Atlanta? It’s hard to quantify says Dr. Lewis. But serving 1,500 patients a month, the Healing Community Center will be a huge help.
“When you can run into somebody like [Dr. Moore] and the Healing Community Center, it’s a great opportunity to work together to be synergistic,” Dr. Lewis said. “His facility is going to unburden some of the responsibilities that Grady has to that particular patient population.”
Diana Denman Holmes is vice-president of the Emergency Medicine division for Locum-
Tenens.com, a full-service physician/CRNA recruiting agency. Founded in 1995, LocumTenens.com is a full-service physician and CRNA recruiting firm specializing in anesthesiology, emergency medicine, OB/GYN, primary care, psychiatry, radiology and surgery with U.S. hospitals, medical groups and community health centers. LocumTenens.com is part of the Jackson Healthcare family of companies. In addition to full-service recruiting, Locum-Tenens.com operates a free job board at www.locumtenens.com.
