Clinic by the Bay, a largely volunteer-operated center, serves a population of 1,000 patients, mostly immigrants, and many of them undocumented and uninsured. The nonprofit has now switched almost completely over to telemedicine visits, furloughed one of eight staff members and canceled its annual fundraiser due to the coronavirus pandemic. (Photo courtesy Kalynn Blakely, taken before pandemic)

Clinic by the Bay, a largely volunteer-operated center, serves a population of 1,000 patients, mostly immigrants, and many of them undocumented and uninsured. The nonprofit has now switched almost completely over to telemedicine visits, furloughed one of eight staff members and canceled its annual fundraiser due to the coronavirus pandemic. (Photo courtesy Kalynn Blakely, taken before pandemic)

Nonprofit clinics struggling with lost revenue, remote care

Coronavirus pandemic makes it harder for vital healthcare providers to raise money, reach patients

Nonprofits providing health care to underserved populations are losing significant revenue from a decline in patient visits, new expenditures and a lack of financial support as they resume the majority of their operations remotely.

Many already operated on thin margins and struggled to break even before the pandemic. Some have been forced to lay off workers. Others, like many nonprofits citywide, are struggling to fundraise or allocate grant money.

San Francisco has dozens of these community health centers serving thousands of patients. They include seniors, immigrants, people of color and undocumented residents. Many serve individuals who are on a lower income, on MediCal or uninsured, or offer a sliding scale of payment, with some patients paying as little as a few dollars.

“We don’t turn anyone away,” said Scott Plymale, executive director of the Community Health Resource Center.

Community health centers have turned to telehealth patient visits during the crisis, remote calls that often include video guidance from medical professionals, but they have their limitations.

Many older patients have some degree of trouble maneuvering new applications. Some might lack the software or internet access needed. And some medical services, particularly those offered by specialists, can’t be provided remotely.

North East Medical Services, which has 12 clinics citywide and more across the Bay Area, anticipates losing $8 million over the next three months and has had to lay off 37 staff members and furlough 210 staff members, about 30 percent of the workforce. (Courtesy photo)

North East Medical Services, which has 12 clinics citywide and more across the Bay Area, anticipates losing $8 million over the next three months and has had to lay off 37 staff members and furlough 210 staff members, about 30 percent of the workforce. (Courtesy photo)

North East Medical Services, which serves a primarily low-income population and has 12 clinics citywide and more across the Bay Area, anticipates losing $8 million over the next three months, said Jessica Ho, NEMS’ government affairs and community liaison.

The nonprofit had to lay off 37 staff members and furlough 210 staff members, about 30 percent of the workforce. NEMS originally saw patient visits plummet to 20 percent the norm. Telehealth calls have brought them back up to 70 percent to 80 percent, but the government doesn’t reimburse them in full.

The nonprofit has closed six of its centers temporarily and offers many services remotely, but it’s still offering in-person treatment for patients who urgently need care. While it generally isn’t avoiding offering routine physical exams in-person, NEMS is allowing some exceptions for children, said Dr. Kenneth Tai, NEMS’ chief health officer.

HealthRIGHT 360, with 10 sites in San Francisco that regularly serve about 9,000 San Franciscans a year, has been largely excluded from the federal stimuli, said Lauren Kahn, vice president of communications and government affairs.

The nonprofit has about 1,300 employees — too many for the Paycheck Protection Program, which requires 500 or less. It also fails to qualify due to other metrics relating to its financial outlook, like owning the centers it operates at, meaning it can get penalized for making its assets or debts look high, Kahn said.

The Federal Reserve’s Main Street Lending Program, which aims to support lending for small- and medium-sized businesses, also excludes nonprofits.

Like other nonprofits, HealthRIGHT 360 is also losing money with the cancellation of fundraising events, Kahn said.

HealthRIGHT 360, with 10 sites in San Francisco that regularly serve about 9,000 San Franciscans a year, does not qualify for federal aid but is losing money with the cancellation of fundraising events. (Courtesy photo)

HealthRIGHT 360, with 10 sites in San Francisco that regularly serve about 9,000 San Franciscans a year, does not qualify for federal aid but is losing money with the cancellation of fundraising events. (Courtesy photo)

Meanwhile, the need for their services hasn’t ended. The nonprofit serves around 30,000 patients across California. Almost 500 people sleep in its beds every night, nearly all of them from the streets.

