Imagine, for instance, that you work in one of the many food, beverage or service industries that support Charleston tourism. You work long hours most days of the week and are proud to bring home a regular paycheck. However, the small business that employs you does not offer health insurance. You make too much income to qualify for Medicaid but not enough money to qualify for credits in the health insurance Marketplace (learn more about the coverage gap). What do you do when you get sick or need medication?
Two retired physicians wondered just that. This question of what members of our community who work hard to make ends meet do when they need healthcare would lead them to establish the Barrier Islands Free Medical Clinic.
The Barrier Islands Free Medical Clinic (BIFMC) serves the health and wellness needs of uninsured, low-income adults who live or work on Johns, James and Wadmalaw Islands or Folly Beach. For those who qualify, services are completely free and provided by a large team of volunteers. The clinic strives to be the medical home for their patients, providing comprehensive healthcare to individuals at no cost. Today, the clinic supports itself through volunteer work, in-kind donations and private funding-- all without receiving state or federal funds.
Identifying a Community’s Need
Drs. Arthur Booth and Charlie Davis were physicians who worked at the same health system in Atlanta. They did not know each other when they both retired to Kiawah, but met at a church function. Drs. Booth and Davis recognized that the barrier islands had a critical need for healthcare for low-income, uninsured adults. With low-income children qualifying for Medicaid and low-income elderly qualifying for Medicare, there was still a significant portion of the community’s population that needed access to care. Both physicians had retired but knew that their lifelong dedication to medicine was not over. In 2006, they established the Barrier Islands Free Medical Clinic as a non-profit, 501(c)3 organization.
In 2008, the clinic opened its doors. Services were initially provided by one volunteer physician for one and a half days a week. The founders’ wives helped staff the front desk. Within three years they had a volunteer staff of 122 physicians, nurses and non-clinical support staff. The clinic treated more than 4,000 patients from a small building on Maybank Highway. By 2013, the free clinic was so successful, it had outgrown its space and started to evaluate new clinic needs.
Impressive Growth, Incredible Outcomes
In 2015, the clinic brought on an electronic medical record (EMR) system. Two years later, it held a groundbreaking ceremony for its new building, still located on Maybank Highway, just across the parking lot and behind the building where it all began.
Today, the new facility has seven exam rooms and provides the perfect layout for patient privacy, ideal care flow and provider needs. The clinic was able to double its patient load with the new space. There is a team of 140 volunteers and only 5.8 full-time-equivalent paid positions.
Forty-three volunteer physicians support clinic hours five days a week, including Monday night walk-in hours. Many of the volunteer physicians are retired but a good many are also still in practice and are committed to the community’s and clinic’s needs. The physicians say the work is especially rewarding because the clinic allows them the ability to practice full-scope medicine and spend as much time with their patient as they would like—something that is often limited by the constraints of working in a health system setting.
Brenda Falls, Clinic Director, attributes the clinic’s success to their volunteers’ dedication to providing patient care, “We have an incredible team . . . we are basically a full-service medical home.”
Today, the free clinic achieves 411 patient visits per month. The clinic was able to expand their patient eligibility to 299 percent of the Federal Poverty Levels. This means that an individual who makes $37,345 a year or a family of four with an annual income of $76,993 qualify for free services at the clinic. In April of this year, the free clinic was able to expand their eligibility to individuals who live or work Folly Beach in addition to the other islands.
While 80 percent of the clinic’s patients are employed, the cost of prescriptions can be a burden for anyone. The clinic prescribes generic medications when possible and helps patients identify the cheapest ways to fill those prescriptions. When generic medications are not available, the clinic has a non-dispensing pharmacy license and qualifies to provide $2.5 to $3 million in expensive name brand medications to patients for free through partnerships and pharmaceutical company savings programs.
Recognizing the high rate of diabetes in the population, the clinic offers a range of diabetes management services on site, including: a diabetes educator and a nutritionist who provide counseling, diabetes education classes, free test strips and meters for patients, and on-site hemoglobin A1C testing. This level of care management helps keep patients’ diabetes controlled and prevents further complications that can arise from unmanaged blood sugar levels.
On top of a dedicated team of volunteers who support the day-to-day clinical needs, a cadre of community individuals, businesses and organizations have made the free clinic’s success possible:
The new building was built on land that was donated by a long-standing Johns Island family.
The Medical Society of South Carolina has been a major grantor from the very beginning, but more recently provided funding for the technology equipment to support the EMR.
Roper St. Francis provides lab and imaging services for free to BIFMC patients as in-kind donation, the equivalent of $1.6 million a year. Roper also supports the clinic’s IT needs as an in-kind donation.
When a patient’s needs go beyond primary care, 19 subspecialty providers see referred clinic patients as in-kind work.
eClinicalWorks, the EMR provider, donates 15 user licenses to the clinic annually.
The free clinic’s annual golf tournament fundraiser netted $255,000 in donations this year
Empowering a Healthier Community
The free clinic continues to grow and expand. Their work is rooted in the conviction that everyone deserves access to top-of-the-line care. They are passionately committed that their patients see no distinction in care from what an insured patient would obtain at another practice elsewhere. “Sometimes you just don’t realize who needs care,” explains Vasco Pickett, BIFMC Executive Committee Member, “Our job is to keep them out of the hospital by keeping them well. Our goal is to uplift them.”
That mission translates to better outcomes for the community as a whole. When an individual does not have to resort to emergency room visits for routine care needs due to a lack of options, those high care costs are saved by the entire healthcare system and everyone’s care costs go down. When an employee is able to obtain the care and treatment they need within their community, they are able to reduce time away from work and keep chronic conditions managed, increasing workforce reliability, avoiding lost income and staying healthier in the long run.
When asked what they need the most, while volunteers and donations are always welcome, both Ms. Falls and Mr. Pickett were quick to respond, “More patients.” They hope that increasing awareness about the clinic and its high standard of care will enable them to reach more community members who need healthcare.
In short, the Barrier Island Free Medical Clinic makes a huge impact on the lives and health of their patients, but it uplifts the health and well being of our community as a whole.