Improving Quality at Community Health Centers

By Jennifer Larson, contributor

November 8, 2013 - As health reform continues to unfold, community health centers have their work cut out for them. They could soon be seeing twice as many patients as they were when the Affordable Care Act was signed into law in 2010. At the same time, they will be expected to continue improving the quality of care they deliver.

How will this be accomplished?

Among the strategies to drive improvement at community health centers are the accreditation process and investments in recruiting providers.

Predicted growth

Community health centers, also known as Federally-Qualified Health Centers or FQHCs, are already the largest national network of primary care providers. There are currently around 1,200 community health centers with 9,000 delivery sites in the United States and its territories, and 1 out of every 15 people depends on a community health center funded by the Health Resources and Services Administration (HRSA) for primary care, according to a HRSA fact sheet.

And the network is only going to grow. The Affordable Care Act (ACA) dedicated $11 billion for health center programs over a five-year period, and a significant chunk of that new funding will go toward new health centers and expanding existing centers. In fact, on Nov. 7, the U.S. Department of Health and Human Services announced it was allocating $150 million, per the ACA, to open 236 new centers, with the goal of serving an additional 1.25 million patients.

As a result, by 2015, these centers are expected to double their current patient load from 20 million to 40 million.

The increase won’t just be from formerly-uninsured people; the centers can expect more insured patients, noted a June 2010 article in the New England Journal of Medicine. “The impending expansion of Medicaid and the establishment of health insurance exchanges will see to that,” wrote Eli Adashi, MD, Jack Geiger, MD, and Michael D. Fine, MD.


Accreditation from a body like The Joint Commission or the National Committee for Quality Assurance, which offers the Patient-Centered Medical Home (PCMH) Recognition model, can indeed lend some additional credibility to a community health center.

Accreditation shows that a community health center has taken the extra steps to demonstrate its commitment to quality, said Michael Kulczycki, executive director for The Joint Commission’s ambulatory care accreditation program. It can also help with recruitment and retention of staff.

“They know what it stands for,” he said.

Lon Berkeley, project director for The Joint Commission’s community health center accreditation program, added that the achievement can also aid centers when applying for grants or contracts with health plans.

United Neighborhood Health Services serves more than 31,000 people through its network of primary care clinics and health programs in high-needs areas around Nashville, Tenn. It received accreditation by The Joint Commission in 2000. And just this year, UNHS also received the Primary Care Medical Home (PCMH) Certification.

Carmela Castellano-Garcia: Community health centers are stepping up to enhance quality.
Carmela Castellano-Garcia, CEO of the California Primary Care Association, said, “Health centers are definitely stepping up the challenge and doing what they can to enhance their quality.”

“For those in the healthcare field, it does mean something and raises our organization in their estimation,” said Mary Bufwack, PhD, CEO, of United Neighborhood Health Services. “When we are recruiting medical staff, it also means something very positive to them. It is often unexpected.”

The California Primary Care Association (CPCA) also wants its members to undertake the accreditation process, so the association recently forged an alliance with The Joint Commission to encourage the others to seek ambulatory care accreditation.

“We think this will enhance their position in the marketplace,” said CPCA’s chief executive officer, Carmela Castellano-Garcia.

Currently only a handful of the CPCA’s 900+ community clinics and health centers are accredited.

“I think there are a lot of competing demands for the health centers right now and there have been for the last several years,” Castellano-Garcia said.

For example, centers have been grappling with issues such as HRSA’s financial support for medical home recognition, the push for electronic health record (EHR) implementation, and the allocation of federal dollars for capital expansion. Pursuing accreditation may have been on community health centers’ “to-do” lists, but got moved further down the list due to these other factors.

But even centers that aren’t currently able to pursue accreditation can benefit from reviewing The Joint Commission’s standards for ambulatory care centers and finding ways to incorporate them, said Berkeley.

“It’s a blueprint for them to use,” he said.

Finding the right providers

Travis Singleton, Merritt Hawkins: Community health centers need more healthcare providers.
Travis Singleton, senior VP for Merritt Hawkins, said that community health centers don't have the recruitment resources to keep up with the immense growth in their patient base.

Given that community health centers are facing a huge expansion of their patient base, the workforce challenge presented by that situation is what Travis Singleton calls “immense.”

“That’s just a massive undertaking, and the challenges are not lost on them,” said Singleton, senior vice president for the national physician search firm Merritt Hawkins, an AMN Healthcare company.

According to the U.S. Department of Health and Human Services, health centers added an additional 2,200 full-time physicians and 2,400 full-time nurse practitioners, physician assistants and certified nurse midwives since the beginning of 2009.

But experts say that more will be needed, as the patient base is expected to grow. Singleton said that between 3,000 and 5,000 providers per year are needed.

And many health centers just do not have the resources to dedicate to recruiting.

Merritt Hawkins recently established a preferred partnership agreement with the National Association of Community Health Centers (NACHC), agreeing to work with the association’s facilities to place physicians and allied health care personnel on both a temporary and a permanent basis. The firm will help the association’s members find mission-driven providers who are well-prepared to meet the needs of the community health centers’ patients in an increasingly complex health care system.

That includes being able to address the financial realities that accompany the situation. Merritt Hawkins will also work with NACHC to help center leaders learn more about structuring their compensation formulas, based on their challenges, and infusing some financial consistency.

“You can be mission-driven and still see more than five patients a day,” noted Singleton. “There’s a fine balance. If these FQHCs aren’t financially viable, they’re not going to be here in two to three years.”

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