FACT SHEET FOR SHAWNEE COUNTY MEDICAL SOCIETY HEALTHACCESS VOLUNTEERS
What is SCMS HealthAccess?
SCMS HealthAccess is a community partnership improving access to health care for low-income, uninsured residents of Topeka and Shawnee County. HealthAccess combines donated physician care, hospital services, and medication assistance in a coordinated program led by the Medical Society. HealthAccess was designed to complement and enhance the work of existing low-income clinics and other community agencies.
Why is HealthAccess needed?
Although many residents of Topeka and Shawnee County have health insurance and reliable access to medical care, 24,000 - 30,000 do not. Often, those without health insurance work in one or more low-wage jobs without health benefits, earning too much to qualify for programs like Medicaid, but not enough to afford health insurance and still meet other essential needs such as food, clothing, and housing.
Beyond the unmet human needs, the illness burden of the low-income uninsured is borne by the entire community through preventable barriers to education and employment, an increased need for social support services, and higher overall health care costs for the community. Although the low-income, uninsured receive some health care, it often comes late in the course of illness and rarely in a coordinated or efficient way.
HealthAccess is an opportunity for doctors, hospitals, local government, and community agencies to help existing low-income clinics provide coordinated, efficient care for the low-income uninsured more effectively than any single entity could provide alone.
Why should I support HealthAccess?
HealthAccess is a highly visible example of physician leadership in action. HealthAccess is designed by physicians, coordinated by the Medical Society, and focused on the fundamental values of the health care profession.
Many physicians already care for uninsured patients; others would gladly help meet this need if the burden was shared fairly and the work valued. HealthAccess demonstrates the commitment of physicians to patients and our community in a way that is organized, efficient, and properly recognized.
How does HealthAccess work?
HealthAccess is a referral network available to existing clinics and agencies that give medical care to the low-income uninsured. HealthAccess is designed to provide comprehensive healthcare services beyond the scope of care available at clinics and agencies. Patients enrolled in the program receive necessary physician care, hospital care, and medication assistance at no cost.
Who can receive this care?
HealthAccess patients must live in Shawnee County, not have insurance, and not qualify for health benefit programs like Medicare or Medicaid. Total family income must be 150% or less of the federal poverty guidelines.
How are patients referred to HealthAccess?
Patients are referred through a variety of entry points including the Marian Clinic, Shawnee County Health Agency, participating physicians, local hospitals, and SRS.
How will patient visits be scheduled?
Patients do not schedule their own initial visit. HealthAccess staff or schedulers from the Marian Clinic or Shawnee County Health Agency will contact your office to set up each patient’s first visit. Each referral is recorded by HealthAccess. We will let patients know when and where their appointments are scheduled.
What do I do when I see a HealthAccess patient?
HealthAccess patients are scheduled like insured patients and should present their HealthAccess card at the time of service. Your office staff should submit a standard billing and coding form (HCFA-1500) to the HealthAccess office by mail, or electronically to Blue Cross and Blue Shield in the same way as insurance plans, except you will not receive payment. After the claim is submitted you may want to immediately write it off. The HealthAccess group number is SCMSHA. This paperwork helps us track the donated services and the value of the care provided.
If the patient needs diagnostic services such as laboratory studies, X-rays, or other tests, and they are regularly done in your office, you may choose to donate these or HealthAccess will assist your office staff in arranging for these studies at other participating facilities. If a referral to a specialist is needed, please contact the HealthAccess office for information regarding participating volunteers. HealthAccess does not include pregnancy related services.
After you have finished seeing a HealthAccess patient, please call or write the referring practitioner just as you do for other patients in your practice.
How are my volunteer hours and donated services tracked?
HealthAccess patients are required to present their Patient Identification Card at the time services are rendered. Blue Cross and Blue Shield of Kansas voluntarily processes all of the HealthAccess claims submitted. They have assigned group number SCMSHA specifically for this program. This number appears on the Patient Identification Card. By electronically submitting a HCFA 1500, HealthAccess will record your volunteer hours. If you prefer, you may also mail these to the HealthAccess office.
If you have decided to participate as a volunteer at the Marian Clinic, you will not need to submit a HCFA 1500. Marian clinic staff will record your volunteer time and will send the HealthAccess office notification of hours volunteered.
Who decides how many times I will see an established HealthAccess patient?
Every effort is made to encourage stable doctor-patient relationships. Together with the patient, you will decide how many visits are needed to be sure their health needs are met. Patients are initially enrolled in HealthAccess for six months. If additional care is needed, patients may be re-enrolled as long as they continue to meet eligibility requirements.
What if a patient needs hospitalization?
Stormont-Vail Regional Health Center and St. Francis Health Center provide donated hospital care for HealthAccess patients. Admit the patient to the hospital as you would other patients in your practice. Ambulance and emergency room care are not included.
What if a patient needs medication?
HealthAccess patients are given a pharmacy card with a $1000 annual limit for use at area pharmacies for outpatient prescriptions written by HealthAccess physicians. Only generic medications are covered. Patients are responsible for a $10 co-payment for each prescription when they receive their medication. Area pharmacists, through the Prescription Network, donate their services and provide medications to the program at cost.
What is the patient’s responsibility in the program?
Patients are responsible for keeping appointments and making a good-faith effort to work in partnership with their doctors to carry out the plan of care recommended. Patients may make a contribution to the program if they can. These contributions are used to help defray the ongoing costs of operating the program, not to reimburse the doctors, hospitals, and pharmacists who volunteer their services.
I already care for low-income patients. Does this count?
Yes it does, THANK YOU! With your help we hope to record and recognize this service. The number of low-income patients you are already seeing counts toward your pledge for HealthAccess; please refer them to the HealthAccess office to be enrolled in the program. By enrolling your patients you receive recognition and your patients become eligible for the comprehensive services HealthAccess provides, such as hospitalization, specialty referral, and medication assistance.
How can I be sure I will receive only the number of patients that I agreed to see?
HealthAccess maintains a special referral system to assure that only the number of patients that you have agreed to accept will be referred to your practice. Referrals rotate among physician volunteers to assure equal distribution of patients.
What about malpractice coverage?
In the unlikely event that a physician would be sued for care donated to a HealthAccess patient, usual malpractice coverage would apply. In addition, the State of Kansas through the Charitable Health Care Provider Program allows health care providers giving care to the medically indigent under certain conditions to be indemnified for liability purposes under the state Tort Claims Funds. This means that a doctor giving care could be defended by the Attorney General’s office and the Tort Claim Fund would be the payer of the first resort if there exists other insurance coverage.
How can I help?
It is up to you to decide how you wish to be involved in HealthAccess. Some recommendations include:
- Specialist Physicians
Accepting 20 HealthAccess patient referrals over a year
- Primary Care Physicians
Accepting 10 HealthAccess patients into your practice over a year
- Volunteering at the Marian Clinic
Volunteering for 24 hours during the year - specialists, primary care physicians, and retired physicians
Additionally, physicians may wish to help by recruiting volunteer physicians or participating in the planning, operation, or evaluation of the program.
Too few people of our community know of the many volunteer efforts by our physician community. One of our primary goals is to help increase awareness of these activities by working with area media and establish ongoing public recognition programs.
We are counting on you!
We know we are asking a lot of you. We know we can count on your support. You know you can count on your Medical Society.
Please call us if you have questions or need additional information. You may reach the HealthAccess office at the Medical Society by calling Karla Hedquist, Program Director, at 235-0996 during business hours.