Free Clinic
Transcription
Free Clinic
NYC Free Clinic Bridging The Gap Supporting the Uninsured of New York City ANNUAL REPORT 2006-2007 Annual Report 2006-2007 Introduction T he New York City Free Clinic (NYCFC), established in 2002, is committed to serving the healthcare needs of the uninsured of New York City. The NYCFC provides its patients the full range of healthcare services, including social services, laboratory testing, and outpatient specialty referrals. Central to the mission of the NYCFC are both the provision of the best possible care to its patients and the educational experience for its volunteers. With the tirelesscommitment of its organizational partners, volunteer base, and management, the NYCFC is able to provide an innovative and comprehensive solution for the unfortunately large number of uninsured New York residents. The following report details organizational developments and patient services statistics between June 01, 2005 and May 31, 2007, NYCFC fiscal years 2005-2006 and 2006-2007. Table of Contents 4 Organizational Partners 6 Article: Healthcare Crisis 7 Article: Supporting the Uninsured of New York 8 History and Milestones of the NYCFC 10 Article: Team-Oriented Approach to Care 12 Fiscal Year 2006-2007: Financial Statement 14 Fiscal Year 2006-2007: Patient Demographics 16 Fiscal Year 2006-2007: Patient Services Statistics 18 Fiscal Years 2005-2007: Physician & Student Volunteers 20 Appendix 22 Looking Ahead: A Vision to Better Meet the Needs of the Uninsured 23 Credits New York City Free Clinic 16 East 16th St New York, NY 10003 (917) 544-0735 www.med.nyu.edu/nycfreeclinic/ info-nycfc@med.nyu.edu 2 Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health Steering Committee Co-Director / Management Co-Director / Development Fundraising Fundraising Chief Financial Officer MD Recruitment MD Recruitment Laboratory Services Laboratory Services Patient Scheduling Patient Scheduling Referrals Referrals Public Relations Patient Advocate Volunteer Scheduling Undergraduate Volunteer Coordinator Outreach Coordinator Webmaster Maura Madou Jolyn Taylor Rena Malik Rushi Parikh Marc Ialenti Jonathan Baghdadi Sajan Patel Pritha Gupta Rose O'Rourke Elizabeth Gurney Nathaniel Smilowitz Brad Kligman Emily Stamell Mansi Shah Pragati Tandon Radhika Bauer Sara Rostanki Gilda Boroumand Robert Baumgartner Steering Committee Advisors IFH NYCFC Medical Director IFH Medical Director IFH-NYCFC Advisor NYCFC Faculty Advisor NYU SOM Dean for Student Affairs NYU SOM Director of Student Affairs Amarilys Cortijo, MD Daniel Blumkin, MD Sarah Nosal, MD Joseph Cavanaugh, MD Lynn Buckvar-Keltz, MD Joseph Oppedisano Abbreviations used in this report: The New York City Free Clinic is made possible through the partnership of: IFH: Institute for Family Health FY: fiscal year NYCFC: New York City Free Clinic NYU: New York University NYUMC: New York University Medical Center NYU SOM: New York University School of Medicine MSI, II, III, IV: medical student, year of medical education New York University School of Medicine Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 3 Annual Report 2006-2007 Organizational Partners T he NYCFC is able to provide comprehensive free care because of the commitment of its organizational partners, volunteer base, and management. Bringing healthcare to the uninsured requires clinic space, laboratory services, pharmacies, and referrals for specialty care, not to mention the time and skills of dedicated physicians, students, technicians, and administrators. To meet these requirements, the NYCFC formed agreements with a number of hospitals, clinics, and non-profit organizations throughout New York City known for their commitment to the uninsured. Primary among them are: The Institute for Family Health: The Institute for Family Health (IFH) is one of the two founding collaborators of the NYCFC and is the clinical operator of the NYCFC. It is an active part of the NYCFC Administrative Board and Steering Committee. IFH supports the NYCFC by generously donating all the clinical space used by the NYCFC while open on Saturdays, as well as associated maintenance, medical supplies, social workers, patient service representatives, and medical staff time. The NYCFC also collaborates with IFH to provide prescription drugs at a greatly reduced cost to patients through the federal 340B Drug Pricing Program. New York University School of Medicine: NYU School of Medicine (NYU SOM) is the other founding collaborator of the NYCFC. It provides extensive administrative support, invaluable advising, and numerous services to the NYU medical students who volunteer at and manage the clinic. NYU SOM donates all administrative office space, associated maintenance, office supplies, financial accounting and auditing, and covers many costs associated with student volunteers. 4 Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health 1<80HGLFDO&HQWHU 6FKRRORI0HGLFLQHDQG+RVSLWDOV&HQWHU Bellevue Hospital Center: New York University Medical Center: New York University Medical Center (NYUMC) graciously donates all laboratory supplies and all laboratory services offered by the clinic, including blood tests, urine analysis kits, Pap smears, radiological services, and sexuallytransmitted infection testing, among many other laboratory services. By providing these services at no cost to the patient, the NYUMC plays an invaluable role in providing quality healthcare for the uninsured. New York City’s Bellevue Hospital Center, the nation’s oldest public hospital, has a long-standing history of caring for the underserved communities throughout New York City. Bellevue graciously entered into an agreement with the NYCFC to charge a deeply reduced cost for outpatient specialty referrals. This reduced cost permits the NYCFC to refer its patients to Bellevue Hospital free of charge to the patient, as the NYCFC is able to cover (through fundraising efforts) the reduced cost of the specialty appointment. The NYCFC is the only free clinic in New York City that provides such referrals free to its patients. Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 5 Annual Report 2006-2007 Healthcare Crisis N ew York City is currently facing a large scale crisis with over 1 million of its residents lacking health insurance coverage1. This means that one in six New Yorkers is either paying out of pocket for the increasing expenses of medical care, or sacrificing necessary care. While most may assume this is a problem stemming from unemployment, in fact more than two thirds of uninsured New Yorkers are employed1. The high rates of uninsured New Yorkers are fueled by the high costs associated with insurance premiums. The average monthly premium for an individual HMO plan in New York City is $8372. This includes the poorest neighborhoods of the South Bronx, East and Central Harlem, and North and Central Brooklyn where more than 1 in 3 residents live in poverty and are unable to afford this additional expense3. Many employers have also increased the percentage of the premium that their employee must pay or have stopped offering coverage options to their employees. Since 1996, premiums have risen by percentages well above the rate of increase of both workers’ earnings and inflation4. Access to health insurance has therefore been limited to the upper classes or those fortunate enough to have it provided by their employer. Due to the high cost of insurance premiums, New York does offer some public insurance programs for low-income families. In addition to Medicare and Medicaid, programs such as the State Children’s Health Insurance Program (SCHIP), Family Health Plus and Child Health Plus provide access to health care for the poorest residents. However, the requirements to qualify for these programs are often so stringent that many middle-class families don’t qualify, yet they are also unable to afford insurance premiums. This increases the risk of being uninsured as an adult in a low-income family. For example, a family of two parents and one child, cannot exceed the maximum gross annual income of $25,755 in order to qualify for the Family Health Plus program5. A problem arises for any family making slightly more than the cutoff because they are still unlikely to be able to afford even the least expensive insurance premium with the high cost of living in New York City. In addition to the financial strain that a lack of health insurance puts on a family, it also leads to the overuse of hospital emergency departments and insufficient preventive care from a regular provider. In 2004, it was found that 65% of non-elderly, uninsured adults in the United States visited the emergency room at least once within the last two years. In comparison, only 27% of insured adults went to the emergency room in the same time frame6. Many emergency departments are being overwhelmed by non-emergent cases because the uninsured are turned away from many other clinics which require them to pay out-of-pocket. In addition, 41% of uninsured New Yorkers reported that they did not receive necessary medical care in the last year, as compared to 11% of insured New Yorkers7. Many serious health problems, such as diabetes, hypertension and asthma can be prevented or better managed by visits to a regular provider. Unfortunately, it is difficult for most uninsured families to regularly visit a doctor, leading to unnecessary complications which may have been avoidable with good preventative care, such as that which the NYCFC is able to provide as a short-term solution for their patients. As many New Yorkers find themselves without health care, it is increasingly important that the health insurance system be expanded to provide access to more people. However, the transition to a more comprehensive insurance system is complex and in the meantime it is essential that other resources are developed and expanded to help those who have been left out. (Please see Page 23 for References) 6 Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health Supporting The Uninsured O ur services are meant to be an initial stop for patients on their way to entering the health care system so they will receive the same quality and continuity of care as insured patients. The only current criterion to receive care at the New York City Free Clinic (NYCFC) is that an individual be uninsured and ineligible for government insurance programs. The Institute for Family Health (IFH) provides every potential NYCFC patient with free social work services including health insurance screening and assistance with registration for government health insurance, and other screening and counseling services when appropriate. These services allow the NYCFC to not only provide comprehensive primary medical care only to those patients who truly qualify, but also to serve as a key access point for uninsured patients by facilitating the process of entering New York’s health care system. of New York Patients who have complex or chronic illnesses are transferred to one of the IFH health centers for regular care, or the patient works with the social workers and medical providers at the IFH to determine an alternative solution. Student volunteers also provide an extensive and current list of free and low-cost health services in New York on the NYCFC website. The NYCFC provided 1207 patient visits, serving 591 uninsured New York residents from June 2005 to June 2007. With these goals in mind, prior to receiving an appointment at the NYCFC, all patients are screened for Medicare, Medicaid, and Family and Child Health Plus eligibility, as well as for any temporary insurance programs. When eligible, the social workers facilitate the application process to ensure successful enrollment. The NYCFC also helps patients find a primary care provider that is convenient for them once the insurance application process has begun. If a patient is deemed ineligible for government insurance programs, he or she is welcomed as a patient of the NYCFC, and is eligible for comprehensive primary care services on site, specialty referrals at Bellevue Hospital free of charge, and low cost prescriptions secured through agreements between the IFH and local pharmacy programs. From June of 2005 to June of 