Q&A: Dr. Michael Kloess, founder of unique, Biblical direct primary care practice
Michael Miller · Feb 25, 2016
Samaritan Ministries member Dr. Michael Kloess runs a direct primary care clinic in Madison, Wisconsin, that not only manages to serve cash-pay patients and those who cannot afford to pay, but to share the Gospel as well. The goal of Our Lady of Hope Clinic is to offer concierge-type service to “benefactors” and free primary care to uninsured members of the community. Along the way, Dr. Kloess says he gives Biblical direction to his patients about their health and lifestyles. The clinic has served approximately 5,000 uninsured patients since April 2009 while keeping overhead low and service to entire families high. We asked Dr. Kloess about his unique practice.
How is Our Lady of Hope Clinic different than a typical physician’s practice?
In many ways Our Lady of Hope Clinic (OLHC) is similar to any other primary care clinic. As a board-certified family medicine physician, I can treat the entire family—men, women and children—for a whole range of primary care concerns. We differ from more traditional clinics in a number of ways.
First and foremost, our clinic is faith-based. We are committed to putting the teachings of Jesus Christ into practice within health care. Being comfortable speaking with patients about their faith and their relationship (or lack of relationship) with Jesus affords me the opportunity to evangelize in the exam room. It also gives me the opportunity to learn from my patients and grow in my faith. As part of our commitment to providing faith-based care to patients, I do not prescribe contraception or counsel patients on sterilization, euthanasia, or abortion. Our clinic is the only clinic in our area that is 100 percent pro-life. While OLHC’s faith tradition is Catholic, you do not have to be Christian to be treated at OLHC. Our patients come from all faith backgrounds. Along with the traditional standard of care recommendations, both my Christian and non-Christian patients have come to expect Biblical answers to many of their medical concerns.
In addition, our clinic is different than a typical physician’s practice by providing consults in natural family planning (NFP) for women who may be suffering from infertility or other gynecological health issues. We find that many women who suffer from infertility often feel pressure to abandon their religious beliefs when trying to achieve pregnancy. We are committed to providing natural and morally acceptable medical alternatives to infertility and gynecological health issues within the Christian health care tradition.
Another way our clinic is different than most is that we do not bill or accept insurance of any kind. The patients who support us are referred to as benefactors. The benefactor patients and our NFP patients pay a nominal fee to be seen as patients. In addition to these paying patients, the majority of our patients (75 to 80 percent) are uninsured patients to whom we offer free primary care visits on a walk-in basis. We differ from other free and reduced-fee clinics in that once an uninsured recipient has been seen at our clinic, he or she becomes my patient. Having a full-time provider improves continuity of care and improves outcomes for chronic conditions for our patients.
How are you able to provide “free primary care to uninsured members of the community”?
We are able to do so in a number of ways. First, our clinic is a registered nonprofit organization, so all of our benefactor fees are considered a charitable donation, less services used. We are also supported by a wide range of individual, corporate, church, hospital and foundation donors.
We are able to keep our operating costs very low—when compared to insurance-based medical clinics—because we do not accept or bill for insurance of any kind. We ask our benefactor patients to carry some form of supplemental insurance, or become members of a health share program, to meet medical needs that may arise outside of our clinic, but we never bill their insurance. This eliminates the need for our clinic to have a billing department, or large staff. In fact, we only have two full-time staff members—myself and our director of development. We also have two part-time employees, a bookkeeper, and our office manager, who is also an RN, so she wears two hats at OLHC.
Our clinic has also been blessed with a large volunteer base. We have several volunteer nurses, including one who has been with us since the beginning and who does all of our volunteer training and scheduling. We have a volunteer Needy Meds coordinator, who works with our uninsured patients to find free or affordable prescription medications, since we do not have a pharmacy in our clinic. We also have a volunteer dietician and pharmacist. Lastly, at any time we generally have over 30 pre-med and medical students volunteering at our clinic. They get hands-on experience assisting me with “rooming” our patients: taking vital signs, starting or updating patient charts, and countless other tasks which keep our clinic running smoothly.
In addition to our volunteers and donors, we have a relationship with Madison’s St. Mary’s Hospital in which the hospital makes a substantial in-kind donation to us in the form of free laboratory testing for our uninsured patients. We are able to draw most lab samples in our clinic and send them to the hospital for testing. For patients requiring more extensive lab work, St. Mary’s allows them to register as outpatients under OLHC, and draws their samples in the hospital’s lab and then sends the results back to me.
How large is your patient panel (benefactors, recipients)?
While most insurance-based clinics have patient panels of 2,500 to 3,000, I currently have 150 benefactor patients. These 150 members are from about 65 different families. In order to support our mission to serve the uninsured, our goal is to have 300 benefactor member patients. Since we first opened nearly seven years ago, we have had over 5,000 uninsured patient visits. Some have been seen just once, others are seen on a regular basis. This means that currently we are giving away 80 percent of our clinic visits to our uninsured patients. Increasing our benefactor members to 300 patients would allow me to continue that personalized doctor/patient relationship that my benefactors enjoy, while enabling the clinic to grow as well. We would like to be able to add another provider in the next couple of years.
