This scenario plagues many Americans across the country and has physicians like Dr. Carlos Vargas of Franklin creating alternatives to combat the problem.
Inspired by a California family clinic, Vargas is starting a community clinic in Franklin called Perpetual Health that will provide primary medical care to the insured and uninsured.
Vargas, 40, got the idea one night when he was surfing the web and discovered a non-traditional community health clinic in Modesto, Calif. The clinic, St. Luke’s Family Practice, fit the bill of the type of services Vargas wanted to provide to his community.
“I have always wanted to do primary care and serve the poor,” Vargas said.
“There were so many things in that model that matched what I wanted to do — it was like a ‘spiritual match,’” he said. “It felt like more than just a neat idea.”
Creating a clinic where the uninsured and insured both benefit and receive care is a new take on health care services. At most community health clinics, only those who have no insurance or have a low-income are able to receive care.
With Vargas’ model, any member of the community has the opportunity to receive primary care.
“There is no reason why we can’t have 10,000 of these,” he said. This is a self-sustaining way to take care of our own.”
Primary Care and the uninsured
Vargas realized that there was a need for another community health clinic in Macon County while volunteering at the Highlands Community Care Clinic.
About 50 percent of the patients he saw were from the Franklin area, he said.
According to the U.S. Census Bureau’s 2005 estimates, 44.8 million U.S. residents lack health insurance and approximately 1.3 million of those uninsured live in North Carolina. In Macon County, about 20 percent of the county’s residents are uninsured, according to a study conducted by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill and The North Carolina Institute of Medicine.
Health departments across the state are working diligently to bridge the gap between health care services and the uninsured. Organizations like the state Rural Health and Community Care Center develop health clinics and recruit physicians to North Carolina.
“There is a need in the state for health care access for the uninsured,” said Mark Snuggs, a data analyst at the center.
The statistics reveal that a lot of people do not work in a job with employer-based insurance, he said. If they have to go to the doctor, they are paying for it out of pocket.
“There is always a need for someone to see these folks,” he continued. “It’s sort of the biggest game in town, state wise,” he said.
When health officials in Macon County heard about Vargas’ idea, the response was supportive.
“I think it’s very positive,” Macon County Health Director Jim Bruckner said. “He’s definitely a physician meeting the needs of the uninsured. I think he is doing his part, and there is a need here in Franklin.”
Kathy McGaha, program director for Healthy Carolinians for Macon County, is also a supporter of Vargas’s clinic.
“A lot of good things are happening in the West (United States) as far as trying to provide people with this care,” she said. “Doctors and organizations are becoming creative to meet the needs of the people who are falling through the cracks.”
Once Vargas’ clinic opens, it will help increase the number of people seen by a physician. About 1,070 patients a year will be seen between the two clinics, Bruckner said. There are 6,500 residents who are uninsured in Macon County.
After graduating from University of North Carolina’s medical school in the late 1990s, Vargas moved to the mountains of West Virginia to complete his residency at West Virginia University’s Ruby Memorial Medical Center.
It was this experience that would attract Vargas and his wife to the mountains of Macon County.
“I just loved the area and the mountains,” Vargas said. “I wanted to live in a place with a small-town atmosphere.”
Vargas moved to Asheville, where he worked as a partner at a family practice. But working as a traditional family doctor was not the path he wanted to follow.
“It just wasn’t for me,” he said.
Acupuncture therapy training helped Vargas expand his vision of the kinds of treatment that could help his patients. When he left the family practice he started incorporating acupuncture therapy in with his family practice medicine.
“I just had to take a dose of my own medicine,” he said.
He started his own practice, called New Mountain Medicine, where he offers integrative health care for his patients.
St. Luke’s family practice in California, the model Vargas is trying to emulate, serves patients who are insured and uninsured. The clinic takes on patients who have health insurance and provides them with the services that one would receive from a family physician. The clinic calls these people benefactors because they pay a set fee for a year of care.
The fee allows the clinic to provide services to those who do not have health insurance, called recipients by the clinic.
But St. Luke’s is located in a community of more than 200,000 people and is quite different than what would be needed to serve patients in Franklin. So Vargas transformed St. Luke’s model to meet the needs of a small community in rural Appalachia.
