Charitable clinics provide health care to kids in need

By Todd Hartman, Rocky Mountain News (Contact)

Monday, December 31, 2007

Chris Schneider / The The Rocky

Ruth Sidransky plays with her son, Elijah Sidransky, 2, as they wait to get a flu shot Friday in Denver at the Rocky Mountain Youth Clinic, where ability to pay is not a factor in patient care.

Not all kids can easily get into a typical doctor's office for a checkup, immunizations, a sore throat or injury. But any kid at all - with or without insurance, regardless of ability to pay - will be seen by doctors and nurses at Rocky Mountain Youth Clinics.

The clinics provide primary health care to newborns, kids, teens and young adults at three offices in Denver, Aurora and Thornton. The clinics also use two mobile health vans and operate 20 satellite clinics along the Front Range in cooperation with other community organizations.

Larry Wolk, a doctor, created the nonprofit clinics more than a decade ago, concerned about the unmet medical needs of young people without resources. The clinics are seeking a Season to Share grant.

Dr. Wolk, how did your agency get started?

I trained at Children's Hospital and Denver Health, both great organizations, but they're not necessarily serving all the needs of all the kids. It's why I was looking into adolescent medicine because teenagers seem to be left behind. I went to the IRS myself to incorporate (his existing practice) into a nonprofit. We worked together to establish charitable rates and charitable rates of pay and what it would take. No physician-owned practice ever went through this exercise of converting from a for-profit medical practice to a not-for-profit clinic. That allowed us to start approaching funders to subsidize the work we were doing.

How else do you sustain the clinics economically?

We continue to generate somewhere around 65 to 70 cents of the dollar we need to operate the program: If we're a $5 million program, we can actually collect $3- to-$3.5 million from patients using third-party insurance or Medicaid or self-pay (or other programs) because we have a very streamlined model. About 20 percent of our patient population is uninsurable and can't pay, and ever since I started the practice, we said we would never deny services to patients who couldn't pay or patient's families who couldn't pay.

Why did you get into this line of work?

My father was a pediatrician, so I had that medical influence through him. But when I went through my residency, my thought was I was being a doctor to help people. And I wanted to find a niche where people really needed help the most - and between kids and teenagers and (work providing health care to) inmates, I'm pretty close to it. It's not a religious thing or that I was raised on a farm barefoot. It just seemed like that's what all doctors are supposed to do.

Can you talk about a case in which your agency really made a difference?

What I always tell people is we do a million small successes rather than the gut-wrenching, big oh-we-provided-a-child life-saving chemotherapy. Ours are more along the lines of we identify children every day that don't have their immunizations, so we provide those. We identify children every day that wouldn't otherwise be able to get their ear infection treated by antibiotics.

What about children who you discover need specialized medical help?

We have a specialist network that we've engaged. We're very resourceful. It's great for us because we capitalize on what Children's Hospital provides, what Presbyterian/St. Luke's provides. We'll talk to specialists, we'll talk to the hospitals, we'll negotiate bills. We can't provide everything, but we find a way to work with the other folks and the other resources in the health care system.

How have your clients changed in the last few years?

Our clients have always been indigent. They're migrants. We serve a lot of minorities. Ethnically, it's kind of the same mix we've had since we've started. We've always tried to get kids in right from birth. The majority of our patients are in the first year of life. We continue to stay focused on the adolescent operation. Those are the kids who fall through the cracks.

What's the biggest need among the people you serve?

My perspective is the biggest need is consistent and affordable health care for kids because we can only handle the primary care piece of it. We're outside their loop if families go to the emergency room or get a prescription filled or they need a specialist or whatever. If we can orchestrate that, that's great. But it's not consistent because there are holes in that system. From families' perspective, I think it's the basics: housing and food and clothing and consistent job availability. These are things that I say directly - and others might say indirectly - affects their health. Studies have shown if you have health insurance, you are healthier. For these folks, if they can have better living conditions, which include getting health insurance, then their kids can be healthier.