2007, the NYCFC provided 1207 patient visits, serving 591 uninsured New York residents. Check out our Website: http://www.med.nyu.edu/nycfreeclinic/ Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 7 Annual Report 2006-2007 History and Milestones T hree New York University (NYU) medical students established the NYU Free Clinic Project in the fall of 1999 with a vision of opening a free clinic to serve the patients falling through the cracks in the healthcare system. One year later, what was then called the Institute for Urban and Family Health (now called the Institute for Family Health) partnered with NYU School of Medicine (NYU SOM) to form the New York City Free Clinic (NYCFC), housed at IFH’s 16 East 16th Street location in Manhattan. opening, IFH received substantial funding from the Starr Foundation to support operational and administrative costs. The Starr Foundation has continued its strong financial support of the NYCFC over the past five years. Costs for patient laboratory testing and referrals have been waived or subsidized through agreements with NYU Medical Center and Bellevue Hospital. Any remaining potential visit costs to the patient are covered by the tireless fundraising efforts of NYU medical students. Patients also benefit from reduced The Association of American Medical Colleges cost pharmacy programs put in place by IFH. (AAMC) and Pfizer awarded the NYCFC the Caring for the Community startup grant in late In 2006, the Langeloth Foundation awarded 2000. With the management infrastructure in the NYCFC with a generous grant for clinic place by the spring of 2001, the NYCFC opened expansion. The funds have thus far been used to the public on March 9, 2002. to reach a larger patient base by increasing the number of clinical teams available to see Since its inception, the NYCFC has operated year- patients on Saturdays as well as by holding round on Saturdays from 9:00AM to 3:00PM health screening outreaches in different New with an all-volunteer student administrative York boroughs. This grant has also made staff committed to serving the uninsured of possible a collaboration with the Reproductive greater New York. One month after the grand Health Access Project to create a women’s health clinic. NYCFC History Timeline Fall 1999 Fall 2000 NYU Free Clinic Project established by NYU medical students Winter 2000 AAMC Caring for the Community founding grant awarded IUFH partners with NYU Free Clinic Project to form NYCFC 8 Spring 2001 March 2002 NYCFC opens Saturday clinic NYCFC Steering Committee formed Supporting the Uninsured of New York City April 2002 December 2004 March 2005 AMA Foundation grant for health prevention & research awarded Starr Foundation grant awarded NYCFC relocates to larger clinic space, adopts electronic medical records New York City New York University School of Medicine in Partnership with the Institute for Family Health Milestones June 2005 - May 2007 Milestones June 2004 - May 2005 • NYCFC was awarded American Medical Association Foundation Grant to research and implement better patient health education and disease screening. • NYCFC obtains new clinic space with more exam rooms providing opportunity for future clinic growth. • NYCFC switches from paper charts to IFH's Electronic Medical Record system for more efficient and effective patient charting and data collection. • NYCFC increases continuity of care by receiving consult reports for referrals appointments at Bellevue Hospital. • NYCFC adopts new scheduling protocol to increase efficiency and number of patients seen per Saturday. • NYCFC implements new patient demographic survey to better assess patient population. Spring 2006 • The Langeloth Foundation awards NYCFC a substantial sum to be used for expansion of patient services at the clinic. • The number of clinical teams are increased and urgent care appointments are added, using the Langeloth grant. • Community Health Screening Outreaches begin in boroughs around New York City, using the Langeloth grant. • The Labs coordinators (two student volunteers) and Tisch Central Labs agree to begin liquid pap smears and reflex HPV testing for our female patients. • NYCFC and IFH work together to improve health care access by extending patient access to the main IFH phone lines for scheduling and medical questions every day of the week as well as for after-hours care. • The referrals coordinators (two student volunteers) work with Bellevue Hospital to minimize referral costs to the NYCFC and begin offering colonoscopy for the subsidized cost of a routine visit. • NYCFC partners with Reproductive Healthcare Access Group to open a women’s health clinic every other Saturday beginning February 2008. September 2007 November 2007 December 2007 Lab services begin to include PAP smears and HPV testing Phone service extends hours and expands to every day of week Lab services begin to include PAP smears and HPV testing Langeloth Foundation grant for expansion of services awarded. Clinical teams expanded Community Health Screening Outreaches commence in boroughs of NYC February 2008 Women's Health Clinic at NYCFC opens Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 9 Annual Report 2006-2007 Team-Oriented Approach I to Care n addition to addressing the healthcare a differential diagnosis under the supervision needs of New York’s uninsured, the of a physician preceptor, the clinical team NYCFC serves as an invaluable tool in presents d u cthe a t icase o n to i s the c eattending n t r a l t physician o the the education of all its volunteers. From in order to assess and develop healthcare NYCFC mission. It is a manifested pre-medical undergraduates to pre-clinical plan for the patient. Moreover, two medical in virtually every aspect (1st and 2nd year) and clinical (3rd and students gather specimens for any lab tests o f t h e cand l i n ianother c , f r opre-clinical m t h e Nstudent YCFC 4th year) medical students, New York ordered, m i n i s t ra t i oall n the t o referrals t h e S a trecommended u r d ay c l i n i c University students at all stages of theira dcoordinates medical training