In order to increase our benefactors, we are currently offering a discounted 90-day trial in which perspective benefactors can pay a very modest fee and enjoy all of the benefits of a full benefactor for three months. At the end of the trial, participants may end their relationship with our clinic with no further obligation, or they may become full benefactors.
You say that “All Benefactors must maintain medical insurance.” Would Samaritan members be able to be benefactors at Our Lady of Hope Clinic?
Absolutely! We have several benefactors who are members of Samaritan Ministries—including my family. While I understand that Samaritan isn’t medical insurance, it does share medical needs that may happen outside of my primary care clinic, such as visits to specialists and hospital stays. That allows OLHC to work very well with a Samaritan membership. OLHC benefactor members get all of their primary care through our clinic for an annual or monthly membership fee, and then have Samaritan Ministries for non-primary care issues. Additionally, as I mentioned earlier, our benefactor fees are a tax-deductible contribution, less services used, so oftentimes families will find that they are saving some significant dollars by becoming benefactor members of our clinic and enrolling in a health share program like Samaritan Ministries.
What are some of the advantages to your practice that patients most appreciate?
There are a lot of advantages to our clinic that our patients appreciate. Obviously, our uninsured patients appreciate having access to a physician, as many of them have not seen a doctor for years. My NFP patients appreciate having a natural and morally acceptable treatment option for their fertility issues. I have been blessed by being able to help many, many couples who struggled with infertility either start or grow their families; this is perhaps the aspect of my practice that gives me the most pleasure.
My benefactor patients appreciate that they are guaranteed same- or next-day scheduling so they are not waiting weeks or longer to see me. They also appreciate that they have access to my personal cell phone number, so they can reach me anytime—day, night, weekend, or holiday. They also appreciate that when they call me I truly know them and their medical needs and histories. By limiting the number of benefactor patients I take into the practice, I can be more available to the patients I have, which translates into better patient outcomes. Since my benefactor base is under 200, I have a personal relationship with each and every one of my patients. Also, by not accepting insurance, my patients and I are able to make individualized health care decisions that are medically appropriate for each of them without the burden of having to get a health insurance company’s approval.
What are some of the problems with regulation of health care that you are able to avoid by having a concierge practice?
When I am in the exam room with the patient, it is just the patient and me, not the insurance company. Being able to discuss medical recommendations without waiting to see if the insurance company agrees allows the patient to make an informed decision right there in the exam room. Too often in an insurance-based clinic, after weighing the provider’s recommendations, the patient is not free to decide for themselves what the best course of action might be. The patient most often has to first obtain the permission of a third party.
In our practice, patients truly appreciate the freedom from bureaucratic oversight, and as a provider I see the increased freedom as a way to improve patient outcomes. It is commonplace now for providers to ask patients if they smoke and encourage them to quit, seeing the relationship between the behavior of smoking and the consequences that smoking causes. It is also now common to talk to patients about their diet and make recommendations for exercise. Again, behavior has consequences.
Unfortunately, the majority of the medical profession does nothing to stop the consequences of sin. In our practice we have the freedom to ask patients about whether they are living a sexually chaste lifestyle in order to avoid sexually transmitted disease or out-of-wedlock pregnancy. We encourage patients to avoid excessive alcohol use and to live by principles of faith to help improve patient outcomes. Most importantly, if patients are not living a life of faith, we have the freedom to offer the patient the love, the mercy, and the grace that comes from Jesus Christ.
Why did you join Samaritan Ministries?
Samaritan Ministries puts into action the biblical philosophy of sharing one another’s burdens. The reason I became involved with Our Lady of Hope Clinic was this very same reason. Fellow believers who have been blessed by God willing to share with those in need struck a chord with me. In addition, my wife and I felt it was no longer acceptable for us to support an insurance company that through our financial support were offering services opposed to our religious beliefs. Plus, the added bonus of being able to save money made joining Samaritan Ministries a financial prudent decision.
In reading the statement of faith, it was easy to see how my family’s commitment to living the Gospel meshes well with Samaritan Ministries.
As a devout Catholic family we are able to join with our fellow Christian believers in professing belief in God, the Father; God, the Son; and God, the Holy Spirit. Jesus Christ, the second distinct person of the triune God, is Himself the Divine Physician. He alone can completely heal our brokenness of body and more importantly our soul. Samaritan Ministries puts into action the Biblical philosophy of sharing one another’s burdens.
The reason I founded Our Lady of Hope Clinic was for this very same reason. Fellow believers who have been blessed by God willing to share with those in need struck a chord with me. In addition, my wife and I felt it was no longer acceptable for us to support an insurance company that through our financial support was offering services that were opposed to our religious beliefs. As an added bonus, being able to save money made joining Samaritan Ministries a prudent financial decision.
For more information about Our Lady of Hope Clinic or a discounted 90-day trial, please contact Julie Jensen, OLHC’s director of development, at 608-957-1137.