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From the passenger seat of an SUV headed down a local street in North Philadelphia, nurse practitioner Kara Cohen leaned out the window and yelled out to a man walking by on the sidewalk.
Sam Santiago, who was driving, twisted the wheel to the right and brought the car to a sudden stop at the curb, and Cohen jumped out.
“I heard you’re back at the place,” she told the man — her patient — as she pulled out her medic bag and set up a collapsible stool on the sidewalk. “I was so happy.”
Cohen is the medical director of Project HOME’s street medicine program. This team of health and outreach workers spends a lot of time driving around the neighborhood of Kensington to meet people on sidewalks, street corners, in parking lots, and under bridges.
Kara Cohen, nurse practitioner and medical director of Project HOME’s street medicine program in Philadelphia, restocks her medical bag with new bandages, gauze, and other supplies before going out to see patients. (Nicole Leonard/WHYY)
This is where they provide medical care and treatment for injuries, illnesses, and chronic diseases to patients who are homeless and who may have complex needs like mental health issues or substance use disorders.
Until recently, health workers practicing street medicine haven’t been able to bill or collect reimbursement for their services from insurance providers when providing care outside the four walls of a clinic, hospital, or office.
But expanded insurance coverage and service code changes this year in Pennsylvania and at the federal level now recognize street locations as legitimate environments where health care services are delivered.
It means providers can now get paid for their work through programs like Medicaid. They hope it will strengthen and better sustain programs for them to expand and meet a growing demand in homelessness services.
“It can be a way to make it viable for excellent care to be provided,” Cohen said. “I’m hoping the kind of care that comes out, like when teams are being made, are things that are held to the same standards as we would expect from brick-and-mortar places, that there’s documentation, consent, abiding by medical ethics, that there’s an attempt for dignity and consistency.”
Kara Cohen, CNRP and associate director the Epstein Street Medicine project, provides medical care to people experiencing homelessness. (Kimberly Paynter/WHYY)
Intensive work and potential barriers to reimbursement
As she sat next to the car and used the open passenger door as a makeshift privacy curtain, Cohen unwrapped some gauze on her patient’s hand to check on a healing wound.
“I’m going to just put some maybe A+D [ointment] on it and clean it up,” she told the man, who she’s been seeing for a couple months now.
Cohen asked if she could find him tomorrow to take some blood work, and listened as he talked about potentially enrolling in medication-assisted treatment for substance use.
It can be difficult for people who are homeless to access medical care in general, Cohen said, with many of her patients feeling unwelcome and judged at private health offices because of their housing circumstances.