participate in all aspectssessions. by the clinical teams. The medical students of the clinic. are supported by undergraduate students who perform administrative tasks such as Administratively, a Steering Committee of During the Saturday clinic sessions, a team-seventeen registering patients at themedical front desk and second-year NYU students oriented approach to care is emphasizedmanages scheduling appointments. These thefollow-up executive operations of the as student and physicians teach andclinic, undergraduates also have the opportunity gaining direct experience not only in learn from each other. Teams of one pre- to shadow the clinical teams in the exam how to run an urban primary care clinic, but clinical and one clinical medical student rooms. have the opportunity to put into practicealso in developing a cost-effective model for healthcare in New York sessions City. Additionally, the skills and the knowledge acquired infree Enabling these clinical are the five fourth-year medical students serve as classes. After recording medical histories, members of the Steering Committee who, conducting physical exams, and generating with the support of IFH administration, manage the executive undertakings of the NYCFC. The Steering Committee includes 19 second year medical students who manage all aspects of the NYCFC , financially and administratively. Also on the Committee are two clinical students acting as liaisons to the six clinical coordinators who oversee the activities during the Saturday clinic sessions. In this way, the medical students on the Steering Committee gain direct experience in the administration and management of an urban primary care clinic. 10 E Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health Over the years, the NYCFC has developed a comprehensive set of free services available to Clinic all patients, and to the Clinic acontinues Coordinators provide stable liaison to expand its services in order and to ensure between the Steering Committee the Saturday access to quality healthcare regardless of clinic sessions while adding their clinical experience personal financial status. Working within "We work in teams to ensure to the management team. this model, students learn the practice of medicine in its purest form, where only the education of volunteers During Saturday clinicissessions, volunteers the patient’s health the top priority in at all and the best care for points in their training are involved in all developing themedical best treatment plan. aspects of patient care. A team-oriented approach New York's uninsured." Whether a member of the and clinical to care isbeing emphasized as student physician teams during sessions - R. James Toussaint, MSIV volunteers teachthe and Saturday learn from each other.or Medical contributing to the extensive coordination teams composed of one preclinical and one clinical and organization goes on behind medical student gainthat experience in seeing patients the scenes, volunteering with the NYCFC by taking medical histories, conducting physical affords students an invaluable opportunity exams, andtheir generating a differential to enrich medical education.diagnosis. At The student volunteers thenengage present in thethe patient’s the same time, students case to the by physician, and local together they develop community addressing healthcare an assessment and plan provide the best care access disparities. Whileto providing care, NYCFC learn first-hand about the possiblevolunteers for each patient. challenges and health disparities affecting the millions of uninsured. Students areat the Yet the experience that volunteers gain NYC Healthcare Facts exposed to public health issues and are NYCFC extends far beyond the provision of care. 1 million adult New Yorkers (1 in 6) are able how these issues translate to learn Fromto a see public health perspective, students the exam room, how they can adversely without health insurance. about both the challenges health affect the health and status of andisparities individual facing the millions of uninsured, see firsthand 47 million Americans lack health insurance. and the administration of and healthcare to a the importance of making a difference one patient at a population. This combination of witnessing Another 500,000 New Yorkers have time.state Working with and providing to care for the of healthcare for the access uninsured inconsistent coverage. some ofYork New City York’s most populations, in New and of underserved being proactive in community the volunteerinvolvement management prepares and clinicalfuture teams learn 3/4 of all uninsured New Yorkers are physicians advocate for their to confront to andbetter overcome the many barriers to employed. patients. healthcare access. 41% of the uninsured report that they have refrained from seeking medical care The NYCFC has developed a uniquely comprehensive due to cost. set of free services available to all patients, ensuring that access to quality healthcare will not be dictated by personal financial status. This model of free Source: Healthcare Access Among Young Adults in New comprehensive care also allows physicians and York City. A report from the NYC Department of Health and Mental Hygiene, May 2007. students to practice medicine in its purest form, where only the patient's wellbeing is considered in developing the best treatment plan. Volunteering with the NYCFC is integral to the Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 11 F i n a n c i a l Re p o r t 2 0 0 6 - 2 0 0 7 Fiscal Efficiency T he NYCFC has developed an operational model to provide comprehensive and quality care for the maximum number of uninsured patients possible given its current level of funding. Funding & In-Kind Contributions FY 2006-2007: while offering the highest quality care and full range of services to the greatest number ofd patients. ucation is central to the E NYCFC mission. It is manifested Students raised the in virtually efollowing very afunds s p e ctot budget. o f tcontribute h e c l i n ito c , the f r NYCFC om th e N Y CThe FC NYCFC's three main funding sources during