Centers without hospital affiliations reported they had more difficulty getting off-site specialty appointments regardless of a patient's insurance status.
Community health centers that are closely affiliated with hospitals have fewer difficulties getting their patients appointments for specialty procedures, such as X-rays, diagnostic tests, and visits with specialist physicians, according to a new Commonwealth Fund survey of community health centers. Centers without hospital affiliations reported they had more difficulty getting off-site specialty appointments regardless of a patient's insurance status.
The report, “Enhancing the Capacity of Community Health Centers to Achieve High Performance,” is a national survey of nearly 800 federally qualified health centers. It examines centers' capacity to provide high-quality healthcare and function as patient-centered medical homes.
According to Edwina Rogers, executive director of the Patient Centered Primary Care Collaborative (PCPCC), many health centers are already well on their way to becoming medical homes. In fact, she says the Department of Health and Human Services is working on a program for health centers to become homes.
“The community health centers need to become medical homes because the core piece of the healthcare solution they offer is primary care,” Rogers says. “They’re ideal candidates to become medical homes and take responsibility for whole patient care.”
She says the incentives for community health centers to become medical homes are obvious: payments and quality of care.
“Third-party payment systems are part of the problem because community health centers are only paid for episodic care and not monitoring,” she says. “What's the incentive now for preventative care after a colonoscopy, for example? They’re not paid for that. Under the medical home model, they would be.”
Community health centers serve an estimated 16 million patients who are predominantly low-income, uninsured, or insured through Medicare or Medicaid. According to the report, many community health centers already provide high-quality, well-coordinated care, but the passage of the Patient Protection and Affordable Care Act could increase demand for their services nationwide, according to Coomonwealth Fund, much as it did after Massachusetts passed comprehensive health reform.
The survey used five different medical home indicators to determine the extent to which a center functioned like a medical home. It found that 29% of centers had all five of the indicators of a medical home, 55% had three or four indicators, and 16% had zero to two.
Specifically, according to the report:
In order to put community health centers on a long-term path to high performance, the authors recommend developing a policy to urge health centers, specialty care providers, and public hospitals to formalize referral and coordination partnerships; encouraging health centers to improve office systems and processes that will enable them to function as patient-centered medical homes; reforming payment to health centers in a way that will promote patient-centered medical homes; and forwarding adoption and use of health IT.
“One of the current challenges is cost of transformation to change systems and practices to be qualified as medical home,” Rogers says. “But many community health centers are closer to being medical homes than some practices are, especially practices in rural areas.”