And the nonprofit is attempting to make the transition online as universal for patients as it can, even if it means having homeless residents walk in to have a Zoom call with a doctor the next room over.

“If you’re getting treated for cancer, you still need access to cancer treatment,” Kahn said. “People are overdosing on drugs all the time and walking in and saying, ‘I need help.’ That’s something that existed before. It hasn’t stopped. So the services need to be continued because the urgency of the health condition continues.”

HealthRIGHT 360 is paying for new equipment, services and protocol. It’s allocated more thermometers and trash cans. It’s paying for shuttle drivers to transport some workers due to the elimination of Muni. It’s also teaching people how to properly take gloves on and off and holding weekly e-town halls with staff.

Much of this is happening without any certainty that it will be reimbursed by the government. Kahn said unrestricted dollars would go a long way in terms of plugging holes from the new expenditures.

“There are definitely some questions about how something will get shored up by the end of the year,” Kahn said.

Clinic by the Bay, a largely volunteer-operated center, serves a population of 1,000 — mostly immigrants, many undocumented, said David Wallace, the clinic’s executive director.

“These are the folks who go to the emergency room when they don’t have insurance — they don’t have health care,” Wallace said. “They work either cash or under the table or whatever, so we’ve really been trying to reach out and make sure they realize we’re here for telemedicine business, and not to be clogging up the ER. “

They’ve been mostly successful at preventing patients from visiting the ER, he said.

However, the clinic has lost about 20 percent of its patients during the crisis. They’ve also spent about $5,000 in the last month on new telemedical equipment and applications — a sizable fraction of the discretionary $70,000 within its $1.5 million budget, Wallace said.

“We don’t have a lot of wiggle room,” Wallace said.

The nonprofit has around 100 volunteers, and because many are older and vulnerable to the novel coronavirus, it has switched almost completely over to telemedicine visits, Wallace said. It also furloughed one of eight staff members due to the pandemic.

A huge blow was the postponement of its spring celebration fundraiser, which would have normally taken place last week but will instead be held through a virtual livestream on June 24 to try to make up for the loss of funding. The fundraiser would typically pull in well over one-third of the center’s annual cash revenue.

Even so, the nonprofit is launching an initiative on Wednesday to address what Wallace says is the greatest need among its patients — food.

During the crisis, around 60% to 75% of Clinic by the Bay’s patients are saying they’re experiencing problems getting food, Wallace said. Challenges include isolation, and a wariness among undocumented immigrants when accessing government resources, he said.

Previously, Clinic by the Bay was in the process of launching a food security project. Its original plan would have had a doctor prescribe specific foods to patients who otherwise couldn’t afford it to help them with chronic conditions.

With the heightened need, the nonprofit switched gears to work with a local restaurant and distribute meals to patients twice a week, Wallace said.

On Wednesday, they plan to serve 20 families 100 meals; if it goes well, they’ll deliver every Wednesday and Friday, Wallace said.

The biggest blow to the clinic is that specialists can no longer see patients, Wallace said. He said the loss of physical therapy has been a particularly big blow, given that many of the clinic’s patients work in construction and agriculture.

The nonprofit Mission Neighborhood Health Center Excelsior Clinic on Mission Street on Friday, May 8, 2020. (Kevin N. Hume/S.F. Examiner) Mission Neighborhood Health Center, with three sites in the Mission and Excelsior, serves more than 12,000 patients annually, primarily on MediCal or MediCal-insured, along with some uninsured patients. In March, a 30% drop in patient visits translated to a loss of around $200,000 — around 25% to 30% of the month’s usual revenue.

The nonprofit Mission Neighborhood Health Center Excelsior Clinic on Mission Street on Friday, May 8, 2020. (Kevin N. Hume/S.F. Examiner) Mission Neighborhood Health Center, with three sites in the Mission and Excelsior, serves more than 12,000 patients annually, primarily on MediCal or MediCal-insured, along with some uninsured patients. In March, a 30% drop in patient visits translated to a loss of around $200,000 — around 25% to 30% of the month’s usual revenue.

The Mission Neighborhood Health Center, with three sites in the Mission and Excelsior, serves more than 12,000 patients annually, primarily on MediCal or MediCal-insured, along with some uninsured patients, MNHC CSO Sabrina Patrick-Urrutia said.

