Mission vs. Survival – The Community Health Center Battle

Categories: Billing, CHC, PMG Insights Blog

February 8, 2018

Healthcare professional offering services to a young patientFor the past several months, Community Health Centers (CHCs) have been faced with the uncertainty around continued funding by the federal government; funding which could jeopardize the basic fundamental of the Health Center Program. According to the Bureau of Primary Health, CHCs, among other things, were meant to:

  • Deliver high quality, culturally competent, comprehensive primary care, as well as supportive services such as health education, translation, and transportation that promote access to health care.
  • Provide services regardless of patients’ ability to pay and charge for services on a sliding fee scale.

Delivering high-quality care doesn’t happen without investments in technology, training, and education. Loss of funding could jeopardize these basic requirements of delivering quality care to a population that is underserved, vulnerable, and often times is challenged with gaining access to care.

Uncertainty for CHCs

Much of the uncertainty is not based on having actual dollars available to continue funding; it’s about politicizing the process, at the expense of patients who desperately need these services. That being said, if the funding were to be dropped entirely, it is expected that centers would be forced to close their doors within months.

CHCs would still have other income streams, including other grants, as well as reimbursements from the insurance plans (often Medicaid) that cover up to 75 percent of their patients. But the loss of the $3.6 billion federal dollars would be a significant hit to all health centers.

For instance, in the state of Florida, of the over $1 billion in CHC revenue, over 40% is comprised of funding that is not patient related revenue. Patient-related revenue consists of reimbursement from insurance plans and patients. Florida serves over 1.3 million patients at CHCs. Federal funding would, in theory, reduce access to over 500,000 patients. We already see signs that centers have been operating on shoestring budgets, with many already indicating that unless funding is restored, they will close their doors. For those patients who rely on CHCs for all medical care, the ramifications can be immense.

How Can I Grow My CHC in Uncertainty?

Like any business, operating under uncertainty does not lend itself to successfully planning for growth, investing in technologies, expanding services, continuing education for providers and staff, and contributing to the well-being of the communities for which the CHCs serve. The leadership at these CHCs must continue to strive towards operating as a business and maximize every revenue stream opportunity including, making sure that all payers are held accountable for reimbursing for services rendered at the appropriate levels. Uncovering every single claim that is denied and making sure that they are being paid in a timely fashion. This is not an easy task; after all, the health center’s missions are focused on patient care, not maximizing revenue.

The recent tax reform passage, while addressing the CHIP program did not give solace to CHCs that they would be able to continue with their mission. The recent budget negotiations in Congress and the White House continue to serve as a “band-aid” to the problem. Centers must take matters into their own hands.

How Will We Survive?

In my time at PMG, I’ve engaged with dozens of health centers who have expressed these same concerns and asked themselves the same question: “How will we survive?” Although PMG has not been able to control what happens in Washington, we have been able to positively affect what happens in the center’s billing department and thus maximizing patient revenue. The Affordable Care Act certainly had an impact on private practice medical providers, as they faced challenges managing the influx of previously uninsured patients, but one thing that they have done very well is to make sure that every dollar that is due to them is paid to them. CHCs need to adopt that same mentality.

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We urge all CHC leaders to take a step back from the recent political guessing game. Assess revenue streams you can control and take steps to maximize those opportunities. We at PMG applaud the work you do and are committed to assisting CHCs in getting paid every dollar they deserve. The nation’s most vulnerable populations depend on it. We only wish those in Washington will come to realize that as well.

Urge Congress to make CHC funding a priority