While Medicaid expansion offered insurance coverage to many of Bradley Free Clinic’s patients, it did not open doors for them to find health care.
Leaders of the Roanoke clinic said Friday they have responded by hiring a full-time nurse practitioner to see patients — including those with Medicaid — Monday through Friday, from 9 to 5.
Dr. Randy Rhea, board president, said Virginia’s expansion of Medicaid to lower-income adults did not solve access problems. He said the clinic realized it needed to expand services to continue providing care to the under-served, low-income people in the Roanoke Valley.
“It’s a new day for the free clinic. Patients who want to be seen during the day now have the option,” he said during a news conference. “But to me, more importantly, patients that call with urgent care needs, acute illness, can now be seen that very same day in their own medical home where they should be seen, thus avoiding a costly trip to the emergency department.”
The free and charitable clinic on Third Street in Roanoke has operated for 45 years with volunteer health care providers, from medical and nursing school students to veteran doctors like Rhea, who has volunteered for 36 years. But with the volunteers, clinic hours have been limited to Tuesday and Thursday evenings and Friday mornings.
“I want to underscore that Bradley Free Clinic’s philosophy has not changed. We are still a volunteer-driven free clinic that functions through the incredible generosity and devotion of our donors and volunteers,” he said.
Executive Director Janine Underwood said that the dream for years has been to have daytime hours, and that a grant helped the clinic hire full-time nurse practitioner Susan Blick.
The Virginia Health Care Foundation awarded a three-year grant with about $100,000 the first year, reduced to 75% in the second year and 50% in the third.
Underwood said they are already applying for grants to sustain the program, and they welcome donations.
She said that because Medicaid reimburses free clinics at a rate that is only one-third of what it pays other providers, the board hasn’t decided whether it is worth the time and money it would take to become a Medicaid provider and to administer billing.
Before Medicaid expansion, the Bradley Free Clinic saw about 2,000 patients a year. Starting in January, more than two-thirds of the clinic’s patients enrolled in Medicaid.
Underwood said they soon began to call.
“We were finding they couldn’t be seen for three months or they had providers designated outside the area that they couldn’t get to,” she said.
To explain how important the clinic is to its patients, Rhea introduced 59-year-old Reggie Long, who had worked for 23 years at the nearby Getty Mart and had done without health care.
Long said he could afford either his mortgage payment or insurance. About 18 months ago, he became ill at work and was taken to the hospital, where his sugar levels were so high they didn’t register, Rhea said.
Long was in a diabetic coma for several days. As he gained awareness, he found he had difficulty talking, walking and thinking.
“His greatest worry was where to turn, so he was referred to Bradley Free Clinic,” Rhea said.
Long said he goes to the clinic once a week. They have helped him apply for disability and get social services to help him remain in his home; offer him occupational, physical and speech therapy and classes in controlling diabetes and nutrition; and provide him with nine medications and insulin to stay well.
Without the clinic, Long said, he is not sure what would have happened to him.
Bradley Free Clinic in recent years has evolved its model as health care needs have changed. It began a few years ago to accept patients who had high-deductible insurance plans that they couldn’t afford to use, and last year it raised its income threshold for who qualifies for the free care.
Expanding hours has been the dream, Underwood said, as the limited evening hours meant they couldn’t help patients who were too ill to wait for an evening clinic.
Dr. John Burton, chair of emergency medicine for Carilion Clinic, serves on Bradley’s board. He said expanding the free clinic will help reduce the number of people turning to the emergency room.
“Having access for our patients in the region for low-cost care, when they don’t need the emergency department for an urgent issue or for ongoing primary care items, is a very, very high priority,” Burton said.
Roanoke Mayor Sherman Lea thanked the clinic for expanding access.
“I am always interested in the many ways we can improve our residents’ quality of life. Access to quality, accessible health care is one measure of a prosperous community,” he said. “I am very thankful the Bradley Free Clinic continues to be a vital part of Roanoke’s multi-faceted health care team.”