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Federally Qualified Health Centers

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Delayed but deeper cuts for safety-net hospitals

April 21, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

For the third time in three years, federal cuts at safety-net hospitals have been delayed but the amount of  future cuts has been deepened.

An article on Governing Magazine’s Web site reports:

“America’s Essential Hospitals, a trade group for public hospitals, acknowledged there’s no returning to the level of DSH {Disproportionate Share Hospitals} spending before the ACA, but the stall in Medicaid expansion has certainly helped make their case that hospitals caring for the most vulnerable can’t sustain cuts. They also argue, however, that there’s evidence the ACA’s coverage expansions might not be enough, and the cuts go too deep. A study last year in the journal Health Affairs examined California, an enthusiastic supporter of the ACA, and found public hospitals there will have unmet DSH costs of more than $1 billion even by 2019.”

Such developments make adequate funding for such institutions as Federally Qualified Health Centers all the more important.

Conn. reports surge of young mentally ill

April 20, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

A new Connecticut Health Department report says that mental disorders surpassed all other ailments as the leading cause of hospitalization in 2012 in the Constitution State for children 5-14, older teenagers and young adults.

Of course, many of these young people have other health problems related to their mental illnesses, such as substance abuse. We wonder how many of these young people frequently present at the state’s Federally Qualified Health Centers.

The New Haven Register reported: “The data show five hospitals had increases of more than 12 percent in the number of days that patients with behavioral health problems were hospitalized. The biggest increases were at Yale-New Haven Hospital, which saw the number of patients rise 61 percent, and inpatient days jump 51 percent; and Waterbury Hospital, with 26 percent more patients and a 37 percent increase in inpatient days. The increase at Yale-New Haven is partly due to its merger with the Hospital of St. Raphael in 2012.”

 

Obama immigration action and FQHC’s

March 30, 2015by Robert Whitcomb in Uncategorized tagged ,

 

President Obama’s executive order on immigration, if upheld in the face of legal challenges, would substantially increase the number of people with insurance coverage and thus have major effects on the U.S. healthcare system, says this article in The New England Journal of Medicine,

The authors write:

“Although the President’s … policy is likely to have a positive effect on insurance coverage of undocumented immigrants, it may, counterintuitively, do more to increase access to insurance for legal immigrants and even citizens than it does for those directly affected by the planned executive order.”

And:

“{T}he reduced threat of deportation may mitigate immigrants’ mistrust as they decide whether to pursue needed medical care, regardless of their insurance status. Ironically, any resulting increase in utilization may exacerbate the financial strain placed on safety-net providers that disproportionately care for immigrants, since many immigrants will remain uninsured if they are ineligible for Medicaid or premium tax credits. Policymakers will therefore need to continue funding streams to support providers who care for uninsured immigrants.”

Cambridge Management Group, which has worked with Federally Qualified Health Centers (FQHC’s),  which serve millions of uninsured and under-insured people, believes that the  Obama immigration action, if upheld, would tend to send more patients to these safety-net facilities. But litigation and Washington gridlock leave much in doubt. And would the Feds provide adequate funding to these FQHC’s?

 

 

Happy news from Capitol Hill for FQHC’s

March 27, 2015by Robert Whitcomb in Uncategorized tagged ,

The nation’s Federally Qualified Health Centers apparently have at least a two-year protection from falling off a federal funding cliff because of bi-partisan legislation that also makes major Medicare payment reforms.

Savings from community health centers are touted

March 23, 2015by Robert Whitcomb in Uncategorized tagged ,

 

Melanie Zanona,  of Roll Call reports: “Advocates for community health centers facing a drop-off in federal payments later this year are highlighting the estimated $24 billion in medical spending {they say} the centers save annually.”
“Mandatory funding authorized by the 2010 healthcare law—which makes up almost 70 percent of the centers’ overall funding—will run out on Sept. 30 unless Congress intervenes.”
“Supporters acknowledged that federal funding cuts could spell doom for the centers, which have existed since the 1960s and have long enjoyed bipartisan support.”
Miss Zanona reports that “Community health centers are projected to serve 28 million patients this year in areas that typically lack access to large hospitals or doctors’ offices.  The facilities are often credited with generating healthcare savings by improving patient outcomes and enhancing poor and uninsured individuals’ access to care.”

