Support Your Local Community Health Center

Healthcare leaders and community leaders who aren't actively working to shore up funding for community health centers stand to damage a valuable primary care resource and the vulnerable population it serves.

Community hospitals, critical access hospitals and other safety net and primary care providers are challenged enough just keeping the doors open and the lights on in this era of reduced reimbursements and narrowing bottom lines. These providers could be excused if they were to adopt an "everyone for themselves" attitude when it comes to pleas for more funding.

Fortunately, most of the frontline providers I've spoken with over the years understand that no successful provider is simply an island of care cut off from the other providers in the community. There has to be coordination and cooperation among providers to improve community health.

That emphasis will only intensify in the coming years with the evolution of population health, the continuing shortage of skilled clinicians, and the expectation that providers will have to do more with fewer resources.

With this in mind, hospital leadership would be well advised to reexamine their relationships with and support for their local community health centers.

Specifically, Federally Qualified Health Centers face a 70% reduction in mandatory funding along with potentially other discretionary cuts as an election-year Congress thumbs through the budget. Funding reductions of that magnitude would shutter many health centers, or at least force staff layoffs and reduce services at a time when demand for care is growing.

Dan Hawkins, senior vice president for policy and research at the National Association of Community Health Centers, believes that when community health centers provide effective and coordinated primary care everybody wins:

• Patients get better care
• Private practice physicians aren't constantly pressed to provide charity care or extended on-call hours
• Hospitals' uncompensated care caseloads are reduced and they don't get dinged for readmissions
• The public sees lower healthcare costs

"For all of those reasons health centers are good partners to other healthcare providers in their communities. They can help them better organize care and control costs and improve health outcomes," Hawkins says.

Hawkins says the Patient Protection and Affordable Care Act will extend healthcare coverage to millions of people. However, he says that the PPACA by itself will not address the challenges that tens of millions of people in this country have when they attempt to access healthcare. A report released this week by NACHC estimates that 62 million people nationwide have no access to primary care because of a shortage of such physicians.

Some basic stats on those affected:

• 43% are low-income
• 28% live in rural areas
• 38% are racial/ethnic minorities
• The vast majority of these medically disenfranchised Americans actually have insurance coverage; 22% rely on Medicaid and 58% have other insurance.

NACHC, which represents more than 1,200 FQHCs in every state and the territories, holds its national conference this week in Washington, DC. Their priorities are to call on President Obama and Congress to fix the "primary care cliff" and to extend mandatory health center funding for another five years, enabling health centers to reach 35 million patients by 2020.

FQHCs now serve about 22 million people at more than 9,000 sites and NACHC says the centers save $1,263 per patient per year because patients have access to timely and appropriate care. When the expected upsurge in demand for primary care kicks in NACHC says health centers could generate up to $24 billion a year in savings.

But to generate that savings and provide the access, Hawkins says, health centers have to be properly funded and they have to be fairly reimbursed by third-party payers.

Hawkins says community health centers would greatly appreciate any help that local providers can give in making the case for continued funding of FQHCs. "As civic and community leaders many in hospital leadership can speak to their elected officials and encourage them to support the continuation of funding for health centers," he says.

"That is what is going to keep those health centers functioning well in their community, and even allow them to reach and serve more of the population, among those who will be gaining coverage and who don't have a regular source of care today, and for those who will be left behind for whatever reason."

"We know that the majority of the 30 million Americans who will remain uninsured even after reforms are fully implemented are folks who by and large will be uninsured simply because they cannot afford the premium costs of insurance coverage. Only a small portion will be uninsured because they are undocumented. The vast proportion will be too poor to afford insurance coverage."

We all know what will happen if funding dries up for community health centers. They will close, and access to primary care will get that much harder, especially for the poor and most fragile people in our poorest and most isolated communities. These people will delay care until it becomes so serious that they'll have to use the emergency room for episodic relief.

They'll get their care in the most expensive setting, and then get discharged back into their environment with no one coordinating their recovery or ongoing care, or creating any sort of sustained prevention or disease management plan. These people will almost assuredly end up back in the emergency room, assuming they don't die first.

It's time for providers everywhere to speak in support of community health centers. Their work is too important. They need your help and you need theirs.