Christ Community Medical Center Nears Fifth Anniversary
by David Biebel, DMin
Today's Christian Doctor - Summer 2000
People go to Memphis, Tennessee, for all kinds of reasons. Some want to see Elvis. Some want to be Elvis, so they visit Graceland, "The King's" lavish mansion, hoping perhaps that some of the glitter, glamour or gold will rub off.
In 1993, four idealistic young doctors moved to Memphis with totally different motives. As one of them said in a later newspaper interview, "You look at the poverty rates, single parent households, unemployment. That area [southwest] has the worst numbers in Memphis. It was very attractive for us."
In fact, before their arrival, there was not even one primary care physician for the more than 50,000 area residents of Southwest Memphis. However, despite the need and the laudable vision of such a highly qualified and motivated group, it still took two years before Christ Community Medical Clinic (CCMC) opened. In the meantime, the doctors described their dream to anyone who would listen, in the process learning the true meaning of: "Great idea. We'll get back with you in a week."
They also learned the true meaning of faith; specifically that it is: "the substance of things hoped for, the evidence of things not seen" (Hebrews 11:1, KJV).
What they "hoped for" harkened back to 1987 when, during their time together as part of the CMDS medical school group at LSU in New Orleans, Steve Besh, Rick Donlon, Karen Miller and David Pepperman envisioned a practice where they could combine their medical training with Christ-centered ministry to the underserved. For two of them—Miller (who has since entered private practice in the Memphis area) and Pepperman—such hopes were radically new, as both came to faith (or deeper faith) during this period. "When I entered medical school," Dr. Pepperman recalled, "I was a fence-sitting Christian—sort of believed, but not wanting to commit because I wasn't ready 'to be good enough.' I felt I was being led to choose medicine—by Whom I wasn't sure—but I never foresaw that God would lead me into primary care for the inner city. It was through CMDS that I met and became friends with people who pushed me off the fence, guided these decisions and became fellow founding members of the clinic."
The "evidence of things not seen" was that they were, finally, there, all in one plage again (after residency), and now they were all licensed in various specialties to cover the waterfront: Pepperman—Family Medicine; Miller—Ob/Gyn; Donlon—Internal Medicine/Pediatrics; Besh—Internal Medicine. Except for one thing. Dr. Besh's Tennessee medical license application had not been approved.
"Returned from my honeymoon in late July 1993," Dr. Besh remembers, "I found that the consultant had filed an incomplete application. So my wife and I moved to Memphis a week later without much money and unable to do any medical work because I had no license."
This wasn't the first or last glitch in their plans. It was just one of many reminders that Someone Else is always in control of the substance, the evidence, and ultimately the outcome of the best-laid plans of mice or doctors.
Waiting for God
You remember the play, "Waiting for Godot." Everybody waits. Nothing happens. In some ways, the next two years seemed this way for the doctors four. Oh, they were busy enough; they just weren't busy doing what they had moved to Memphis to do. Drs. Besh, Donlon and Pepperman supported themselves doing ER work in area hospitals. And Dr. Miller returned to LSU for a fellowship in uro-gynecology and pelvic surgery.
"We banged our heads in the dark for two years," Dr. Donlon recalls. "We had lots of admirers but no money. We made presentations to banks and civic groups and other institutions. Every time, we would expect a miracle. But sometimes, we didn't even get a reply. What carried us forward was our common commitment to the Lord, to each other, and to the poor. We believed, and still do, that Jesus is honored by serving those who do not have access to ongoing medical care. And just like them, we've had to learn to really trust God to meet our needs."
Dr. Pepperman, who "rode shotgun" in many of the presentations, looks back at those two years with thanksgiving. "The obstacles we faced trying to start a specifically Christian clinic—thus ensuring no limitations on our evangelism—from scratch at times seem insurmountable: no money, no backers, no non-profit status, promises changed, people thought we should start a clinic in an affluent area to support an indigent care clinic—all these and more, overcome to the greater glory of God's provision. Now the memory of those times provides strength when I'm having problems. I wouldn't trade them for anything."
While the doctors were doing what they could, and waiting for God, God was working through two professionals—lawyer Charles Key and accountant Judson Cannon, CPA—as they toiled tirelessly behind the scenes to ensure that when the vision became a reality, it would have a good foundation. Dr. Besh acknowledged, "This started before we actually moved to Memphis. Without this help we would have spent far more time, money and energy on our start-up, and the office very well would not be in existence. They provided far more than valuable services. They provided essential encouragement as we negotiated the maze of hospitals, banks and insurance plans in our planning stage. They worked with us on creating an office staff, a board of directors and a business plan. They continue to be intimately involved in our operations as a medical corporation, and continue to encourage us as friends and brothers in Christ."
