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Free clinic to start billing

For nearly 23 years, thousands of North Baltimore residents without health insurance have relied on the 350 volunteers at Shepherd’s Clinic for the medical care they need but cannot afford.

Above, Melissa DeLong, M.D., medical director of the Shepherd’s Clinic, with Ephraim Oduche, a patient of the clinic since 2009. Bottom, the clinic is on Kirk Avenue in the Coldstream-Montebello neighborhood. (The Daily Record / Maximilian Franz)

But starting this year, the Affordable Care Act will — theoretically — help many of those patients become insured. That puts Shepherd’s Clinic, a nonprofit affiliated with MedStar Union Memorial Hospital that caters specifically to the uninsured, in a weird place. How to continue its mission of serving a vulnerable population in the community when many of its patients suddenly have insurance after all?

The answer, said the physicians who manage the Kirk Avenue clinic, is a new primary care practice, under the same roof, staffed by MedStar-employed physicians who will bill for their services as they would in a traditional office practice.

By taking this step, the clinic is evolving along with the community it serves, said the clinic’s medical director, Dr. Melissa DeLong, who is also an internist at Union Memorial.

The new practice, called the MedStar Union Memorial Hospital Adult Medicine Specialists at Kirk Avenue, will enable existing patients to continue visiting the same location and possibly the same doctor, even after they become insured. The goal is to provide continuity of care, which is crucial to ensuring that people keep up with their health needs, Delong said.

“As these patients become eligible for insurance, we wanted them to be able to maintain their medical home, so we’re forming this kind of hybrid model,” DeLong said (the clinic will still serve the dwindling number of insured). “The ACA is bringing this new opportunity for many patients to be able to enroll in insurance, so we want to support that transition, but also not force them out of this place where they’ve been for years.”

This won’t be the first time some of the clinics’ patients have transitioned out of the program. That has typically happened when patients have turned 65 and become eligible for Medicare. Sometimes, said DeLong, “We really had to convince them that this was a great thing, because they really didn’t want to leave the clinic.”

As Shepherd’s physicians were planning how to handle the ACA, they were concerned that some patients might resist getting insurance, even if they qualified for Medicaid, because it would mean leaving the clinic and finding new doctors. That was the motivation behind launching the new practice.

For low-income patients who remain uninsured because they’re ineligible for Medicaid or subsidies on the exchange, the volunteer physicians will continue to be available in four of the eight exam rooms.

The new MedStar practice, which will also accept new insured patients, will use the other four rooms.

One patient, Ephraim Oduche, 63, said he’s grateful he will be able to continue receiving care at Shepherd’s. He first visited the clinic several years ago after an accident left him jobless and uninsured, he said. The electrical engineer has “a lot of different ailments,” so for the past five years, he’s been a regular visitor, he said.

Last month, Oduche learned he’d been accepted into Medicaid because of his disability. Without the new practice, the clinic would have had no way of billing Medicaid, and Oduche would have had to go elsewhere. But Oduche only lives a few blocks away, he said.

“I can get what I need here,” he said. “Dr. DeLong has been instrumental in helping me figure out the insurance. If left up to me, I would opt to remain here.”

In addition to primary care, the clinic also provides services such as behavioral health counseling, cooking lessons and other wellness programs.

In its last fiscal year, which ended June 30, the clinic logged 7,029 patient visits. Total revenue was $780,119, and expenses totaled about $742,000.

Down the line, new revenue from billing insurers will likely help bring in more MedStar physicians to fulfill an anticipated demand surge, said Dr. Dana Frank, chairman of the Department of Medicine at MedStar Good Samaritan and Union Memorial hospitals.

Shepherd’s Clinic has a longstanding relationship with MedStar, which has helped provide clinical, technological and financial support since its inception, said Frank, whose responsibilities include building primary care “access points” in surrounding neighborhoods.

The idea for the clinic was hatched in 1989 by a Union Memorial physician’s assistant who noticed the emergency room was overcrowded with uninsured patients seeking non-emergency care.

The clinic saw its first patients in June 1991, and with the help of Union Memorial’s former chief of staff, Dr. William H.M. Finney, forged a relationship with the hospital that enables the clinic’s patients to receive free specialty and surgical care.

In 1999, Finney created a foundation in his name for the sole purpose of raising money for the clinic, which has twice relocated to larger digs. It’s been at Kirk Avenue since 2006.

Nestled in the Coldstream-Montebello neighborhood near Baltimore City College, the clinic is large and welcoming, with no detectable “doctor’s office” smell. Even on a rainy day, the office is bright, the walls plastered with vivid works by local artists. Patients and staff members greet one another by name.

In the rear, all traces of a medical clinic disappear, giving way to a yoga studio, a demonstration kitchen and a suite for massage and acupuncture therapy. This part of the clinic won’t change; DeLong said the services will continue to be offered by volunteers for all patients, regardless of insurance status.

“These are services that our patients probably wouldn’t be able to access otherwise,” DeLong said.