Expanding access to dermatologic care for uninsured patients: A retrospective analysis of a free clinic

Summary: Abstract Body: Uninsured patients face substantial barriers to healthcare, resulting in poorer outcomes and limited access to specialized services, especially dermatology. The Rhode Island Free Clinic (RIFC) is the state’s largest free clinic, with a monthly dermatology clinic for uninsured adults. This study evaluates common dermatologic needs among uninsured patients, the demographics of free clinic patients, and the impact of free dermatologic care. A retrospective chart review of RIFC dermatology visits from March 2018 to May 2024 was conducted. A cost analysis was performed using current procedural terminology codes and Medicare reimbursement rates. A total of 457 patient encounters involving 272 unique patients were recorded. Most patients were female (61.4%), Spanish-speaking (74.8%), Hispanic or Latino (86.0%), and unemployed (55.5%). The wait time for an initial dermatology appointment averaged 55.7 days. Common visit reasons included rashes (48.5%) and lesions of concern (44.5%). Among 586 recorded diagnoses, inflammatory skin conditions were the most prevalent (38.7%), and 9 skin cancers—including squamous cell carcinoma and sebaceous carcinoma—were diagnosed. Estimated Medicare cost savings for office visits totaled $40,650.15 (modeled using code 99213), 594.1 work relative value units (wRVUs), and 1,256.75 total RVUs (tRVUs). Procedural services, excluding benign lesions, added $4,455.51 in savings for the healthcare system, with 34.38 wRVUs and 137.74 tRVUs. This study highlights the vital role of free dermatology clinics in delivering essential care to uninsured, low-income patients, while saving the healthcare system significant costs. High referral rates for suspicious lesions and multiple skin cancer diagnoses underscore the importance of such services. Our results offer key insights into the demographics and clinical needs of free clinic dermatology patients. Megan Hoang¹, Fatima N. Mirza¹, Victoria M. Hoffman², Alyssa Iurillo³, Oliver Wisco¹, John Kawaoka¹ 1. Dermatology, Brown University Warren Alpert Medical School, Providence, RI, United States. 2. University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States. 3. Indiana University School of Medicine, Indianapolis, IN, United States. Minoritized Populations and Health Disparities Research