They primarily cater to immigrant and lower-income communities who happen to be primarily Latinx in the Mission, she said.

In March, a 30 percent drop in patient visits translated to a loss of around $200,000 — around 25 percent to 30 percent of the month’s usual revenue. Though last month’s budget hasn’t been calculated yet, MNHC expects it took a much bigger blow compared to March.

Even so, the center has launched a carrier service to deliver medications to high-risk patients from their pharmacy during the crisis.

Patrick-Urrutia also counted the center fortunate to have received financial support from the federal Health Resources and Services Administration and the PPP. She showed concern for nonprofits like HealthRIGHT 360.

“We want a common message on how we keep our health centers whole,” Patrick-Urrutia said.

She considered the possibility of the federal government creating an exception to the employee limit for health centers to receive PPP assistance.

“Although some may have over 500 (employees), because they have multiple sites, the number of employees (needed) adds up,” she said. “We would like to see more from Congress or the state be able to support that and recognize that even the largest health centers also need to remain whole and have financial backing.”

The Community Health Resource Center delivers about 15,000 units of service to patients per year, many over 60 years old, the executive director Plymale said. They’ve seen a spike in demand for behavioral health services during the pandemic.

In addition to behavioral health services, the center offers nutrition counseling, health education and health screenings, the latter currently impossible to offer safely during the crisis, Plymale said. The center normally delivers these services to a host of YMCAs and other sites, including at the MNHC and Project Homeless Connect.

Plymale hope to maintain revenue streams by getting reimbursed for telemedicine services from insurance companies. He said that if it doesn’t get reimbursed, the center would get cut off from patients, which is when it would have to start looking at staffing levels.

The center is looking at a loss of potentially tens of thousands of dollars this year — anywhere from 10% to 30% of the center’s revenue, he said.

One factor is that its grant proposals have been almost completely denied in the crisis. Plymale said foundations they’ve appealed to are concerned about the financial implications for their overall funding.

Donors also appear to be more cautious due to the uncertainty of their own financial situations, Plymale said.

“Between grants and donations, it’s unsure where we’ll end up,” he said.

dhorowitz@sfexaminer.com

Editor’s Note: A previous version of this article stated that Clinic by the Bay’s spring celebration fundraiser was canceled. The fundraiser was postponed to June 24th and moved online. Donors can pitch in or RSVP at www.clinicbythebay.org/spring.

Bay Area NewsCoronavirussan francisco news

If you find our journalism valuable and relevant, please consider joining our Examiner membership program.
Find out more at www.sfexaminer.com/join/

Just Posted

Lers Ros Thai restaurant on Larkin Street in the Tenderloin is one of many throughout The City to have begun offering outdoor dining through the Shared Spaces program since the pandemic began. (Kevin N. Hume/S.F. Examiner)
Bay Area counties to shut down outdoor dining, non-essential businesses

Regional stay-at-home order to take effect Sunday, sooner than statewide order announced Thursday

Former Golden State Warriors’ Kevin Durant walks up to receive his 2017-18 Championship ring at Oracle Arena in Oakland on Tuesday, Oct. 16, 2018. Durant, now playing with the Brooklyn Nets, will play against his former team at Chase Center in February. (Kevin N. Hume/S.F. Examiner)
Kevin Durant to face former teammates at Chase Center in February

Schedule released Friday calls for Warriors to play Christmas and New Year’s Day games

Photo by Abalone Runner/ <a href="https://commons.wikimedia.org/w/index.php?curid=74406455" target="_blank">CC BY-SA 4.0</a>
Former Newsom spokesman Nathan Ballard facing domestic violence, child abuse charges

Prominent Bay Area political strategist Nathan Ballard is facing domestic violence and… Continue reading

Construction crews work on new red bus rapid transit lanes on Van Ness Avenue on Thursday, Dec. 3, 2020. (Kevin N. Hume/S.F. Examiner)
SFMTA board scrutinizes Van Ness BRT spending

Proposed contract modification would allocate $2.6 million for pedestrian monitors

Mayor London Breed said “I need to hold myself to a higher standard” in response to criticism of a recent meal at a Napa Valley restaurant. (Kevin N. Hume/S.F. Examiner)
Breed calls criticism for French Laundry trip ‘fair’

Mayor said she regrets that actions ‘distracted’ from public health message as COVID-19 cases rise

Most Read