Project Access
A win-win program for physicians and patients

Do you ever see patients in your office who have no insurance, but come in and pay cash because they finally got worried enough (or sick enough) that they couldn’t go on without seeing a doctor? I certainly do. The working poor of our society often don’t have health insurance because their employers don’t offer it and if they do, the employees can’t afford to buy it. They need every dollar they can earn, so they won’t miss work to go to the doctor unless they are desperate. When they finally do show up, their disease often is quite advanced. For the patients I see in my colorectal surgery practice, that means they often have waited too long for me to be able to fix the problem with office treatment. Now they need surgery, but I can’t operate on them, except in an emergency (such as an abscess), because the patients can’t afford to pay the hospital or surgery center. Therefore, they leave with a problem that a minor operation could have corrected.

This group of patients presents to primary care physicians with chronic diseases that are out of control or totally untreated. They wait until they are too sick to work and then go to the emergency room. Sometimes they require hospitalization. Then when they leave the hospital, they may quit taking their medications because they can’t afford them, starting the downward spiral again.

Fortunately, DCMS has launched a pilot program to deal with this problem. It’s called Project Access. It is a collaborative effort among DCMS, physicians, clinics, hospitals, and business. Individual physicians and hospitals are being recruited to participate, and more than150 physicians have signed up to help.

Here’s the concept: A limited number of patients who are employed, but make less than 200% of the federal poverty level, will be enrolled and given an ID card (similar to an insurance card). They will be assigned to a primary care physician or referred to a specialist, as appropriate. When they come to the office, they will present their Project Access ID card and, although their visit will be “billed” to Project Access on the standard HCFA 1500 insurance claim form, the services are provided for free. Each participating physician will indicate how many Project Access patients he is willing to treat each year (6 to 10 for primary care physicians and 15 to 25 for specialists).

The advantage for us as physicians is that we can see these patients in our office; the occasional Project Access patient will be interspersed among our regular patients. We will have all the exam and treatment equipment we normally use. We won’t have to take half a day off once a month to go to a free clinic to accomplish this goal. At the end of the year, we’ll receive a report showing how many patients we saw and the value of that charity care (based on coding from the 1500 forms). We’ll be able to quantify the charity care that each of us already provides in our offices that otherwise we would write off as “bad debt.” If the patient needs referral to a specialist, specialists are signed up who are willing to see the patient. If the patient needs surgery, hospitals are signed up that have agreed to accept the patient. Pharmaceuticals will be available to patients at reduced cost.

“Will it really work?” you may ask. The best aspect of Project Access is that it does work. Project Access was started in Asheville, NC, by the Buncombe County Medical Society in 1996. Since then, more than 10,000 patients have been seen by 520 physicians, representing 85 percent of the county medical society membership. As you might expect, 80 percent of Project Access patients report that their health is much better now that they are in the program. What you might not expect is that emergency room visits in Asheville have declined by 28 percent since the program started. And Project Access is not a permanent welfare program for these people—half of the former Project Access patients now have healthcare insurance! Perhaps that is because they are healthier and are able to stay on the job and perform better.

Project Access is equally successful in Wichita, Kan. Drs Michael Bates and Paul Uhlig shared their stories of success at our Project Access Community Forum on Feb 28. Alan McKenzie, CEO of the Buncombe Medical Society, gave us data on the success of the program in Asheville at that same meeting. Plans are underway to start Project Access in Austin, Houston, and several other cities around the country.

We are starting slowly, to make sure we have all the pieces of the administrative structure soundly in place. In the long run, the secret to the project’s success will be enrolling as many physicians as possible to distribute the patient load as broadly as possible. If you have not yet signed up, I urge you to give it your careful consideration. We need your help!

For more information or to enroll in Project Access, contact Sharka Jones, Project Access manager, at 214-948-3622 or sharka@dallas-cms.org.

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