“If we can pull it off here, it can be pulled off anywhere,” Vargas said.
While formulating the clinic’s specifics, Vargas sought out the help of his church and received a blessing from his priest. Vargas considers this deed a spiritually-guided effort and part of his Catholic faith.
“It’s a Christian mission in a community,” he said.
Next year Vargas hopes to have the clinic fully operational. He already has a board of directors established and is currently looking for an office space.
In order to make the clinic work, Vargas needs 300 benefactors to participate. Each benefactor will pay a sliding fee, which will be used to operate the facility.
The annual fee is $550 for kids, $1700 for those over 60 and $1,300 for those 35 years of age and older.
The 300 benefactors will generate enough money to subsidize a full-time clinic. The other part of the time Vargas will be providing free clinical care.
Benefactors who pony up the money will be able to see a return. The clinic is in the process of receiving its nonprofit status and will keep track of the number of visits from each benefactor. If a benefactor does not visit the physician enough to use up his contribution, whatever money is left will be considered a donation and can be deducted from taxes.
In addition, benefactors who donate to the clinic have the option of lowering their health insurance premiums. Since they are paying for primary care, they can investigate or explore higher deductible or lower premium options from their insurance company, Vargas explained.
The only time a benefactor would use their health insurance at Vargas’ clinic is if he or she needed lab work or X-rays.
At a typical free clinic, patients wait for long hours just to be seen by a doctor who has been working all day somewhere else. Treatment is quick and rushed because of the number of people. A 5:30 p.m. appointment can lead to one sitting around until 8 p.m. at night just for prescription for an antibiotic.
Vargas is changing this process at his clinic.
At Perpetual Health clinic patients will be able to see Vargas four days a week by scheduling an appointment. Vargas said having appointments will allow him to actually spend time with his patients.
“I want to be able sit down and figure things out,” he said.
This will also help create a professional environment for Vargas and his patients.
“They will not be rushed through or wait forever,” he said.
In addition, patients will be able to access the clinic’s scheduling book on the web. The clinic will offer virtual office visits that will allow patients to go online and see when there is an appointment opening instead of calling the office to make an appointment.
When Nick Murphy heard about Perpetual Health, he thought the clinic would fit his needs perfectly. He has Medicare but would like additional coverage.
“I want something better than that,” the 65-year-old said. “Medicare is good if I am in an accident, but not for routine care.”
Murphy said he was also attracted to the idea of being a benefactor because the donation is part of his Catholic faith.
“That’s what being a Catholic is all about,” Murphy said about his donation.
At Perpetual Health, Murphy will pay a fee of $1,700 a year for care. His fee will help people like Lori McCreadie.
McCreadie has been battling heart problems since she was a child. Seeking medical care was not an issue for McCreadie as a child because she had health insurance through Medicaid. She lost the coverage when she turned 19, however, and because she had a serious medical condition and no health insurance she stopped going to the doctor.
“Who’s going to pickup a person with a pre-existing condition like hers,” said her mother, Charlene Puckett.
McCreadie hasn’t been to see her heart doctor or seek routine care for her pacemaker since she lost her insurance.
Because McCreadie lives with the heart condition, she is more prone to illness than others.
“She just gets sicker than other people,” Puckett said. Living a “normal life” is difficult for McCreadie. She works part-time as a waitress and has ambitions of going to college but is unsure of a major.
When Puckett heard about Vargas’ clinic, it was a glimmer of hope for her daughter. Vargas will be able to treat McCreadie for her primary care needs.
“When I heard about this, I was very excited and I’ve been on cloud nine ever since,” she said.
How it works
Perpetual Health is a community-supported practice. The clinic will provide care to two types of patients. The “benefactors’ are people who will be paying a sliding fee that is based upon their age. The fees range from $550 for children to $1,700 for those over the age of 60.
The benefactors will pay this fee up front, which will be used to help with the clinic’s daily operations. The benefactor donation enables them to have unlimited visits to the clinic.
The money generated from the benefactors will also provide free health care to the uninsured. The clinic calls these patients “recipients.” The clinic’s hours will be divided between the two groups of patients.
For more information about the clinic visit www.perpetualhealth.info.