Health Centers Flashcards
Lecture Objectives
1) be familiar with the Public Health Services Act and its relevance to Community Health Centers
2) to understand the function/missions, patient demographics, patient services, and revenue sources of a typical Health Center in addition to the various community benefits provided by Health Centers
3) to know the basic criteria/requirements that a health center must meet to be certified as a Federally Qualified Health Center (FQHC)
4) to understand the advantages of FQHC certification to include look-alike designation
5) to understand optometry’s current role in Community Health Centers to include advocacy efforts (such as National Health Services Corps eligibility) to increase optometry’s participation
What is a Health Center?
non-profit public or private entities that serve designated medically underserved populations/areas or special medically underserved population; a primary care clinic that serves as a medical home for particular groups of patients
Examples of Health Center?
Church Health (private) Christ Community (public)
T/F Health Centers are community based and patient directed organizations
true
What is one of the largest safety net systems of primary and preventive care in the country?
a Health Center (50% rural 50% urban)
What is the Community Health Center Timeline?
Public Health Service Act 1944, Economic Opportunity Act 1964, and Health Centers Consolidation Act 1996
What is the Public Health Service Act?
1944 streamlined the administration of the Public Health Service, provided a framework for federal public health and state public health cooperation, consolidated and revised nearly all legislation relation to public health services, amended multiple times since original passage of law
What is the Economic Opportunity Act?
1964, created the first community health centers in the US, 1965 funding was approved for the first two neighborhood health center demonstration projects, later 1975, congress permanently authorized neighborhood health centers as community and migrant health centers
What is the Health Centers Consolidation Act?
1996, combined different authorities under Section 330 of PHSA to create a consolidate health center program known as community, migrant, public housing and homeless health centers, program administrated by the Health Resources and Service Administration within the US Department of Health and Human Services
Who do Health Centers Serve?
1 in 14 people in the US, 1 in 10 children, 1 in 7 people living in poverty
Federal Poverty Level definitions
a measure of income issued every year by the Department of Health and Human Services, Federal poverty levels are used to determine eligibility for certain programs and benefits, including savings on Marketplace health insurance and Medicaid and CHIP coverage
What is the current Federal Poverty Level?
for individual $13,590 and family of 4 $27,750
70% of health center patients are…
below the poverty level
Demographics of health center patients
multiracial, not just minority
What age patients utilize health centers?
61% 18-64, 8% 65+, 31% <18
What’s the largest part of Health Center reimbursement?
medicaid (increased due to Affordable Care Act)
What are Grant supported Federally Qualified Health Centers FQHC?
community health centers, migrant health centers, healthcare for the homeless programs, public housing primary care programs
Migrant health center
regional centers for migrant workers
What are Health Centers other than FQHC?
non grant-support health centers aka look-a-like (public), outpatient health program/facilities operated by tribal organizations (public), other health centers (private)
What is a look-a-like?
a health center that qualifies for a grant but does not receive one, maybe not enough grants
What are components of a FQHC to be qualified?
need, services, management and finance, governance
What is need?
serve a medically underserved populations
What is services?
provide appropriate and necessary services with fees adjusted on patients’ ability to pay; ex: required and additional services + sliding fee discounts
What is management and finance?
demonstrate sound clinical and financial management
What is governance?
be governed by a board, the majority of which includes health center patients
MUA vs MUP
medically underserved area vs medically underserved population
HPSA
health professional shortage area
What is a medically underserved population?
not enough primary care providers, high infant mortality, high poverty, high older adult population
What are required and additional services?
health center provides all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals
Typical services provided by a FQHC
after hours care, basic lab, behavioral health, case management, dental care, emergency care, hospital/specialty care, pharmacy, primary health care, radiological services, transportation
Nationally, what percent of health centers offer vision services?
25%
What are sliding fee discounts?
determine eligibility for patient discounts adjusted on the basis of the patient’s ability to pay; full discount to individuals and families with annual incomes at or below 100% of the federal poverty guidelines; no discounts for patients with incomes over 200% of the federal poverty guidelines; no patients will be denied by health care services due to inability to pay
Management and Finance
key management staff, contractual/affiliation agreements, collaborative relationships, financial management and control policies, budget, program data reporting systems, scope of project
Governance
board authority, board composition, conflict of interest policy; half of the board must use the services
What are benefits of FQHC?
Section 330 Grant Funds, and medical malpractice coverage aka federal tort claims act
What are benefits for FQHCs and Look-alikes?
prospective payment system reimbursement (medicaid), cost-based reimbursement, eligibility for reduced drug costs/drug discounts, eligibility for vaccines for children program, designation as a HPSA (needed for NHSC eligibility), eligibility for other federal grants/programs
Largest revenue sources of Health Centers
1 Medicaid, #2 Section 330 grants
What are the community benefits of health centers?
a health home for underserved people, a voice in the operation of the health home, broader health insurance coverage, less costly care, better care, creates jobs and other investment opportunities in economically depressed communities
A health home for underserved people
improving public health, reducing the emergency room burden, providing needed services
What are the biggest challenges of health centers?
workforce recruitment, lack of adequate referral network, increasing operating costs, inadequate physical space, insufficient insurance reimbursement
Community Health Centers and the Affordable Care Act
strengthening community health centers is one of the strategies to increase access to affordable care; established the community health center fund that provides $11 billion over a 5 year period for the operation, expansion, and construction of health centers throughout the nation; projected to allow services to approximately 20 million new patients across the country (medicaid)
What percent of Community Health Centers provide in-house optometric service?
18% (National Health Service Corps currently excludes optometry)
What is the National Health Service Corps?
builds healthy communities by supporting qualified health care providers dedicated to working in areas of the united states with limited access to care; formed 1972 Department of Health and Human Services, connects 40,000 primary care practitioners to communities with limited access to primary care (currently 10,000 providers)
What disciplines is the National Health Service Corp open to?
medicine, dentistry, nurse practitioner, certified nurse-midwife, physician assistant; offers scholarship and loan repayment programs
What AOA committee is trying to get included in the National Health Service Corp?
AOA Health Center Committee
Rural Health Clinics
4,000 in the US (vs 2000 Health Centers + their clinics); another program also attempts to increase primary care services for patients in underserved communities, must be located in a rural area, required to use a team approach of physicians and non-physician practitioners
What is the main advantage of having Rural Health Clinics?
enhanced reimbursement rates for Medicare and Medicaid services
