A recent study of 6 FQHCs in New York found that state Medicaid reimbursement policies are exacerbating workforce shortages and creating a divide between them and hospitals. And that’s doing real harm to their patients.
Federally qualified health centers (FQHCs) are often the only access point for underserved populations needing healthcare services, and telehealth can be a critical tool for improving that access.
But a new study out of Columbia University finds that several FQHCs in New York City are struggling due to inadequate Medicaid reimbursements for telehealth, which exacerbate workforce shortages and create disparities between those safety net clinics and nearby health systems and hospitals.
“Telehealth has many advantages for patients and providers, but only if it’s supported by equitable and sustainable funding policies,” Thalia Porteny, PhD, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health and first author of the study, said in a press release. “Our findings underscore the urgent need for Medicaid reimbursement reforms to address workforce shortages and ensure vulnerable populations can access the care they need.”
Telehealth is often viewed as a crucial element in helping people access care, and was a resounding success during the pandemic in helping hospitals connect with patients, but providers often won’t embrace the technology unless they’re reimbursed for switching away from billable in-person care. That’s especially true of FQHCs and other clinics, who need that support to buy the technology and train staff.
In the study, Porteny and her colleagues interviewed executives and staff from six FQHCs across New York City, and found that inadequate state Medicaid subsidies had caused them to lose about 40% of their mental health staff. Alongside the inadequate payments, restrictive policies around working at home, which were eased during the pandemic, are prompting many mental health workers to leave.
“One participant explained how making mental health practitioners come to the FQHC not only hindered workforce flexibility but did not add clinical value: ‘Every therapist…and psychiatrist [is] making financial sacrifices to work for folks like us, [and now] they have to come to the health center to get on the phone basically, and talk to their patients. And there is zero clinical value to that,’” the study noted.
This, in turn, is contributing to disparities in accessing care.
“One FQHC informed us that they had 700 patients on a waiting list for behavioral health services, because their health center lost half its behavioral health practitioners when they began to require that their practitioners work in the office, rather than remotely,” the study reported.
The study also noted that Medicaid reimbursement policies are designed to support larger health systems and hospitals while hindering small, resource-thin clinics like FQHCs.
“As one noted, ‘When a lot of the rules are made, or when a lot of the emergency fundings for [telehealth] programs come out, they’re all geared through the hospital, and then they expect the hospitals to work with everybody else, where we all know nine times out of 10, that doesn’t happen.... The decision makers at the top who pull the purse strings…are leaning towards hospitals.’” Porteny and her colleagues reported.
The upshot of the study is that FQHCs and other small providers are struggling to embrace telehealth at a time when they should be using the technology to improve access to care. The concern is heightened that those reimbursements may be even further reduced by potential Medicare and Medicaid cuts.
“In the face of potential Medicaid cuts and broader austerity measures, our study’s findings suggest that it would be detrimental to implement cost-cutting measures in telehealth reimbursements in community health centers in New York and more broadly,” Sorcha A. Brophy, PhD, an assistant professor of health policy and management at Columbia’s Mailman School and co-author of the study, said in the press release. “Such budget cuts could exacerbate provider shortages, increase barriers to care for vulnerable populations, and ultimately lead to worse health outcomes. Consequently, this could further destabilize community health centers—a healthcare program that has long enjoyed bipartisan support.”
The study supports improving Medicaid policies toward telehealth, through both better reimbursement and support for work at home plans, digital literacy and training, and other services.
“Participants held a common belief that if telehealth reimbursement policies were well aligned with practitioners’ compensation expectations, as was the case during the COVID-19 PHE response, access and compliance issues would greatly improve in FQHCs because there would be more opportunities and flexibility to see practitioners,” the study concluded.
“As one participant described, ‘Behavioral health compliance went up dramatically [during COVID-19]. Behavioral health was always an area where patients used to cancel or no show. Well, once you had a telemedicine platform for behavioral health, suddenly we had 100% compliance rate.’ Another explained, ‘We used to have a 30% no show, but because of [telehealth during COVID-19] our no-show rates were reduced to like 16%, you know, so it got cut in half.’
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
FQHCs and other clinics rely on Medicare and Medicaid reimbursements to support telehealth programs, improving access to care for their underserved patients.
Federal and state policies not only provide reimbursement for FQHCs using telehealth, but create guidelines around how they can use virtual care. Those guidelines were relaxed during the pandemic to increase telehealth use and coverage.
A recent study finds that New York City FQHCs are losing staff, particularly those providing mental health services, because of inadequate Medicaid reimbursements, and that’s affecting patient care.