The Fund-jam Breaks
In the spring of 1995, the board of the Baptist Memorial Health Care Foundation listened to the doctors' plans, sensed their deep, long-term commitment, and within days approved their request for help—a $200,000 grant to relieve the start-up debt. Then the Baptist Memorial Health Care System guaranteed up to 90 percent of the loan for which the doctors had applied. They also supplied the clinic with some never-used equipment from their inventory.
In addition, representatives of the Baptist institutions connected the physicians with contractors and other suppliers of goods and services willing to help either free or at least a reduced rate. An ideal location was found—a freestanding former bank building that had closed due to multiple robberies. But when a pawn shop came up with the cash first, the doctors decided to locate their clinic a block further north, at 3362 South Third Street in a former grocery store than needed several hundred thousand dollars worth of renovation. The original 5,000 square-foot-clinic, with ten exam rooms, an X-ray room, waiting rooms, administrative area, staff offices and a community education room opened in September 1995. The dream was finally becoming a reality!
Yet many practical issues remained, most of them finacial, and many of them complicated by the fact that the clinic opened during the year when Tennessee implemented "TennCare," shifting over 20 percent of the state's population (and most of the patients in the clinic's catchment area) into managed care. The initial budget called for $1 million in gross revenue to cover expenses. This project was based on the four doctors seeing a total of 100 patients per day, while working for about half the normal physician salary in Memphis. Actual expenditures for the first ten months were $740,000. But patient traffic was much slower than expected—an estimated 4,000 visits during this time. And payment levels from TennCare were modest and often delayed for months, contributing to nearly constant cash-flow difficulties. This led to a fiscal crisis and a meeting where the founders discussed that they would probably have to disband the office and abandon the project because the money simply wasn't there.
"This occurred in the summer of 1996, about eight or nine months after we opened," Dr. Donlon recalls. "We were clearly not going to be able to make payroll within a few weeks, and I had been advised that we should pick a day to close the clinic and attempt to liquidate our hard assets to pay our creditors. At the strong urging of my partners (and their wives, particularly Beth Pepperman) I requested an additional two weeks before making such a final decision. In that short time we met with Baptist Hospital and they decided to temporarily bank an enlarged line of credit at the bank, giving us some additional time. We then went back to all the TennCare MCOs and pleaded for access to their patients who lived in our community. We know all along that these MCOs had assigned these patients to other physicians outside the neighborhood and that these patients often had great difficulties accessing their doctors. We also contacted local politicians and asked for assistance. All along we prayed and prayed. Within a matter of two months we had more than tripled our number of patients and the crisis abated, at least for awhile.
"We just didn't believe that God had brought us that far to have us fail, although we recognized that this was possibly His will and certainly His prerogative," Dr. Donlon added.
The Vision—and Constituency—Expands
Although initially most CCMC patients were African American, a rapidly growing segment are from the Hispanic community. Approximately 20 percent of CCMC's obstetrics patients are Spanish-speaking as are 5 percent of primary care patients. It is expected that this group of patients will continue to grow.
CCMC also serves a large group of refugees and immigrants. Through a cooperative arrangement with Refugee Services, CCMC serves all those being resettled into the area. This group includes adults and children from Vietnam, Cambodia, Somalia, Sudan, Bosnia, Iraq, and several other countries.
Today, the clinic has grown to three locations with more than fifty staff including six medical doctors, a dentist, psychologist, a nurse midwife and two nurse practitioners.
For the fiscal year ending June 30, 2000, CCMC had an annual budget exceeding $2,500,000. Of that, approximately $1,800,000 was to be generated from fees collected for services delivered to patients, with the remainder to include almost $200,000 received as donations from individuals and churches and $500,000 derived from grants received from foundations and government. Patient visits to the Third Street Medical Clinic now exceed 18,000 annually, and visits to the Brannon-McCulloch clinicl total more than 6,000. Visits to the Dental Clinical that opened on January 31, 2000 began at 200 per month. Current projections for the fiscal year July 1, 2000 through June 30, 2001 are for a total of 29,000 patient visits including all clinical services at all three locations.
Current programs and services offered by CCMC include: Adult Primary Care, Pediatric Primary Care, Obstetrics/Gynecology, Dentistry, Psychology, Pastoral Counseling, Home Visitation, Prenatal and Parenting Classes. The Clinic also partners will the Baptist Memorial Health Care Corporation to offer Memphis Healthy Churches, a health awareness and disease prevention program specifically aimed at African Americans and offered through their churches.
CCMC's psychologist, Alex Galloway, has developed and maintains a relationship with more than thirty African-American churches by providing counseling training, acting as a personal counselor to the pastors, and providing referral services for them when needed. "Most importantly," Dr. Donlon explained, "Dr. Galloway is the principal investigator and coordinator of CCMC's home visitation program, called the PANDA study (for Parenting Assistance and Newborn Development Activities), which was funded by a local foundation through a three-year grant of $600,000. This program provides multiple home visits by our nurses to first-time mothers both during their prenatal care and after delivery. This sort of intervention has previously been shown to reduce premature deliveries, low birth weights, and infant mortality. Every one of those home visits included evangelistic and discipleship material, most of it modified from CMDA's Saline Solution program.