administration to the Saturday clinic sessions. FY 2006-2007 were: Administratively, a Steering Committee of seventeen 1. NYU Supplemental Funding and The NYCFC received essential in-kind second-year NYUSOM medical students manages the Student Council contributions from three main sources during executive operations of the Funding clinic, gaining direct fiscal year (FY) 2006-2007: experience not only in how to run an$7,030 urban 2. Langeloth Foundation Grant primary care clinic, but also in developing a cost $22,399 1. Institute for Family Health/Starr effective model for free healthcare in New York 3. NYU SOM Student Fundraising efforts Foundation – clinic space, administrative City. Additionally, five fourth-year medical students 437 overhead, medical director, psychosocial serve as Clinic Coordinators to provide$31, a stable services, medical supplies liaison between the Steering Committee and the 2. NYU Medical Center – laboratory and IFH supports the NYCFC by donating radiology services 3. Bellevue Hospital Center – reduced clinic space and medical supplies, thereby eliminating overhead costs. IFH also provides cost specialty referrals the NYCFC medical directors and advisors Virtually all financial contributions made to the and clinic social workers. NYUMC remains NYCFC go directly to providing patient care. committed to supporting the NYCFC by The NYCFC has no overhead costs because providing all laboratory and radiology services clinic space and medical supplies are donated offered by the clinic. Bellevue Hospital Center by IFH through the generous support of the remains committed to supporting the NYCFC Starr Foundation. Additionally, all laboratory by providing specialty referrals at a reduced and radiology services are provided free cost to the clinic, enabling the clinic to refer of charge by NYU and Bellevue Medical patients to Bellevue Hospital Center at no Centers. Therefore, all clinic funding raised cost to the patient. by NYCFC students is directed to specialty referrals, patient education materials, and Budget FY 2006-2007: other essentials of the NYCFC’s uniquely The NYCFC annual student-raised operating comprehensive patient care. budget for FY 2006-2007 was $51,246. With To minimize these costs, the clinic has this money as well as our in-kind contributions, developed collaborative relationships with a the NYCFC was able to provide care to an number of hospitals, clinics, and nonprofit average of seventeen patients per Saturday organizations throughout New York City. for a total of 662 visits. Of the total budget, The NYCFC remains committed to seeking $44,000 went to specialty referral services, innovative solutions to minimizing costs while the remaining $7246 was distributed between volunteer support materials and 12 Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health training ($2,752), telephone services ($366), patient education materials and office supplies ($1,365), Steering Committee meeting expenses ($1,036), specimen and materials transport ($456), and $1,271 went to volunteer support and miscellaneous materials for both the clinic and community outreach teams. Even with the innovative and highly effective cost-reduction model employed by the NYCFC, the current budget limits the ability to serve additional patients and implement new prevention and outreach strategies. Since 2005, the NYCFC has continuously campaigned to secure additional funding in order to sustain current patient services; to allow for the expansion of services on Saturdays; to add an additional clinic devoted to women's health services; and to support community health outreach initiatives. Only with continued and additional financial support can the NYCFC better meet the health needs of New York's uninsured patient population. Income Statement 2006-2007* Sources of Funding Fundraising Langeloth Foundation Grant NYU SOM Student Council Total Funding $31,437 22,399 7,030 $60,866 Expenses Referral Services $44,000 Volunteer Support Materials & Training 2,752 Telephone Services 366 Patient Education Materials & Office Supplies 1,365 Steering Committee Meeting Expenses 1,036 Specimen & Materials Transport 456 Miscellaneous 1,271 Total Expenses $51,246 * This income statement does not reflect in-kind contributions from the Institute for Family Health/Starr Foundation, New York University School of Medicine, New York University Medical Center, and Bellevue Hospital Center. Student-Raised Finances for the Past Three Fiscal Years 70,000 60,000 50,000 40,000 30,000 20,000 Funds (In Dollars) 10,000 0 2004-2005 Saturday clinic sessions while adding their clinical experience to the management team. 2005-2006 2006-2007 Fiscal Year Income Spending Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 13 F i n a n c i a l Re p o r t 2 0 0 6 - 2 0 0 7 Patient Demographics T he NYCFC has expanded and diversified its patient population in each year of operation. During FY 2006-2007, the NYCFC served 335 patients during 662 patient visits. 14 Supporting the Uninsured of New York City New York Patient Population Residence and Fiscal Year by During FYs 2005-2007, the NYCFC served patients from 30 of New York City’s 34 communities as defined by the New York City Department of Health and Mental New York City New York University School of Medicine in Partnership with the Institute for Family Health Hygiene Community Health Survey 2003. Indicated on the map is the number of NYCFC patients from each New York City community during the past two fiscal years. Data are presented as number of patients from each community in FYs 2005-2007. Total FY 2006-2007 Patient Population by Residence Staten Island 3.0% Total FY 2006-2007 Patient Population by Residence Bronx 4.6% Queens 21.9% During FY 2006-2007, the NYCFC served patients from all five boroughs of New York City. The majority of our patients come from Manhattan and Brooklyn. Brooklyn 35.0% Since the NYCFC's opening in March 2002, the number of patients has increased annually across all age groups. FY 2006-2007 saw a majority of patients between the ages of 18 and 35, with the largest group consisting of