28 Questions Every Health Center Should Ask Regarding Health Reform

28 Questions Every Health Center Should Ask Regarding Health Reform

In the Fall 2010 issue of News & Views, E. Benjamin Money, President & CEO of the North Carolina Community Health Center Association (NCCHCA) lays out 28 critical questions CHCs should ask themselves as they plan for health reform implementation.  What answers would your health center give and how can you take advantage of the potential opportunities?

Looking Forward to Health Reform:

28 Questions Every Health Center Should Answer

Now that health reform is the law of the land, several unknowns from the past year are settled. The decisions health centers make in the next 5 years will set the stage for us to be critical partners in our communities’ health care delivery system, or isolated bit-players struggling to compete in a performance-driven, consumer-oriented marketplace.

 Here are several opportunities and critical questions for health centers…  

New Funding for Health Center Program Expansion

$1B in first year ($1Billion for new activity)

$1.2 B in 2012 ($200M for new activity)

$1.5 B in 2013 ($300 M for new activity)

$2.2B in 2014 ($700M for new)

$3.6B in 2015 ($1.4B for new activity)

 Types of Expansion

  • Increased Demand for Services
  • New Oral Health Services
  • New Pharmacy Services
  • New Behavioral Health Services
  • New Enabling Services
  • New Service Sites
  • New Health Center Organizations

 Key Questions:

1)      Can my health center plan for expansion based on the assumptions of the last Health Center Growth Initiative?

2)      Should our focus be inward or outward? Do we need to strengthen programs in our existing service area or look to expand access in other communities?

3)      What happens to the funding after 2015? With the looming federal debt, will Congress maintain the increased funding for health centers or look at the newly insured and re-balance their investments?

4)      Can we sustain any expansion over the long-term?

Capital Financing

    • $1.5 billion over five years
    • Expanding and improving existing facilities
    • Constructing new sites  

5)      Will the BPHC issue a new grant opportunity or will they fund down the list of approved-but-unfunded Facility Improvement Grants from the fall?

6)      Will our construction plans be suitable for patient population changes resulting from Health Reform?

7)      How long will interest rates remain low? How much can I afford to borrow?

Primary Care Workforce

    • National Health Service Corps Program Funding
    • $290 million for FY 2011;
    • $295 million for FY 2012;
    • $300 million for FY 2013;
    • $305 million for FY 2014;
    • $310 million for FY 2015.
    • TOTAL = $1.5 billion over five years.  

Health Reform will increase demand for primary care services, but fewer medical students choose primary care careers.  

8)      How will my health center compete for a limited pool of providers?

9)      How will my health center retain the providers it has?

10)   How competitive is my compensation and incentive package?

11)   What in my community attracts and retains providers and their families?

12)   What is our relationship with the medical and nursing schools? How are students exposed and attracted to work at my health center?

Medicaid Eligibility & Financing Changes

Beginning January 1, 2014, Medicaid expands to all individuals under age 65 (including all children, pregnant women, parents, and adults with no restriction) with incomes up to 133% FPL.  

13)   Will private providers accept more Medicaid patients or wait on privately insured patients to increase?

14)   How do our current patients perceive us? Do they feel valued and appreciated? Newly insured patients will have a choice…Will they shop around for another provider?

15)   What is my health center doing to retain current patients?

16)   Where are those patients that will be insured in 2014? Is my health center currently their medical home?

17)   Are we leading the way in customer service?

18)   What are we doing to improve quality? How do patients know that quality is important to us?

19)   Are our patients building relationships with their providers or do they see a revolving door of locum tenens.

Medicare Reimbursement for FQHCs

January 1, 2011 - FQHC preventive services are updated to include an expanded list of preventive services covered under Medicare

October 2014 - FQHCs’ Medicare reimbursement will be updated to a new PPS payment methodology. At this time, both the Medicare cap and productivity screen are eliminated.  

20)   Does my health center have an accurate assessment of the costs of services? Can changes in cost be measured in real-time?

21)   Do changes in my service area population warrant developing services to meet the needs of the elderly? Why would seniors choose to come here?

Individual Health Insurance Mandate

    • Requires U.S. citizens and legal residents to have qualifying health coverage.
    • Those without coverage pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household in-come.
    • The penalty will be phased in from 2014 to 2016.
    • Beginning after 2016, the penalty will be increased annually by the cost-of-living adjustment.
    • Exemptions will be granted for various groups (i.e. financial hardship, religious objections, American Indians, and others).
    • Massachusetts health centers saw a dramatic increase in the number of patients seeking care as a result of their state’s health reform.  

22)   How will my health center compete for the newly insured patients with private practices in your community? Should we? What is the risk if we don’t?

23)   How does the community perceive my health center…as a “poor-peoples clinic” or first-class health care that serves all? What is the appearance of my facility?

24)   How will patients find us? Can they get all the info they need via our website?

25)   Will my health center be ready to meet the demand?

26)   Is my appointment schedule flexible, but efficient?

27)   How hard is it to navigate our phone system?

28)   What is the wait time on the phone or during a visit?

Many more questions such as the role of your health center in an accountable care organization or teaching health center can be answered once these fundamental issues are ad-dressed.

We do know for certain that Health Reform in not the panacea.

There will continue to be poverty.

There will continue to be disparities in health.

There will continue to be special populations with unique health care needs.

There will continue to be the undocumented without access to many services.

There will continue to be a need for community health centers.

— E. Benjamin Money, MPH

President & CEO