January 26, 2003
Project
Access makes strides in health care
By: Leslie Boyd, Ashville Citizen-Times
Then she got pregnant, developed complications and had to go out on disability. Soon after, her position was eliminated, and with it, her health insurance.
Her husband, Richard, had stopped working as a landscaper because of fibromyalgia, a pain and fatigue disorder, and later had to stop doing office work because the repetitive nature caused severe pain in his hands and wrists. Her son William was diagnosed with bipolar disorder, and the baby, Jazmyn, has mild cerebral palsy and a genetic disorder.
"I was paying $652 a month to continue my health insurance and the only income we had coming in was my disability," Eldridge said. "I had to borrow and borrow off my credit cards to pay the bills."
She hit the credit limit on all her cards and had to declare bankruptcy. The family was able to keep the house, but had no borrowing power and no way to pay the medical bills.
Then they heard about Project Access, a network of physicians; county government funding for medications; and Mission St. Joseph's Health System, which provides free medical care to people in need.
THE PROGRAM
Project Access, run by the Buncombe County Medical Society, serves uninsured people who have incomes of less than 200 percent of the federal poverty level, which is about $32,000 per year for a family of four. It saw its first patient in April 1996. At any given time it serves about 1,000 people, providing primary care to 300 patients and specialty care to 700.
"These are people who would wind up in the emergency room with serious problems if they weren't attended to," said Alan McKenzie, the executive director of the medical society. "Now they're cared for when they're not as sick, and it costs less to treat them. It's a win-win situation."
Almost as soon as Project Access was operational, other communities began to ask how they could set up similar services. The medical society has offered advice to dozens of communities across the country, and now it will be able to act as a formal consultant with the formation of the American Project Access Network, which kicked off in Raleigh last month.
Already, an informal network of programs exists in communities from Michigan to Georgia. But McKenzie hopes to formalize that network and shorten the start-up time for communities deciding to implement the program.
So far, 18 communities have operating programs, all assisted by the Buncombe County Medical Society, said David Werle, the access network's executive director.
"People don't think they have the resources to do this, but we're showing them they do if they work together," he said.
According to a recent study by the American Medical Association, about two-thirds of doctors in the United States provide charity care for an average 8.8 hours per week. But, McKenzie said, few would say so in public for fear they would be inundated with needy patients.
"What we've done here is get them together so they can say it collectively," Werle said. "It's called secret care and we're declaring it."
Nearly 90 percent of specialty doctors in Buncombe County provide some free care. Together they provided over $4 million in care in the last year.
THE PATIENTS
For patients, the care means they can get on with their lives.
The Eldridges have seen several doctors, including a family practitioner, an internist, a urogynecologist and a gastroenterologist.
"Each time I go to the doctor, I feel like I get to keep my dignity and my pride," Michelle Eldridge said. "I can't tell you what that means."
Richard Eldridge has gone back to school to study phlebotomy. He is almost assured of a job when he graduates because of the shortage of medical personnel, and that job will have health insurance.
That happens a lot, McKenzie said. In fact, about half of Project Access patients go on to get jobs with health benefits.
Project Access operates like a health plan. Patients get a card that they present at the doctor's office, and the office fills out paperwork similar to a claims form. It all allows care and its value to be tracked, McKenzie said. It also allows the patients the dignity of handing over a card at the doctor's office instead of having to say they're uninsured.