patients aged 26-35 years. This has been a consistent trend since the clinic's inception. Manhattan 35.4% Patient Age: Fiscal Year 2006-2007 120 100 80 60 40 20 of Patients Number 0 Under 18 18-25 26-35 36-45 46-55 56-65 66+ Patient Age (Years) Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 15 F i n a n c i a l Re p o r t 2 0 0 6 - 2 0 0 7 Patient Services Statistics P atients come to the NYCFC with a variety of health concerns and medical conditions. It is therefore essential that the NYCFC offer comprehensive free services, which are widely utilized by clinic patients. Most Common Chief Complaints by Category FY 2006-2007 autoimmune, chest pain (cardiovascular or heartburn origin), cyst, domestic violence, hernia, lump, prescription refill, and shortness of breath. Most Common Referrals to Bellevue Hospital, by Specialty FY 2006-2007 Gastrointestinal, Mammography, Obstetrics and Gynecology, and Ophthalmology Data indicate that health maintenance, comprise the top four specialty referrals obstetrics and gynecology, and "Other" made by the NYCFC during FY 2006-2007. comprise the majority of NYCFC patients' A total of 175 specialty referrals were made chief complaints during FY 2006-2007. by the NYCFC to Bellevue Hospital Center during this time. All specialty referrals are Health Maintenance includes immunizations free to the patient. and physicals as well as preventive medicine and laboratory follow-ups. "Other" includes Most Common Chief Complaint by Category FY 2006-2007 Respiratory (3.1%) Psych (3.6%) Allergy/Immuno (1.8%) Cardiology (8.5%) Other Chief (9.9%) Most Common Complaints by Category FY 2004-2005 Most Common Referrals to Bellevue Dermatology (6.1%) Hospital Center by Specialty FY 2004Endocrine (4.8%) ENT (3.1%) GI (5.2%) OB/GYN (14.4%) GU/Renal (4.2%) MSK/Rheum (5.4%) Health Maintenance (29.8%) 16 Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health 2005-2006 2006-2007 Grand Total BMP 51 42 93 Card. 7 7 14 CBC 87 59 146 Derm. 25 11 36 ENT 6 5 11 GC/Chlam. 53 66 119 GI 20 33 53 Gluc. 20 32 52 HbA1C 4 11 15 HIV 53 45 98 Lens Crafte 2 3 Prescribed Medications Most Commonly Ordered Lab1 Services Most Commonly LFT 47 29 2006-2007 76 FY 2006-2007 FY Lipid Profil 123 89 212 29 26total of 389 prescriptions 55 The seven Mamm. most commonly ordered lab A were written by OB/GYN 17 NYCFC during 45 FY 2006-2007. The 15 most services at the NYCFC during FY28 2006-2007 the 16 33 were: lipid Ophth. profile, Gonorrhea &17Chlamydia common medications fell into the following Ortho. 14 5 19 (GC/Chlam.), Pap smear, complete blood therapeutic categories: allergy and cough Other 188 hormone 124 312 count (CBC), thyroid stimulating (Flonase, Nasonex), asthma (albuterol), Pap 59 66 125 (TSH), HIV, and basic metabolic panel (BMP). cardiovascular (hydrochlorothiazide, Lipitor, PT lab tests were ordered 3 4 7 A total of 811 during metoprolol, quinapril), c ontraceptive 32 73 this period. RPR All laboratory tests41are free to (Microgestin, Orthotricyclen), diabetes 7 5 12infection (ketoconazole, the patient. Surgery (metformin), TSH 57 56 113 mental health (trazodone, metronidazole), UA 38 24 62 Zoloft), pain (aspirin). X-Ray 8 6 14 Fiscal Year 2006-2007 140 124 Number of Labs Ordered 120 100 89 80 60 66 66 59 56 45 42 40 20 33 7 11 5 32 29 32 26 17 11 24 16 5 2 4 5 6 0 Lab Type Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 17 Annual Report 2006-2007 Physician and Student Volunteers A ll students associated with the NYCFC are volunteers and are not financially compensated by the clinic. Volunteers at the Saturday clinic are NYU medical students and undergraduates, and physicians from IFH, NYUMC, Bellevue Hospital Center, and private practice. More than 600 students and healthcare professionals have volunteered in some capacity at the NYCFC since it opened in March 2002. From 2005-2007, 9 physician preceptors, 211 medical students, and 21 undergraduates volunteered at the NYCFC. Physician Preceptors Amarilys Cortijo, MD Sarah Nosal, MD Daniel Blumkin, MD Robert Wolff, MD Ginger Gillespie, MD Linda Prine, MD Elizabeth Molina-Ortiz, MD J Robbins Lines, MD Ruth Lesnewski, MD Daina Danovitch, MD Six to seven supervised clinical teams, each comprised of one clinical and one preclinical medical student, see patients during the Saturday clinic. Clinical teams present to the attending physician preceptors on staff. Three additional medical students serve non-clinical positions performing laboratory services and processing specialty referral requests, among other functions. Four undergraduate students manage the front desk, assist in conducting patient surveys, and shadow the clinical teams throughout the day. In total, more than twenty students and physicians volunteer at the NYCFC each Saturday. New student volunteers rotate through the clinic every four months. Steven Chan Samyra El-ftesi Mike Guarnieri Richard Chang Lauren Ende Stacey Gunn Jennifer Chen Juliana Eng Pritha Payel Gupta Stephanie Cheng Oren Erlichman Liz Gurney Zina Chepurny Tom Facelle Emily Hanson Samir Chheda Adam Fein Jack Harbell Vivian Chin Daniel Fein Asheesh Harsha Bradley Ching Emily Feingold Melissa Herrmann Veena Choubey Miriam Fishman Monica Ho Reezwana Chowhurdy Francisco Folgar Kumari Hobbs Medical Student Volunteers Tina Chu Anthony Fontana Jennifer Hoffman Grace Chung Catherine Ford Jonathan Hoffman Anu Abraham Jessica Maria Atrio Michelle Black Jeremy Clain Daniel Frenkel David Hong Nitya Abraham Jonathan Avery Adam Blaisdell Jason Collins Justin Friedman Shuyan Huang Melissa Acevedo Diego Ayo Eve Bloomgarden James Crawford Adam Gaffney Anthony Shivani Agarwal Jonathan Baghdadi Cassyanne Aguiar Amar Bansal Sarabeth Broder-Fingert John Cruz Todd Cutler Shanique Brown Shawn Ahmad Elaine Barfield Kimberly Bucknor Linda Galperin Isenalumhe Tian Gao Rajat Jain Peter Czobor Al Garfall Rachana Jani Alex Gavlin Rebecca Jessel Benjamin Ge Nancy Jiang David Aizenberg Maya Barghash Alexis Burakoff Manesh Dagli Lourdes Al Ghofaily Vanessa Batista Charlie Butler Adele Damlamian Amber Alayyan Robert Baumgartner Caprice Cadacio Jennifer Danielsson Brian Ginsberg Josh