Access Now Provides Specialist Care for the Uninsured

The Academy came up with a program modeled on a very successful one developed in Asheville, North Carolina, called Project Access.

Nichol:  Project Access is all around the country and it's sort of the same thing except they mostly provide primary care, not specialty care.

Marilyn Nichol is the Access Now Program Manager. She explained that they began with a pilot project in late 2007.

Nichol:  This was mainly the need for more specialists to participate in helping care for the uninsured in the Richmond area, so that we could try to help keep a lot of them out of the emergency rooms and get them what they needed beyond what the clinics could provide.

The need became instantly apparent. Access Now was going full speed in just a few months.

Nichol:  In the first year, they anticipated approximately 600 patients; that was in '08, we kinda polled the clinics and said "Okay, what do you think our capacity should be?  What do you think you'll be sending to us?"  And they said, "Ah, probably about 600 patients."   Well, the first year, we saw 1175 enrolled.

There were, she said, about 400 doctors volunteering at that time.

Nichol:  In the second year, there was an increase of 40 percent in those new patients enrolled in the program.  That doesn't even include patients coming back for a second referral or something, this is just brand-new patients that we haven't seen before.  And our doctor volunteers increased to over 850 doctors.

Clearly, Nichol added, the recession played a big part in that. Clinics were reporting the same kind of increased demand. The need continues to grow.

Nichol:  We're seeing about 25 percent so far this year increase over last year.

Ogle:  So are you expecting you'll see 2,000 people finally?

Nichol:  Oh, absolutely, absolutely.  I think 2010 will definitely see 2,000 people.

The Richmond Academy of Medicine works with the safety net free clinics, federally qualified health centers and occasionally the Health Departments to identify individuals who qualify.

Nichol:  The patients are seen in the clinic for their primary care.  They qualify if they are at 200 percent or less of the federal poverty guidelines for their total household income, and that's gross income.  They cannot have any other form of insurance, as well, no Medicaid, Medicare, or qualify for any of that, and this is all based on what the hospital standards are in the community for charity-care patients.  We knew that if the patient ended up in the hospital, this is what we would have to comply with, whatever their standards were, we wanted to follow that and respect the fact that that's what they're seeing for charity care in the two hospital systems, HCA and Bon Secours, do see our patients for free; anything that's needed beyond what the physician who refers needs, in other words, if any other procedure, those two hospitals write off everything for our patients.

Access Now covers just about everything that a patient may need beyond a primary care physician.

Nichol:  We refer them to the doctor; if the doctor needs to perform a procedure surgery, may even get into cancer treatments, all that is provided and the doctor can perform that surgery within the hospital if need be, or their surgery centers and it's all written off.  It does not provide for any sort of prescription medicines; often, the doctors will try to provide samples for them or they can use the community pharmacy, which is based out of the Cross Over Clinic.

Access Now serves most of Central Virginia and is hearing from more clinics just about every day.

Nichol:  More and more people are calling and asking how can they refer patients, 'cause we find that so many in some of these rural areas come all the way to Richmond anyway for their health care, so if they're doing that anyway, why not get into this program?

John Ogle, WCVE News