Catholic Health East : Best Practices

RHC: Mercy Health System of Maine, Portland, ME

Contact: Nathan Nickerson, NP

Title: Program Director

E-mail:
Fax:
Phone: 207.879.3433

Description of the Best Practice:

Portland Street Clinic, the result of a unique collaboration among Mercy Hospital, the City of Portland Public Health Division, and the health care community, has been providing free comprehensive primary care to uninsured, low-income adults in the Greater Portland area since October 1993.

Implementation & Time Frame

The relationship between Mercy Hospital and Portland Public Health (PPH) began in 1990 when PPH initiated the Homeless Health Program. At its inception, this program had extremely limited funds and a single staff person who offered free primary care services to homeless individuals at sites where people congregated to meet other basic needs, such as soup kitchens and shelters. Mercy Hospital was approached for assistance, and they offered much needed free ancillary services (e.g., lab, x-ray, etc.) for the program’s clients. The program grew in scope and volume of services as did Mercy’s understanding of the health care and other needs of persons living in poverty.

A community planning effort was initiated in Portland in the early 1990s with the intent of bringing together the separate and fragmented health and social services for low-income and homeless people. A collaboration of several agencies was created, and a building was purchased to house a full array of services under one roof. The resultant Community Resource Center (CRC) has become a central service site and place of welcome for people with multiple needs. It is now a nationally recognized model in which multiple agencies provide a full array of services in a fully-coordinated and integrated manner.

For many of PSC’s patients, access to the resources to comply with the recommended plan of care can be more difficult than accessing a primary care provider. For instance, many are not able to pay for prescribed medications. Portland Street Clinic is committed to ensuring that no patient leaves the clinic without the needed medications or resources in hand. To that end, an extensive medication supply is stocked by pharmaceutical samples provided by pharmaceutical companies or physician donations and the pharmaceutical companies’ Compassionate Care programs are utilized extensively. Mercy Hospital includes the Portland Street Clinic each year as a gift opportunity in its Annual Gifts Campaign raising $8,600 annually.

Financial Profile

The Portland Street Clinic developed as a model that is supported by Mercy Hospital financially with continued funding of ancillary and staff salaries while being administered by the Public Health Division. It is staffed and coordinated by two nurses, a part-time medical director, and a part-time clerical assistant. The paid staff provide the continuity of care that is so important in primary care, while the direct patient care is provided by more than 200 health professional volunteers (about 120 of whom are physicians). Volunteers at the clinic site work an average of one evening each month, although some commit to weekly service. Half of the volunteers provide primary care onsite, while many of the sub-specialists see patients from either the Homeless Health Program or the Portland Street Clinic in their own offices, at no cost, as their volunteer contribution. Nurses, dentists, social workers, psychologists, and a psychiatrist also contribute their respective services and allow for very comprehensive care plans. Inpatient care, surgical services, and ancillary testing are arranged through Mercy Hospital at no charge to the patient.

Outcome

Significant outcomes for Portland Street Clinic include:

• Over the past two years, more than 1,200 individuals were served with 4,200 clinic visits.
• Services were provided to people from over 20 communities in the Greater Portland area.
• The majority of PSC patients support themselves and their families through employment, but in jobs without health insurance. Working patients are evenly divided among the self employed, part-time/seasonal employment, and service industry jobs.
• The clinic serves a higher proportion of people from ethnic minority groups (12 percent) than are found in the general Portland population (4 percent).

During 1998,

• 177 people also were seen by volunteer specialists in the community for consults for specialized care.
• 60 mammograms and 101 complete physicals and pap smears were provided to women.
• 54 patients received immunizations, including flu, pneumovax, Hepatitis B, and Td.
• An average of 10 callers a week are connected to other primary care services.
• Specialty clinics were offered onsite in podiatry, dermatology, and orthopedics.
• Mercy Hospital provided close to $140,000 worth of laboratory and special procedures.
• Almost $80,000 worth of medications were acquired at no cost for PSC patients.
• Over 50 patients a year are able to transfer their care to other primary care providers because they find jobs that include health insurance benefits.
• The frequency of ER visits for these individuals has steadily declined per patient survey. Also, the majority of patients polled stated that they would have presented to the ER for their health concerns if Portland Street Clinic were not an option for them.

In the coming year, Portland Street Clinic will be moving to a larger site with greater capacity that will allow for more scheduling flexibility. It is envisioned that this will be an opportunity to serve even more individuals who might otherwise go without care, with daytime and evening sessions.

Best Practice Narrative is limited to a one page summary.
Supporting data is limited to one page.