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 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.
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, 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.
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.
“If you’re getting treated for cancer, you still need access to cancer treatment,” Kahn said.
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.
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.
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.
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, typically pull in well over one-third of the center’s annual cash revenue.
Even so, the nonprofit is launching an initiative to address what Wallace says is the greatest need among its patients — food.
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.
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 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.
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/