Healthy Change: 'Benefactor' approach in Modesto provides for uninsured

Dr. Robert Forester is one of two doctors who started St. Luke's, a charity care program unique to Modesto. David Barton, 15. Barton's parents are "benefactors." (Bart Ah You/The Modesto Bee)

There are two entrances to St. Luke's Family Practice.

The first door to this unique nonprofit Catholic doctors' office — housed at the back of a Modesto shopping center — is for well-to-do patients who pay an annual premium to access boutique-style medicine.

The other door, a few feet away, is for the uninsured.

For the seven years St. Luke's has been in existence, a steady stream of gardeners, housecleaners and others who are down on their luck has come through this second door, seeking medical care after everyone else has turned them away.

But recently, Dr. R.J. Heck, co-founder of St. Luke's, has noticed a new sort of uninsured patient in his waiting room. Unemployed real estate agents, lawyers, nurses and other professionals once firmly rooted in the middle class are turning to the safety net for care.

Dr. Robert Forrester and Dr. R.J. Heck started St. Luke's Family practice in Modesto. (Bart Ah You/The Modesto Bee)

"Anecdotally, we have seen more people who were professionals, or who are professionals and cannot afford to insure themselves anymore, in here," Heck said.

Against this backdrop, St. Luke's is experimenting with a unique, and somewhat controversial, Robin Hood approach to care. Well-to-do "benefactors" pay an annual fee ranging from $575 for children to $1,800 for seniors to have unparalleled access to Heck and his partner, Dr. Bob Forester.

St. Luke's then uses those fees to fund free care for uninsured "recipients." The doctors say it is the first such practice in the country.

Forester, 51, lit upon the idea in 2001, while on a family vacation in Lake Tahoe. He had been in family practice for 14 years. He liked his job, but he was concerned about the patients he saw losing insurance and getting shut out of care.

"More and more, I had this experience of patients coming in and then, all of a sudden, they couldn't get past the front desk," he said. "They fell off their insurance, they'd lost their job, they'd suffered divorce — something happened."

He shopped the idea around to other doctors but couldn't persuade anyone to take the risk. Then, one evening, he and his wife had dinner with Heck and his wife.

At the time, Heck, now 46, was recovering from a stroke. He was in family practice locally and was looking to slow down from the 80-hour weeks he'd been putting in. And he wanted to do something for the community.

"That's what I'm going to do with the rest of my life," he told Forester.

Dr. R.J. Heck is one of two doctors who started St. Luke's, a charity care program unique to Modesto. Essentially, wealthy "benefactors" pay a yearly fee to have access to Heck and Dr. Robert Forester. Heck with patient Satya Singh, 53. (Bart Ah You/The Modesto Bee)

In 2004, they opened a 950-square-foot office. They recruited benefactors through local churches and service clubs such as Kiwanis and Rotary. And they began to treat the uninsured. Both practicing Catholics, they named St. Luke's after the patron saint of physicians. All people, regardless of faith, are welcome.

Dr. Peter Broderick, president-elect of the Stanislaus Medical Society, went through the county residency program with Forester in the late 1980s.

"It doesn't surprise me they are doing this kind of innovative work," he said. "(St. Luke's) is a very compelling model."

Still, the practice has its critics.

Some potential benefactors refused to sign up because the doctors, in keeping with their religious views, won't prescribe birth control.

And rich and poor patients are not only divided by separate waiting rooms. Benefactors continue to have private insurance or Medicare to cover prescriptions, procedures and hospital stays. By contrast, serv-ices for the uninsured are more limited.

Heck and Forester do what they can, negotiating lower rates for blood tests, helping their sickest patients sign up for emergency Medi-Cal coverage and prescribing drugs that cost just a few dollars at Wal-Mart and Target.

"What's the option?" Forester asks. "Do nothing? That's madness to me."

Dr. Robert Forester visits with patient Doug Wheelock, 57, of Modesto. (Bart Ah You/The Modesto Bee)

Not a solution but a gap filler

Criticism notwithstanding, many uninsured "recipients" say St. Luke's cared for them when they didn't know where else to turn.

"I think it's great that doctors are out there who will be willing to help someone, for a change," said Carol Berry, 58, who was insured through her husband's job at a school district until he got injured. Before finding St. Luke's a few years back, Berry said, she'd stopped going to the doctor because it was too expensive.

Heck agrees with those who say the St. Luke's model is not a solution to a broken health care system — especially with a national shortage of primary care providers. Heck and Forester see just 575 benefactor patients between them. Even with the 1,200 or so uninsured patients they treat each year, they still see far fewer patients than many primary care doctors.

"It's not going to be the solution to uninsured health care countrywide," Heck said. "However, it can certainly be a gap filler in more places than just Modesto."

Forester said St. Luke's is trying to expand the number of uninsured it can help by doing phone and e-mail consultations and group visits, and by hiring a full-time nurse practitioner to focus solely on the uninsured.

"I look at St. Luke's as kind of a Band-Aid," Forester said. "I wish we could be driven out of business by everybody having some form of coverage. But I don't see that happening for awhile."

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