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Relief in Sight for Federally Qualified Health Centers

 |  By John Commins  
   December 11, 2013

Because of medical liability concerns, federally qualified health centers have been mostly unable to tap into the good will of local clinicians who want to volunteer their medical services. Pending legislation may turn that around.

The nation's 1,200 health centers and the approximately 22 million patients they serve may soon benefit from legislation under consideration in Washington, DC, that is so commonsensical and cost-effective that even the current incarnation of Congress, arguably the worst ever, probably won't screw it up.

Because of medical liability concerns, federally qualified health centers have been mostly unable to tap into the good will of local clinicians who want to volunteer their medical services. Staff clinicians at FQHCs fall under the Federal Torts Claim Act. Volunteer clinicians do not and the cost of medical liability insurance is prohibitively expensive.

The Family Health Care Accessibility Act of 2013 (H.R. 2703) would extend FTCA protections to all clinicians practicing in FQHCs. If the bill becomes law, it has the potential to provide immediate and substantive relief for FQHC clinicians while improving access to care for vulnerable populations.

More clinicians means more volume and maybe keeping the doors open a little longer at these clinics just as the nation is poised to expand the Medicaid roles and millions of Americans gain some sort of coverage through the health insurance exchanges.

A 2009 Government Accountability Office report found that only 7% of FQHCs reported using volunteers. In addition, supports of the bill say there is virtually no fiscal note attached to the legislation. The GAO estimated that nationally "an additional $6 million would be paid in claims and lawsuits from fiscal years 2009 through 2013 if FTCA coverage were expanded to FQHC volunteers. The Congressional Budget Office estimated that the expansion would result in claim and lawsuit costs of less than $500,000 in fiscal year 2009, $1 million in each of fiscal years 2010 and 2011, and $2 million in each of fiscal years 2012 and 2013." 

The Family Health Care Accessibility Act could be funded from health centers' annual appropriations. Without the liability protections, the National Association of Community Health Centers and other supporters of the bill say that medical malpractice insurance for physician-volunteers at CHCs could cost as much as $100,000, reducing the number of professional healthcare volunteers at a time when health centers are expanding services and access to meet the growing needs of their

An earlier version of the bill in the 111th Congress passed the House 417-1 but bogged down as the session expired. According to an arcane govtrack.us formula, the newest version of the bill has only an 8% chance of clearing the House Energy and Commerce Health Subcommittee, where only 11% of bills emerged and only 3% were enacted in 2011–13.

However, the bill has broad bipartisan support, starting with sponsors, Rep. Tim Murphy, (R-PA), and Gene Green, (D-TX), and they're confident it will pass this session and become law. "The Family Health Care Accessibility Act is exactly the kind of bipartisan reform that Congress should pass so low-incomes families and children have access to quality affordable coverage," Murphy said in a media release touting the bill.

At a subcommittee hearing last month, Robert MtJoy, CEO of Cornerstone Care, Inc., a FQHC serving about 23,000 people in rural southwest Pennsylvania, testified that access to affordable primary care continues to be one of the most persistent challenges in healthcare.

"Research indicates that approximately 60 million Americans live in a community without access to a primary care provider. While health centers are engaged in many workforce development initiatives, one immediate solution to alleviate this workforce shortage is the use of volunteer providers," MtJoy told the subcommittee.

"By extending FTCA coverage to include volunteer providers, there will be more providers available to meet the needs of the millions of patients who still lack access to care. Recruitment and retention of healthcare providers is one of the greatest challenges I have. And unfortunately the looming critical shortage of primary care physicians will be more profoundly felt in rural areas like mine. We've got an aging physician population getting ready to retire and this bill allows us to take advantage of this valuable resource to assist us in addressing this shortage."

While this bill seems likely to pass, it won't hurt if healthcare clinicians and executives from across the nation contact their representatives in Congress to ensure that they intend to vote for it. In fact, anyone who supports improving access to primary care should encourage Congress to support The Family Health Care Accessibility Act.

It makes sense for mission and margin.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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