Expanding the boundaries of care
Date: October 31, 2010
Barbara Cook remembers the woman with a lump in her breast and the construction worker who suffered a seizure as he worked on high-rise scaffolding. When she used to treat such uninsured patients at East Baltimore Medical Center (EBMC), the former president of Johns Hopkins Community Physicians worried that they might not receive the follow-up care she recommended. Lacking health coverage, most could not afford to pay in advance—the usual requirement—for diagnostic care such as mammograms and neurological tests.
Now they can, thanks to The Access Partnership (TAP), a program that began in May 2009 to route uninsured and underinsured EBMC patients from the community surrounding the Hopkins Hospital campus into needed specialty care at the hospital. Today, the program is serving patients in seven ZIP codes near the The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.
TAP patients, who must demonstrate financial need, pay a one-time fee of $20 for a referral and receive no additional bills. All Hopkins specialty physicians donate their services to the program.
“We’re hoping this will become a model program for hospitals,” says cardiac surgeon William Baumgartner, president of Johns Hopkins’ Clinical Practice Association, who chaired the committee of physicians, administrators and medical students that led to TAP’s creation.
Formed after the closing of the Caroline Street Clinic for the Uninsured in 2006, Hopkins’ East Baltimore Community Clinic Task Force set out to determine how Johns Hopkins Medicine could best serve its neighbors in need. One recommendation was to place them in primary care clinics, such as EBMC, that already serve low-income residents. Another was to improve these patients’ access to Hopkins specialty care.
“Although we’ve always taken care of the uninsured in neighborhoods around Hopkins, it’s often through the Emergency Department,” says Cook, medical director of the partnership, “or it’s because they become so sick they end up in the hospital. This program makes our care more efficient and effective.”
Not only does the program bridge a crucial medical gap, it also teaches internal medicine residents primary care that is careful and cost-effective. Cook makes sure that referring physicians try standard treatments before calling specialists. “Primary care doctors, for example, are supposed to treat all manner of foot ailments,” she points out. “So if a podiatry referral comes in for a diabetic patient with no evidence that the doctor looked at the patient’s feet, I send it back.”
She denies requests for MRIs for back pain unless records show that physical therapy, analgesics and other conservative measures did not work. She has also refused four sleep study requests.
“If a person weighs 300 pounds and is snoring at night, you can pretty safely say that they have sleep apnea,” Cook says. “But if they can’t afford the equipment they need to treat it, why pay the money to do a study? Instead, what the patient really needs to do is to lose weight and try other things to improve sleep hygiene.”
Also key to TAP’s success are the program coordinators who collect fees from patients, schedule their appointments at the specialty clinics, and remind them of the time and location of their visits. In addition, they keep in touch with patients to make sure they’re recovering well following treatment.
“Before TAP,” says nurse practitioner Pam Mahoney, “months would go by where our patients would simply have to linger with abnormal studies and various conditions while a person with health insurance would be taken care of right away. Now, through the TAP program, patients are able to get the care they need.”