Many of these facilities are in low-income rural areas, such as Appalachia, that vote heavily Republican. That’s one reason why we at Cambridge Management Group, which has done extensive work  with Federally Qualified Health Centers, guess that a bipartisan deal will save federal funding for these community health centers, though maybe, as is often the case on Capitol Hill, at the last minute.

 

Tenn. weighs changing Medicaid mental-healthcare

March 12, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

 

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Officials of TennCare, the Tennessee Medicaid program, seek to reform mental- and behavioral-health treatment under its 2016 budget.

The Nashville Tennessean reported that TennCare is proposing implementing ”an evaluation mechanism for people receiving mental health treatment under the bureau’s Level 2 case management classification. People under this categorization receive visits from case managers in addition to therapy or other treatments, such as medication.”

”The proposed changes would institute a review after three months to evaluate whether case manager visits are needed rather than everyone receiving visits, said Keith Gaither manager of managed-care organization (MCO) operations at TennCare.”

”Gaither said that the MCOs have been looking at this category of patients for more than two years to determine whether there was a way to tailor treatment on a case-by-case basis rather than extending the case management to everyone.”

It is unclear what impact all this might have on hospitals and Federally Qualified Health Centers.

 

 

 

 

A new little co-op takes on a behemoth insurer

January 20, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

goliath

“David and Goliath (1599) oil painting by Caravaggio.

Herewith the story of Evergreen Health Cooperative, created under the federal Affordable Care Act to offer “patient-centered” care and cut healthcare-market costs. (We keep being slightly amused by term ”patient-centered” care. Isn’t that  the population that healthcare was always suppose to be centered on? Well, maybe not….Follow the money?)

Evergreen has two parts: a nonprofit insurance company with a traditional network of doctors and a health system that directly employs providers.

“We’re the first new commercial insurer in 20 years in Maryland as far as we know,” Peter Beilenson, M.D., a former Baltimore health commissioner, told The Baltimore Sun. “It’s not easy to have a successful startup in a state that basically has a monopoly,”  citing  CareFirst BlueCross BlueShield, Maryland’s dominant insurer.

Evergreen is one of 24 such co-ops in America, officially called Consumer Operated and Oriented Plans, and, as The Sun noted, ”many of them face similar behemoths.”

And the ACA doesn’t let these co-ops do traditional marketing. Further, government rules  make  it hard to sign up large employers that could bring  in many paying customers at once.
”That fierce competition {from big insurers} is the biggest hurdle to the co-ops’ success …. But there are a host of other potential stumbling blocks, including name recognition and funding, and the co-ops are responding by boosting their industry knowledge, aggressively marketing their services and cutting premium prices to lure customers, ” reports The Sun.

Evergreen looks to small businesses that it could attract on its own and enroll in groups. ”So far, about 1,000 small businesses employing {a total of} about 12,000 people have switched to the co-op.”

Research ”shows those insurers that follow the {co-op} model could save around 20 percent on hospitalizations alone, one of their biggest costs.”

We wonder how some of these co-ops might be integrated with Federally Qualified Health Centers.

 

 

 

Trying to address overcrowding at a big E.D.

January 19, 2015by Robert Whitcomb in Uncategorized tagged , , ,

mob

In what might or might not be some useful ideas for other big urban hospitals, two New York officials have released a report on overcrowding in the emergency department of huge and prestigious New York Presbyterian Hospital, in  northern Manhattan.

Federal healthcare regulators said 5 percent of the hospital’s E.D. patients leave before  medical professionals see them — compared with the national average of 2 percent. That might not seem like  much of a difference, but given  the huge population that runs through Presbyterian, it means a lot of untreated and/or irritated customers. Of course, given the location, a lot of these patients have no insurance and chronic illness. They’re heavy duty.

Among the suggested improvements: increased staffing, improved patient privacy, ”better access to urgent-care centers, and inclusive partnerships with community health providers and professionals,” reports WCBS. It should be noted that some politicians pushing these reforms see Presbyterian as an opportunity to create more local jobs, for which the politicians would take credit.

We at CMG have been in that E.D. (or E.R. as we instinctively first call it as pushback to certain commercials on TV)  and so suspect that many, perhaps a majority, of patients there would do better going to urgent-care facilities, including  Federally Qualified Health Centers, if there were enough of them. And most need patient-centered medical homes.

 

 

 

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