Allen-Dickler Jeremy Beitler Brooke Davey Joelle Glick Nicole Kaban Quazi Al-Tariq Sabina Berezovskaya Mariela Cantera Jason DeBonis Michelle Goldberg Lana Katsnelson Deepti Anbarasan Jonathan Berliner Joe Carey Wojciech Dec Jordana Firestone Goren Marra Katz Elisa Aponte Chris Betchel David Carey Michael DiLorenzo Abby Green Dan Asay Mitesh Bhalala Demetrio Castillo Cindy Dodard Vadim Gretchouchkin Lauren Kennish Carolina Cernicica Rachel Edlin Michael Guarnieri Amer Assal 18 Lara Bishay Adrianna Campos Supporting the Uninsured of New York City Vicky Jones Brian Keegan John Keogh New York City New York University School of Medicine in Partnership with the Institute for Family Health (Continued) Medical Student Volunteers Kevin Small Katherine Khvilivitzky Allison Markowsky Shaline Rao Nat Smilowitz Brian Kim Kelly Maurelus Tara Rao Joshua Smith Jolyn Taylor Amy Yang Jessica Kim Anna Maw Stephen Rawlings Rick Smith Vitaly Terushkin Elaine Yang Minjee Kim Jeffrey Mayne Justina Raynor Daniel Soloman Sayone Thihalolipavan Ben Young Pablo Kim Kira Melamud Shivani Reddy Christian Song James Toussaint Jonathan ZagZag Carlene Kingston Kavi Menon Sruthi Reddy Carina Sorenson John Trahanas Jeron Zerillo Rebecca Kleinerman Michelle Mergenthal Derek Daniel Reformat Jaclin Springer Chizoba Umeh Shugi Zheng Brad Kligman Emily Miller John Reilly Ramya Srinivasan Levon Utidjian Inna Zhitomirsky Scott Koenig Sarah Mitchell Amanda Rubenstein Emily Stamell Alina Vaksman Lauren Kornreich Marisa Mizus Nate Reyes Teerath Peter Martin Wolff Tanpitukpongse Andrea Stroud Christopher Valente Meredith Kursmark Carrie Morgenstein Monalyn de los Patrick Sullivan Maksim Vaynrub Patrick Kwon Shweta Motiwala Joanne Sun Christopher Velez Juan Jose Lado Elizabeth Moye Barrie Rich Gloria Sung Kush Verma Catherine Lau Regina Mysliwiec Tanique Richards Nicole Sunseri Karin Warltier Ann Lee Miriam Nazmy Briana Riemer Rupali Surendra Avasare Amber Wheeler Annie Lee Jeff Neil Jordan Rihani Jordan Swartz Amanda Wilson Catherine Lee Vincci Ngan Eric Riles Pragati Tandon Amelia Wnorowski Grace Lee Ade Olasunkanmi Christy Riley James Lee Maribelis Olivares Sylvia Rivera Tom Lee Jonathan Oren Dave Robida Jennifer Leung Eleza Orenstein David Robida Brian A. Levine Arielle Ornstein Alexis Rodriguez Seth Lieberman Rose O'Rourke Caroline Rosenberg Brian Liem Kristin Ow Chapman Jennifer Rosenberg Emerson Lim Jenny Pan Sara Rostanski Ilya Lim Austin Pantel Jared Rubenstein Irene Isabel Lim Rushi Parikh Farrah Sajan Clarence Lin Susan Park Lourdes Sanso Edward Lin Sajan Patel Ryan Santos Dan Lorch Sunal Patel Claritsa Santos Malavé Reyes Labitigan Eric Wong Undergraduate Volunteers Front Desk Outreach Jackie Cartier Anne Sebastian Angana Homchaudhuri Hilary Mra Naoreen Chowdhury Kandy Bahadur Tracie Lin Sisi Guo Aqsa Durrani Tiffany Wu Angelina Daysudova Ria Nair Dina Elachi Shauna Kwok Elinor Zhou Saad Rasheed Scheduling Sanaa Somalya Charlotte Seyon Marcus Tiffany Hamil Linda Kim Anna Podolanczuk Amisha Shah Jessica Laifer Kristina Dvorakovskaya Michelle Ma Rebecca Podolsky Mansi Shah Ria Nair Ryan Macht Michael Postow Sarah Shalev Tiffany Wu Maura Madou Irina Privorotskaya Gaurav Sharma Jon Maffie Seema Pursnani Varun Sharma Rena Malik John Quick Peter Shue Brijesh Malkani Sergio Quijano Yelena Shusterman Nate Margolis Katharine Raisler Jeff Shyu Tracy Marien Satya Rao Jessica Singer Jennifer Louis-Jacques Sherine Patterson Jennifer Setlur Katrina Lust Alan Pinyavat Colleen Lynch Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 19 Annual Report 2006-2007 Appendix Student-Raised Finance Statement 2005-2006 E ducation is central to the Sources of Funding NYCFC mission. It is manifested Fundraising $24,478 in virtually eve ry aspect South Asian Community Health Grant 10,000 o f t h e c l i n i c , f r o m t h e NYU SOM Caring for the Community Grant 9,000N Y C F C administration to the Saturday clinic sessions. AMA Reach Grant 5,000 AAMC Caring for the Community Grant 3,000 Laura B. Vogler Foundation Grant 2,500 Administratively, a Steering Committee of seventeen New York Community Bank 1,000 second-year NYU medical students manages the NYU SOM Student Council 6,240 executive operations of the clinic, gaining direct Total Funding $61,218 experience not only in how to run an urban primary care clinic, but also in developing a costExpenses effective model for free healthcare in New York Referral Services $27,500 City.Materials Additionally, five fourth-year medical Volunteer Support & Training 2,781 students serve as Clinic Coordinators to provide Telephone Services 927 a stable liaison between the Steering Patient Education Materials & Office SuppliesCommittee 921 and the Steering Committee Meeting Expenses 628 Specimen & Materials Transport 412 Miscellaneous 1,549 Total Expenses $31,620 Most Common Chief Complaint by Category: FY 2005-2006 Psych (2.4%) Respiratory (1.8%) Allergy/Immuno (4.7%) Cardiology (2.1%) Dermatology (4.9%) Other (7.5%) Endocrine (3.5%) ENT (0.8%) OB/GYN (15.8%) GI (2.7%) GU/Renal (4.6%) MSK/Rheum (4.6%) Health Maintenance (44.6%) 20 Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health Saturday clinic sessions while adding their Total FY 2005-2006 Patient Population by Residence clinical experience to the management team. Bronx (3.5%) During Saturday clinic sessions, at all Statenvolunteers points in their medical training are involved in all Island (0.5%) aspects of patient care. A team-oriented approach to care is emphasized as student and physician Queens volunteers teach and learn from each other. Medical (21.3%) teams composed of one preclinical and one clinical medical student gain experience in seeing patients by taking medical histories, conducting physical exams, and generating a differential diagnosis. The student volunteers then present the patient’s case to the physician, and together they develop an assessment and plan to provide the best care possible for each patient. Brooklyn (37.1%) Yet the experience that volunteers gain at the Manhattan NYCFC extends far(37.6%) beyond the provision of care. From a public health perspective, students learn about the challenges and health disparities facing the millions of uninsured, and see firsthand the importance of making a difference one patient at a Patient Age: Fiscalto Year 2005-2006 time. Working with and providing access care for some of New York’s most underserved populations, 120 the volunteer management and clinical teams learn to confront 100 and overcome the many barriers to healthcare access. 