"I am persuaded," Dr. Donlon added, "that this will be the most influential outreach CCMC has ever been involved in. The potential for bringing the gospel and discipleship to hundreds of young inner city moms and their families is staggering."
The End of the Amateur Hour
The central key to CCMC's growth and success thus far is that so many individuals with crucial skills—starting with the founding physicians and continuing on every level, from volunteers to paid staff—have embraced the vision and become part of the team, usually at some degree of personal sacrifice.
One such person is Executive Director Burt Waller, who left his position as CEO of the Regional Medical Center at Memphis to work with CCMC. In an newspaper story about Mr. Waller's uncommon career move "downward," Dr. Donlon said, "He is getting a small fraction of his former salary. But this is the end of amateur hour here. I was doing a lot of the administration myself, with no formal training. Burt understands business systems and the politics of the local health care world."
"I'm frequently asked how we make CCMC work financially," Mr. Waller says. "The keys are 1. Doctors responding to God's call and who are therefore willing to earn far less than they could earn in a suburban practice; 2. Occupancy of inner city space that is far less costly than traditional office space; 3. Willingoness of other doctors and providers to donate equipment, furnishings, and supplies for the start-up of the clinic; and 4. Support of foundations, individuals, and churches willing to fund specific programs and initiatives not otherwise affordable."
Goals and Plans
CCMC is now a charitable, not-for-profit organization governed by the twenty-one member Board of Directors. Members are drawn from both the neighborhoods served and the community of supportive churches. The Board's goal is to create a financially viable model of basic health care. This means that CCMC's core services (primary care, OB care, and dental care) should become economically self-sufficient. The Board believes that if this viability can be demonstrated outside the realm of government, then CCMC's approach can be duplicated, and access to care for inner city residents improved.
"We have not yet achieved that goal due to the continuing growth of CCMC," Mr. Waller said, "but we still believe it is attainable."
CCMC's three-year-plan, approved in December 1999, established several goals: 1. To increase the number of patients served by Brannon-McCulloch, and to achieve financial break-even; 2. To replace the Brannon-McCulloch facility; 3. To initiate a mobile clinic to serve the refugee community and the rapidly growing Latino community; 4. To maintain the level of service at the Third Street facility, to initiate the dental clinic there, and to open the exercise and wellness center.
Cost Versus Value
Achieving these goals and others will require the continuing commitment of the current staff, plus the addition of other likeminded professionals willing to make a similar sacrifice—which turns out, at least to everyone interviewed, not to be a sacrifice at all. For example, Dr. Pepperman said, "I get to work at a place where the staff prays together in the mornings, there are Scriptures and Bible scene murals on the walls, the executive director initiates collective fasting, beseeching God's help for financial problems, and patients ask me to pray for them if I fail miserably and miss an opportunity. What more could I ask for?"
Dr. Donlon echoes these sentiments, "In terms of 'the sacrifice,' it's worth it. We get to serve in the name of the King. We only pray that God will be please with our work and increase our effectiveness. I can't imagine a more fulfilling and challenging life."
Two years into his involvement with CCMC, Mr. Waller reports, "Many of my friends and professional colleagues simply can't comprehend why someone would give up a career as a major hospital CEO with a substantial income to use his talens in the inner city. Personally, I haven't experienced it as a sacrifice at all. The personal rewards here are much greater than in my previous work, and I've seen God sustain this ministry through numerous difficult days and situations. I regularly thank God for this opportunity and the abundance I've received through it."
Sources for information in this article include the Memphis Healthcare News and The Commerical Appeal.
Advice from the Founders of CCMS:
- Expect opposition.
- Be prepared for a longer process than you might have imagined.
- Don't compromise your mission or values in the process—there will be lots of people and organizations who would distract or redirect.
- Think about discipleship as well as evangelism. We have seen many converts, but we struggle to find effective ways to "teach them to obey everything I have commanded you."
Suggestions for Others Considering a Similar Project
- Find committed doctors who believe God is calling them to the specific ministry. These are the essential foundation for success.
- Build a constituency of support among other providers, churches, and individuals who share a concern for the spiritual and physical well being of those you desire to serve.
- Identify talented and experienced individuals willing to volunteer their time to assist in planning and start-up. This includes attorneys, accountants, grant writers, and practice managers. These endeavors are far more complicated than they appear to be.
- Establish credability and rapport with the community you plan to serve. Even in underserved areas, simply opening the door will not automatically result in patients.
- Seek the advice and assistance of others involved in similar ministries or in serving similar neighborhoods.
- Communicate! There are many people who are willing to provide support, but they must know about your work and its needs.