A
fter residency and fellowship
in St. Louis, Mo., my wife and I
moved to Louisville in February
1989 with two very young chil-
dren. I was fortunate to eventu-
ally have a third child, a wonderful family, a
great job and enough money that allowed me
to not worry about how I would provide for
them. God had truly blessed me. For years, I would say to my dad
(my best friend) that I didn’t feel like I was doing enough for others.
He would always answer by telling me, “you have a young family
to take care of and someday there’ll be time for you to do more.”
In 2007, with our children old enough, the time to do more had
arrived. It was time to help those with less, especially those without
insurance but who desperately needed medical care. As I initially
looked for places to help, many were interested in my money. But,
I had a hard time finding a place in my community to donate my
time. That seems odd, I know, but true. Money is easier to give but
giving precious time is what’s important.
Along with my incredible wife, Sandy, and dear friend and co-
worker Susan Dillon, we embarked on starting our own free clinic.
My wife (who is very good at these things) came up with a won-
derful name, “Have A Heart.” We had an attorney file paperwork.
I asked my existing group if I could use our existing office space
and equipment on Saturdays and evenings, and in February 2008
we started seeing patients. We decided the first part of our mission
would be to focus on patients who were uninsured and earning less
than 200 percent of the federal poverty level. It’s hard to imagine
how little money that is, but for a single person it is $16,000 a year
or less and for a family of three, less than $20,000/yr. It was easy
back then, Sandy did the scheduling, Susan did the testing and other
volunteers including myself worked up the patients and then I saw
them. We used existing space with no overhead.
I am not sure why, but initially I was concerned about having
enough patients. Where would we find them? How would we get
referrals? At that time, 12 percent of Kentuckians were uninsured
and did not qualify for Medicaid; 12 percent had no medical safety
net. There are some wonderful primary care clinics in the Louisville
community: Park Duvalle clinics, the Family Health Centers, Family
Community Clinic of St. Joe’s, Shawnee Clinic, Triad Health Clinic
and Mercy Medical.
Approximately 40 percent of all primary care visits to such fed-
erally qualified health clinics are for cardiovascular reasons. How-
ever, these clinics have no direct referral source for specialty care.
The schedulers at these clinics simply reviewed a list of providers
hoping to find someone to take an uninsured patient, hoping to get
somebody who would be willing. We wanted “Have A Heart” to be
FEATURE
their direct referral clinic.
We got so busy that we added an evening clinic once per month.
We were still booked one to two months in advance. Of course, at
the same time, it was essential to be sensitive of people’s volunteer
time since we were 100 percent volunteer-serviced. I would never
want to ask too much from those helping because I realized very
quickly that when asked, our volunteers would answer YES without
hesitation.
We were helping many, but we also had a high no-show rate
close to 30 percent. That meant taking valuable appointments from
those waiting and that patients needing to be seen were not getting
seen. The obvious, but false, belief was to think those patients were
too lazy to come in. But in reality, amongst our country’s indigent
population, more than 50 percent of doctor appointment “no-
shows” are due to transportation issues - they can’t afford a car and
are forced to rely on family, friends or public transportation. Our
original office was in a more affluent part of town, typically removed
from the population we were serving. The reality was that, for most
patients to get to us by bus, it took at least an hour one way or by
car about 10 to 15 minutes.
A number of things happened around this time. First was the
realization that our clinic was too far away from most of the com-
munities we sought to serve. Second, our full-time medical group
was acquired by our local hospital, whose indigent care did not
align with ours. Third, how could we sustain a free, volunteer-only
clinic without having to ask for money? The first two dilemmas were
easy to figure out. We knew we needed to be closer to the people
we served, with our own space and equipment. That meant we
needed a lot more money. We would have to go from no overhead
to having the expense of running an office, so how to sustain it took
more thought. Our founders believed if there were other providers
like ourselves, willing to work for fewer dollars to provide for those
with less, that we could create a sustainable clinic catering to the
uninsured and underinsured of our community. By billing patients
with insurance, we could use that revenue to pay for the indigent
population.
In January 2017, we started seeing our first patients in our new
office, closer to the demographics of our patients. It was adjacent
to an east and west bound bus stop, therefore accessible to many.
It did cost a lot of money. People were generous, and the reward
was apparent. Our new patient visits doubled in the first year, test-
ing was up 70 percent and the total number of patients was close
behind. In addition, we started our care coordinated team for our
sickest patients. We assign them a volunteer nurse and social service
coordinator. We see those patients every three months, speak with
them more frequently on the phone, and discuss care questions
(continued on page 20)
FEBRUARY 2019
19