80 The NYCFC has developed a uniquely comprehensive 60 set of free services available to all patients, ensuring that access to40quality healthcare will not be dictated by personal financial status. This model of free Number 20 of Patients comprehensive care also allows physicians and students to practice medicine in its purest form, 0 where only the patient's is considered Under 18 wellbeing 18-25 26-35 36-45 in 46-55 developing the best treatment plan. Patient Age (Years) 56-65 66+ Volunteering with the NYCFC is integral to the NYU SOM experience as the majority of students serve in some capacity at the clinic over their four Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 21 Looking Ahead: 2008 and Beyond To Better Meet the Needs T he New York City Free Clinic continually strives to improve its services, expand its patient base, and reach out to the underserved communities of New York City. Recently, the NYCFC has improved its Saturday clinic by increasing its patient capacity, by expanding the number of clinical teams and hours, and by collaborating with the Institute for Family Health to provide fulltime patient service representatives available by phone to our patients. of the Uninsured In addition to the Saturday clinic, the NYCFC has worked to provide services to underserved populations in two new exciting ways. The first is through community outreach programs. A team of student volunteers led by a dedicated physician utilize public health and prevention strategies to screen for cardiovascular disease and risk factors while offering education to patients throughout the greater New York City area. The second way in which the NYCFC has expanded its services is through the inception of a Women’s Health Clinic, opening in February 2008. This newest addition to the NYCFC will provide much n eed e d w o m e n ’s health services as there is a substantial shortage in the range and availability of women’s healthcare to the uninsured and underserved in NYC. NYCFC Steering Committee Top Row (Left to Right): Radhika Bauer, Gilda Boroumand, Rushi Parikh, Marc Ialenti, Elizabeth Gurney, Nathaniel Smilowitz, Pragati Tandon, Robert Baumgartner, Jeremy Beitler Middle Row: Mansi Shah, Brad Kligman, Rena Malik, Maura Madou, Jolyn Taylor, Emily Stamell, Sara Rostanski Bottom Row: Sajan Patel, Jonathan Baghdadi, Rose O'Rourke Not pictured: Pritha Gupta, Allison Markowsky 22 Supporting the Uninsured of New York City New York City New York University School of Medicine in Partnership with the Institute for Family Health Credits The successes of the NYCFC are due entirely to the strong commitment of its volunteer base, management, and organizational partners to providing quality and comprehensive healthcare services to the uninsured while educating the next generation of healthcare professionals. With the continued devotion of current collaborators and the never-ending search for new operational and financial partners, the NYCFC will continue growing and enhancing services to better serve the needs of New York’s uninsured. References From "Healthcare Crisis" Page 6, by Jessica Watterson (1) “Health Care Access Among Adults in New York City.” New York City Department of Health and Mental Hygiene. May 2007. http:// www.nyc.gov/html/doh/downloads/pdf/ hca/hca-nyc-adults.pdf (2)“Premium Rates For HMO Standard Individual Health Plans by County.” New York State Department of Insurance. August 2007. http://www.ins.state.ny.us/ihmoindx.htm (3)“Health Disparities in New York City. New York City Department of Health and Mental Hygiene. 2004. http://www.nyc.gov/html/ doh/downloads/pdf/epi/disparities-2004.pdf (4)“Increases in Health Insurance Premiums Compared With Other Indicators, 1988-2006.” The Commonwealth Fund. 2006. http:// www.commonwealthfund.org/chartcartcharts/chartcartcharts_ show.htm?doc_id=472720 (5)New York State Department of Health. http://www.health.state. ny.us/nysdoh/fhplus/who_can_join.htm/. Maximum gross annual income $25,755 for family size three, two parents and one child, effective January 1, 2007. (6)“Under 65: ER Use - Comparisons with US Insured and Uninsured, 2004.” The Commonwealth Fund. http://www. commonwealthfund.org/chartcartcharts/chartcartcharts_show. htm?doc_id=482809 (7) See Reference 1. To request a copy of the Free Clinic Annual Report, please email: info-nycfc@med.nyu.edu or visit us online at: www.med.nyu.edu/nycfreeclinic/ Layout & Design: Cristian Valenzuela- MS I Bridging the Gap: The New York Figures/ CityData FreePresentation: Clinic Annual Report 2004-2005 reflects clinic services and patient data Jonathan Berliner- MS I David Gutman- MS I Cristian Valenzuela- MSI Authors: Maura RZ Madou- MS II Jolyn S Taylor- MS II Jeremy R Beitler- MS IV Maya Barghash- MS IV Karina L Vivar- MS I Gilda Boroumand- MS II Jessica Watterson- Undergraduate Intern Acknowledgements: Patient database creation and management: Pragati Tandon- MSII Data Entry:The entire 2007-2008 steering committee and all of the undergraduate clinic volunteers, as well as invaluable help from: Kristin Ow Chapman, Kristina Dvorakovskaya Niushen Zhang, Irene Isabel Lim, Karina L Vivar, Jessica Watterson, Swathi Tadoori Additional Content Input: Mansi Shah, Marc Ialenti, Rena Malik, Rushi Parikh, Addie Peretz Editing: Maura Madou, Jolyn Taylor, Irene Isabel Lim, Karina L Vivar, Cristian Valenzuela, Joseph Oppedisano, Maxine Golub New York City Free Clinic 16 East 16th St New York, NY 10003 (917) 544-0735 www.med.nyu.edu/nycfreeclinic/ info-nycfc@med.nyu.edu Copyright © 2008 New York City Annual Free Clinic Bridging the Gap: Re- 23 New York City Free Clinic 16 East 16th St. New York, NY 10003 (917) 544-0735 www.med.nyu.edu/nycfreeclinic/