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Voluntary program
lets patients work off bills
(November
2004 Issue)
By Nan Shnitzler
In "To Kill a Mockingbird," farmer Walter Cunningham compensated
Atticus Finch for legal services with sacks of produce. Updating
the age-old practice, Franklin Memorial Hospital in rural Maine
lets eligible patients exchange goods and services for medical care
in a program called Contract for Care.
"We're the first to say it's not a new idea; we've just brought
it to the current day," says Dan Marois, director of marketing and
planning.
The 70-bed non-profit hospital, part of Franklin Community Health
Network, offers Contract for Care to non-insured patients whose
income falls between 100 and 200 percent of the federal poverty
level. If they do not qualify for Medicaid and a payment plan would
be prohibitively burdensome, Contract for Care is the most appropriate
in a continuum of health access options offered by the network.
"It's a specific group that doesn't qualify for benefits - people
caught in the middle who can't pay a $6,000 bill," Marois says.
Contract for Care might be construed as barter, but there is no
tax ramification because it is voluntary, according to Marois. In
fact, the program is run by the volunteer services department where
the skills of any volunteer are matched to a project the hospital
needs. A patient, family member or friend signs a non-binding agreement
that describes the nature of the volunteer work, the number of hours
committed and the end result. Proof of income is necessary.
"It's not necessarily dollar for dollar, but we're taking something
other hospitals write off and getting a service or contribution,"
Marois says. "I'm convinced the pride and self esteem the person
has for being able to contribute is the most valuable part of the
program."
Volunteers do not displace hospital employees. Rather, as the contract
explains, volunteer work, such as landscaping, data entry, mailroom
services and handcrafted donations to the gift shop, frees up resources
the hospital can use for other crucial services. A quilt Marois
described as "museum quality and probably worth thousands" made
by a local artisan is on display, part of a Contract for Care. A
valuable byproduct of the program, Marois says, is that patients
finish their contracts and continue to volunteer.
Richard Batt, president of Franklin Community Health Network, originated
Contract for Care in 1998. Since then, nearly 200 people have participated,
settling bills from a few hundred dollars to $20,000.
Marois and Rick Wade, senior vice president of the American Hospital
Association, agree the program is easily replicable to other rural
hospitals. While neither knows of any other formal program, they
both get inquiries.
Wade sees no downside to Contract for Care. He says the heath network
created a program tailored to its circumstances that ensured people
got the health care they needed while offering a dignified option
to avoid charity. Further, he says, it gives people a sense of connection
to rapidly disappearing community hospitals.
"People I've spoken to felt it was an immensely rewarding experience,"
Wade says. "Forget all the rules and regulations; this works."
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