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Community Health Centers Poised for Expansion

John Commins, for HealthLeaders Media, September 4, 2013

A Downward Slope
"Having prepared for a decade of strong growth, health centers now face significantly diminished funding and the prospect of a slower expansion of Medicaid, both of which exert downward pressure on health center expansion," the Kaiser Commission on Medicaid and the Uninsured stated in March.

"In light of health centers' role in our healthcare system and their unique potential to advance the goal of expanded access to care for the medically underserved, these shifts in the direction of retrenchment pose a challenge going forward." Wiltz says he is experiencing the effects of that retrenchment.

"We got money to do the capital development at almost all centers in the U.S. Before that we were in two double-wide trailers and an old house. A lot of centers were in churches and schools and had not gotten any money from capital development to even get out of those dilapidated buildings into more modern facilities," Wiltz says.

"We built these facilities with the thought that these uninsured would be covered through Medicaid expansion. That was the model that we have been operating on. I have two buildings that have been renovated and are ready to go but I can't open them because if I do and 80% who come to us are uninsured, I don't have operational dollars."

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3 comments on "Community Health Centers Poised for Expansion"


Robert C. Bowman, M.D. (9/12/2013 at 12:23 PM)
Dr. Wiltz faces more adversity as he is in a state ranked 40th in CHC economic impact per person. As with the US design for health spending, most states fall short while 6 states benefit. Six of the top 10 states in CHC economic impact have the top concentrations of physicians and top economic impact from all other sources. Also rural CHCs fail to receive a share based on need - likely due to 1000 rural counties that benefit little by various state and federal designs. Many are simply not aware of CHC, FQHC, or Rural Health Clinics. They suffer most from lowest education, health, and other government spending - by design. They also suffer under pay for performance and highest readmission penalities (1 - 2%) - 14% of the hospitals in these 1000 counties, 9% for rural, 3% of urban hospitals. As 30 - 50% of Critical Access Hospitals close due to new federal recommendations, the strain on rural CHCs will be even greater. We should not have designs that send less spending and close facilities and drive off clinicians where there is least health spending per person and fewest clinicians. Our nation fails to produce the clinicians that will accept the family practice positions of CHCs with MD 7%, DO 17%, NP 25%, and PA 23% found in family practice positions. All including RNs have little primary care or underserved primary care training as well. NACHC has been working with A T Still University for over 16 years to produce the PAs, dentists, and osteopathic physicians needed for CHCs. More is needed. State primary care associations should have MD, DO, NP, PA, and RN students embedded in CHCs for preparation, training, and obligation - all specific to family practice positions where most needed. We need designs for most Americans rather than current designs favoring few.

Todd (9/5/2013 at 11:39 PM)
Its about time you expand. FQHCs got a big windfall from Obamacare. Quit expecting urgent care centers to play the role of PCMH and primary care.

Jeanette Wood (9/4/2013 at 2:43 PM)
I applaud your efforts to expand days and hours to serve our communities. I encourage you to offer access 7 days/week to further reduce the use of emergency rooms for non-emergent conditions.