UO Magazine > Healthcare's Safety Net: Community Health Centers

Healthcare’s Safety Net continued...

TO PREVIOUS PAGE

One of the biggest challenges for providers comes when a patient must be referred to a specialist. One program has addressed the need for access to specialist care for CHC patients. The Anchorage Project Access has signed up 350 specialists who will see CHC patients in their offices through a coordinated program that schedules the visits and provides patients with a card that looks much like a typical private insurance card. The project has trained personnel in the specialists’ office to submit a bill to

Project Access, eliminating front-desk confusion and adding to patient dignity. Though the project technically doesn’t pay for the care, records are kept on how much charity care each physician gives. “The patient gets seen and everybody is happier. Most importantly, the physicians who really want to do charity care know they’re not the only ones providing it,” says Hunt. Anchorage Project Access was modeled after a similar volunteer provider network developed by the medical society in Asheville, North Carolina.

Financial matters

Health centers have to make up the money somewhere, and federal grants help. Since Medicaid is the largest insurer of FQHC patients—about 37 percent of their total revenue—Medicaid payments also are essential to keeping the centers afloat. Medicaid reimburses FQHCs on a cost-per-visit basis. According to a 2003 Kaiser Family Foundation report, the number of Medicaid patients served by health centers nearly tripled from 1980 to 2001, topping out that year at 3.6 million people. By comparison, total Medicaid growth for this period was 50 percent. Health centers and Medicaid have a complex and fundamental interrelationship—the dynamics in one are bound to affect the other.

Community health centers have become the mainstay of health-care delivery for countless Medicaid beneficiaries. Weaver and Curtin say the point is to ensure that the cost of providing care for those patients enrolled in the program is covered by Medicaid dollars and not absorbed by the grant dollars allocated to provide care for the uninsured and underinsured. “These community organizations get their funding from a variety of sources and the way I look at it, each payer is trying to make sure they are paying their portion,” says Weaver. The Deficit Reduction Act of 2005 likely will impact states’ Medicaid funding and eligibility benefits; Medicaid funding remains volatile for CHCs in 2007.

Joe Pierle, the CEO of the Missouri Primary Care Association, based in Jefferson City, says, “We have to have a good payer mix in order to take care of the uninsured. If we didn’t see any private, Medicare, or Medicaid patients, we wouldn’t be able to care for the uninsured because we don’t get enough grant dollars to offset all of the care we provide to them.” The Missouri Primary Care Association assists CHCs in this mostly rural state by helping with provider recruitment and retention, developing local programs, offering technical assistance and provider networking opportunities, and conducting legislative advocacy. Most states and regions have similar associations.

Diversity and sensitivity

Serving a diverse mix of patients seems characteristic of CHCs, whether in an underserved urban location or a small rural town. From the Anchorage Neighborhood Health Center to Westchester County—just north of Metropolitan New York City—CHC physicians seem to enjoy the diversity and the opportunity the clinical, language, and even “social work” challenges their jobs present. Daren Wu serves as the chief medical officer of Open Door Family Medical Centers in Westchester County. With more than 40 clinicians in four offices and two school clinics, including primary care physicians, podiatrists, optometrists, and a nutritionist, the CHC serves patients who have a hard time accessing care in Westchester County. It’s not that physicians and hospitals are scarce. “But for those lacking economic means or those having language barriers, the services are not accessible,” he says.

That population includes a fair number of immigrants from Central America, Mexico, and South America, predominantly Brazil. Wu says about half of his staff is bilingual. In border states and throughout the country and territories, health centers such as Wu’s are opening their doors to all residents.

Amy Chang is a recruitment specialist for the Northwest Regional Primary Care Association in Seattle. The association is a collaboration of state care associations in Oregon, Washington, Idaho, and Alaska, broadening provider recruiting resources. Her understanding of CHCs comes not only from her current position but previous experience visiting migrant camps and from growing up uninsured. Her father was a founding member of a health center and her mother was on the board of a health center for three years. Today, she works to overcome stigmas about community health centers when recruiting providers.

Wiltz, the Louisiana internist, also serves as secretary of NACHC’s board of directors. He says the mission of the CHC in Franklin originally was to care for sugar cane workers. “There is a big misperception in the country about the uninsured—that they’re not working people,” he says. “These are some of the hardest working people. Most of them are employed; they just can’t afford [health insurance] premiums.” Still other CHC clients may work two or three part-time jobs because their employer intentionally keeps them below 40 hours to avoid having to provide benefits. Franklin and other rural communities feel the crunch suffered by small employers who can’t offer affordable family coverage.

CHCs take in those who work, those who don’t, and those who live in their communities illegally, no questions asked. It’s a fundamental part of their mission and of public health—to provide care without regard to income, health insurance status, race, culture, or legal status. The NACHC has adopted a policy opposing legislation that would limit access to health center services in any form. Further, the association has supported efforts to expand Medicaid coverage to eligible migrant workers who cross state lines. They also have opposed any effort to criminalize humanitarian assistance, regardless of immigration status. The association points out that ignoring any part of the community or any single health problem, whether natural or man-made, risks the entire community’s health.

Serving all members of the community means that CHCs are largely ahead of their peers in cultural competence. Although federal regulations set the core principles, Pierle of the Missouri Primary Care Association says local communities have flexibility on how to design their programs to serve their populations. Wiltz agrees. “We take pains to hire personnel who are culturally competent and sensitive,” he says. Bilingual staff, translators, outreach workers, and a variety of providers all add up to a more culturally-sensitive health experience.

It’s also a recent push with the Joint Commission. Wiltz knows all about that, too. His center was the first Joint Commission-accredited CHC in the state of Louisiana. The HRSA says that nationally, about one-third of CHCs are accredited, most by the Joint Commission and a few by the Accreditation Association for Ambulatory Health Care. Curtin says the quality of CHCs is an attraction for many physicians. He mentions other benefits, most notably malpractice coverage under the Federal Tort Claims Act. “If you sue one of us, you’re suing the federal government,” says Curtin.

Another financial benefit for physicians is possible loan repayment. All FQHCs qualify as health professional shortage areas (HPSAs), making providers eligible to apply for loan repayment under the National Health Service Corps for two years, renewable for two more. “If you’re a primary care physician and you want to do rural health care in Michigan, you could find a CHC job that will pay you $125,000 a year and up to $35,000 a year to pay off your loans,” says Curtin. “And we would hope that after four years, we’ve convinced you to stay with our system.” g

Teresa Odle is a free-lance writer in Albuquerque, NM. She has edited national medical practice newsletters and written for trade magazines.

BACK TO FIRST PAGE

TOP OF PAGE