Under current Healthcare policies and climate, this could be a good year for FQHC’s — Federally Qualified Health Centers.
Take, for example, the findings of one industry group based at the University of Michigan — CHRT (the Center for Healthcare Research & Transformation) which has as a mission, “to promote evidence-based care delivery, improve population health, and expand access to care.” CHRT recently published a Policy Paper (pdf) on FQHC’s — Federally Qualified Health Centers — in which they noted that these types of health centers are a key component “of the health care safety net that provided care to more than 20 million Americans in 2011.”
Also from the CHRT report this chart of FQHC patients by coverage types:
Chart above shows a decade of changes by patients’ coverage type. Note increase in Medicare and Medicaid based patients for FQHCs. (source UDC data from HRSA).
As the chart shows, Medicaid and Medicare patients have already been increasing this decade. This paper also notes the opportunity as, “Expansions in Medicaid and privately insured populations are expected to put a significant demand on primary care, particularly in underserved, low-income communities, where large increases to the number of newly insured are anticipated.” Newly insured should spell more revenue to these clinics to offset expenses.
In Eagle’s home state of Ohio, Compass Community Health Care Center (CCHCC) has just announced that is has been received Federally Qualified Healthcare Center (FQHC), Look-Alike status. Dr. Terry Johnson, Medical Director Compass Community Health, explained the thinking behind application for the designation:
“We have a health crisis in southern Ohio – in particular in Scioto County where our poor health indexes are among the lowest in Ohio. As an FQHC-Look-Alike, Compass will be a stronger partner within the Scioto County Health Coalition and with all other healthcare providers who are working so hard to make Scioto County healthier.”
The question is, how do smaller clinics pay for the increase in a way that dials them in with new policies coming out? For those in compliance, the future looks good for continuing medicaid support. “Medicaid expansion will have a major impact on finances for community health centers”, believes Gary Pritts, President of Eagle Consulting Partners, Inc. “Each entity stands to lose less on uncompensated care because of the expansion.”
By “compliance”, Pritts points to increases in reimbursements based on the Affordable Care Act’s (ACA) rules and policies, and the National Assoc. of Community Health Centers described this in a recent report on Final Medicaid and Exchange Regulations Implications for Federally Qualified Health Centers (PDF). It’s a long sentence, but it spells out how FQHCs can their services in better with MEdicaid under the ACA:
“The Medicaid statute contains a number of critical requirements relating to FQHCs services and payment that were in the Medicaid statute prior to the passage of the ACA and should apply to FQHC services provided to the new group of Medicaid beneficiaries established under the ACA. Specifically, federal Medicaid law (1) establishes the services of an FQHC as a required Medicaid service, (2) defines these services to include rural health clinic services as defined in the Medicare statute plus any ambulatory service included in the state Medicaid plan, and (3) requires state Medicaid agencies to reimburse FQHCs for these services based on a prospective payment system (PPS) per visit rate as provided in Section 1902(bb) or through an alternative payment methodology (APM) that the FQHC agrees to and which will result in the FQHC being paid no less that it would be paid under PPS.”
