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FQHCs: Serving the Underserved

by Andrew McCabe, Senior Manager, Product Innovation

In areas of the country that are medically underserved, Federally Qualified Health Centers (FQHC) can make all the difference in delivering quality care to the community. Strictly speaking, an FQHC is a non-profit health center that provides comprehensive primary care for patients of all ages, regardless of their ability to pay, and receives grant funding under Section 330 of the Public Health Service Act. FQHCs also receive a host of benefits that include cost-based reimbursement from Medicare and Medicaid, access to National Health Service Corp (NHSC) programs, participation in the Public Health Act 340B drug discount program, and malpractice insurance under the Federal Tort Claims Act (FTCA).

At athenahealth, we’ve come to know these organizations well beyond their formal definition: we understand their billing requirements (many), reporting requirements (unique), and quality management programs (diverse). We’ve come to know their extraordinary mission, their energetic staff, and the impact they’re making on the health care landscape.

Nowhere has this effect been more evident to me than during an FQHC-focused athenahealth Leadership Institute, which I attended back in the spring. A recap of the event by my colleague, John Fox, captures a snapshot of the difficulties leaders face at 50 geographically and demographically diverse FQHCs, and the spirit with which they tackle challenges across all aspects of care.

And the FQHC impact is felt by millions across the country. Today, more than 1,100 FQHCs, in 8,500 locations, deliver care to more than 20 million patients—that adds up to 80 million visits per year. And the need for FQHCs is only growing: According to an estimate from the Kaiser Family Foundation, the number of patients served by federally qualified centers will double to 40 million by 2019. This increase is driven in part by the Affordable Care Act (ACA), which will drive thousands upon thousands of today’s uninsured into FQHCs across the country. To help cover this underserved population, ACA appropriated $11 billion for Federally Qualified Health Centers.

The National Association of Community Health Centers (NACHC) presents a highly informative annual chart book, titled “A Sketch of Community Health Centers,” that provides an overview of the federal health center program and the communities they serve. Some insights from the 2013 Chart Book:

  • 72% of FQHC patients are at or below the federal poverty limit – FQHCs serve one of every seven uninsured patients nationwide;
  • 36% of FQHC patients are uninsured (vs. 4% for patients visiting private physicians), 39% are covered by Medicaid (vs. 13%), and 14% have private insurance (vs. 61%);
  • 18% of FQHC visits involve patients with chronic conditions vs. 14% at other physician offices;

While Federally Qualified Health Centers serve a patient mix under potentially difficult circumstances, their providers consistently demonstrate a high level of quality care. “The NACHC’s chart book demonstrates that FQHCs deliver preventative services to low-income patients at a higher rate than other caregivers, while also reducing disparities in access to care. For example, low-income patients being treated for hypertension at FQHCs are more likely to be counseled on a combination of diet, exercise and medications than their peers, nationally. More important, the study shows these FQHC patients are also more likely to comply with these protocols.

During the aforementioned Leadership Institute, I pressed many participants to share administrative frustrations and their concerns with scaling their office operations to continue meeting patients’ needs. Dealing with Medicare and Medicaid billing requirements is time-consuming, as is tracking “wrap around” payments from Medicaid (these payments ensure an FQHC receives the entire per-diem fee due).

Similarly, Uniform Data System (UDS) reports, an annual readout of patient demographics and practice performance, represent a huge undertaking for these organizations. I have heard phrases like “all hands on deck” used to describe the months-long process of compiling and auditing UDS reports. Additionally, FQHCs must be able to track numerous performance-based incentive programs, as they can be a critical contributor to their financial success.

Although FQHCs have to spend precious time, effort and money on these administrative functions, participants at the Institute spoke of needing to cut administrative costs in order to grow outreach efforts. They discussed keeping clinical staff with patients rather than reviewing charts for UDS reporting. And they reinforced the need to know, at a glance, at any time, how providers are performing along clinical quality measures.

Scaling FQHCs to accommodate double the patient volume over the next six years, while continuing to meet government mandates like Stage 2 Meaningful Use, will require a shift in internal operations and a sound technology strategy. FQHCs are doing some pretty remarkable things for the underserved in our communities—now it is our job to ensure these organizations have the right tools to keep pace with their oncoming growth, something Family First Health CEO Jenny Englerth will speak to in a blog post later this month.

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