Family Practice Gives Virtually Free Health Care to the Uninsured

“Some of the uninsured haven’t seen a doctor in 10 years or more. For such people to find conscientious medical care is an immense relief …â€?

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Rohnert Park CA — Dr. Robert Forester of Modesto, California, and his partner, Dr. R.J. Heck, have done something most family physicians would say is impossible: they give half their time to providing virtually free primary care to uninsured patients. Yet last year they had net incomes of $177,000 plus $15,000 for their retirement accounts.

They do it by spending the other half of their day on patients who pay an up-front fee averaging around $1,000 a year in return for same-day access for all needs, flexible appointment times and 24 hours a day on-call coverage. Both sets of patients, according to Forester, are enthusiastic about the arrangements.

“Some of the uninsured haven’t seen a doctor in 10 years or more. For such people to find conscientious medical care is an immense relief,� he says. “Over the past four years we have made more than a dozen diagnoses of life-threatening diseases at curable stages. Patients like these test the skills of a family practice to its limits.�

Both doctors are practicing Catholics and wanted their work to reflect their faith. In those four years they calculate that St. Luke’s Family Practice has provided $500,000 of free health care involving more than six thousand office visits. They have been helped by the willingness of well wishers to provide services at reduced cost and the decision of the IRS to treat the practice as a non-profit corporation.

On their side, the paying patients, called “benefactors,� appreciate the personal attention they are given, Forester says. They value the flexible appointment times and prompt treatment and the doctors’ willingness of spend more time with them than in a conventional practice.

“And for us, one of the best things is that we have regained our status as physicians whose paychecks are signed by our patients, not third-party payers,� he comments.

At the heart of the office is a computerized record keeping system that enables two doctors and one medical assistant to meet the needs of three thousand exceptionally diverse patients. “When we started we knew the system had to save time, it had to be flexible and it had to cut costs – and it has done all three. But in addition we wanted it to provide the kind of enhanced health care that the benefactors are paying for and it has done that too,� Forester says.

“When patients come in I can show them on a desk-top monitor the results of all the evaluations they’ve had – all their chart notes, consultations and lab work. Together we can track their weights and lipid panels over time. I can show them anatomic diagrams to clarify any questions they have. We can check medication side effects and drug interactions and view their spirometry, EKGs and a dozen other things, right on the monitor.

“Patients love the idea of reviewing the evidence together: suddenly everything is much clearer. Because they understand it better they are more comfortable asking questions. They feel more involved and they are more involved.�

The uninsured patients apparently feel the same way. Many are Spanish-speaking, Forester points out, so diagrams are particularly useful. “By a single click, I can also convert a handout on the screen to Spanish. You can imagine the relief that is to some patients.�

The computerized record keeping system chosen was ChartWare of Rohnert Park, California, which was awarded five stars by Family Practice Management, journal of the American Academy of Family Practitioners. Says Forester: “Besides cutting time and costs, the system is so flexible that we can make it do just about any task we need. In a practice like ours that is quite a task.�
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