It’s a Tuesday in mid-December, and it is still light out at 4:45 p.m., so it is easy to see the folding sign outside the Level A side door to Mayo Clinic Health System in Menomonie. It says, “Free Clinic of the Greater Menomonie Area,” with an arrow pointing to a brown door with a number 3 on it.
It’s my first time here during — or before — open hours at the free clinic, although I spent lots of time here some years ago when I worked on Level B downstairs. So I don’t know what to expect when I step inside.
The waiting room is empty except for several volunteers behind the reception desk. Then there is a young woman who comes in and picks up a slip of paper from the desk, followed by a young man, and then another young man. No ... that’s the pizza deliveryman, with food for the volunteers, so two patients so far for the free clinic.
Then another older man, a middle-aged woman, and another young woman come in. It’s a sort of slow day for the free clinic — but it’s early yet, since registration is open 5-7 p.m. on a walk-in only basis.
I had heard stories about 50 or so people lining up outside before the free clinic door opened at 5 p.m., when it first started in 2005. Volunteers were able to set up a lottery system inside, with a number pulled out of a hat, so that it didn’t matter so much when people got in line, and patients no longer felt the need to line up early.
Since the Affordable Care Act (ACA or Obamacare), many of those former patients can see a medical professional without depending on the free clinic. That original 50 or so dropped to 15 to 20 after the ACA and is now down to 6 to 12 an evening.
Two physicians or nurse practitioners/physician assistants are available to see them, after completing their daytime clinic, rather than the three that were needed in the past. Several of the providers have been volunteering since the clinic started in 2005.
How it works
The first step says clinic coordinator, Elizabeth Ritz Witt, R.N., is for a new patient to complete a health history/registration form. Then an intake volunteer talks with the patient to review their income eligibility. “If a patient has BadgerCare, VA benefits or other insurance, they are not eligible,” Ritz Witt says.
The patient will be seen at least once, and an interviewer will see if they have other insurance benefits, and if they are in need of other social services like food, clothing or dental care.
“Ninety-nine percent of our patients are eligible for the free clinic, and on occasion they are referred to Human Services of Dunn County to apply for BadgerCare or ADRC assistance (Aging and Disabled Resource Center) if they are at 100 percent of the federal poverty level,” Ritz Witt explained.
“About 18 months ago, we increased our eligibility from 200 percent above the federal poverty level to 250 percent,” she added. "For a single person, that is $2,512 a month income."
Ritz Witt noted that the level increases with each additional family member.
"If the person needs reproductive health services, screening for sexually transmitted infections or pregnancy tests, they will be referred to the Dunn County public health department because the free clinic does not duplicate services provided elsewhere,” she said.
Like all medical clinics, the key service is a visit with the physician or other medical provider.
“We take turns,” says Jim Walker, M.D., medical director for the free clinic and a founding member of the board. Because the providers and most of the workers are volunteers, the cost of running the clinic has remained around $100,000 to $120,000 a year for its 13-year history. The Mayo Foundation gives the clinic money to cover labs and special tests.
“They are liberal with us,” Dr. Walker observes.
The clinic's big fundraiser of the year is the Gifts of the Heart Banquet and Auction, set for Saturday, Feb. 19 at Off Broadway Banquet Center in Menomonie. Another upcoming fundraiser is Guest Server night at the Barrel Room, Thursday, Jan. 18, 6 to 9 p.m. 100 percent of the cash and check tips will go to the free clinic, and board members of the free clinic will serve as wait staff.
Filling the gaps
“The same people have volunteered with the free clinic since we opened,” Walker says, noting that while patient numbers are down since the Affordable Care Act, there are still plenty of gaps in medical care. “We’ll continue to fill that gap. ... The support from the community has been awesome.”
A young mother in the waiting room and lifelong Menomonie resident who recently found out about the free clinic, echoes Dr. Walker's sentiments.
“I think it’s an awesome service for the community,” she said. Her children had BadgerCare, and she and her husband tried to find a good policy through the Affordable Care Act. “The premiums were high — almost as much as our mortgage."
They ended up taking a high deductible, catastrophic policy, and finding they could not afford regular doctor visits. “The $3,500 deductible ... it’s a lot on a young working family,” she said.
Another young woman waiting for care was referred to the clinic by her doctor. “He knows I couldn’t afford my insurance,” she said. “But I can’t skip the medications.”
The clinic works with drug companies’ patient assistance programs to secure low cost or free prescriptions for patients.
Later, I talked with a couple of former patients by phone. Helen wanted to express her gratitude that the free clinic “helped me at a time when I needed it.” She had heart valves replaced in another part of Wisconsin, and when she could not be home alone, she moved to Menomonie to live with her daughter: “But my insurance did not cover this far. I had to find a cardiologist, a general practitioner and a rheumatologist.”
In March, Helen's daughter took her to the free clinic. “I was at the end of my prescriptions, and I was waiting for Medicare, Part D, that would not kick in until July,” she said, noting that the needed the medications and the lab monitoring to make sure her blood was clotting properly. She was able to get the tests and the medications she needed while she was waiting for her new insurance coverage.
Frank also was not there, but he remembers well his dramatic visit in 2011 when he was immediately sent down the hall to the hospital. “I was filling up with water,” Frank said. “I had congestive heart failure.”
He says they removed 60 lbs. of water: “Basically it saved my life.”
A later visit helped Frank get dental care through the Marshfield Clinic Dental Clinic. “The free clinic picked up $350. They are a godsend to the community. They steer you in the right direction.”
Bernardo, a farm worker who calls on the clinic translator when he makes a visit, was referred by his employer who recognized the signs of diabetes and knew it was important for Bernardo to be seen.
“I was able to get tests,” Bernardo said, and subsequently lost 70 pounds. The clinic offers diabetic education once a month and schedules those patients in advance with a nurse diabetic educator.