Community Health Centers Adapt to Increased Demand for Care

Centers Report Treating More Patients—Mainly Uninsured—Over Last Two Years

News Release
Dec. 19, 2007

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Despite significant federal funding increases, community health centers (CHCs)—the backbone of the nation’s safety net—are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services, according to a study released today by the Center for Studying Health System Change’s (HSC).

Since 2000, federal funding for federally qualified community health centers—key providers of preventive and primary care for underserved people—has doubled to nearly $2 billion annually in 2006, according to the Health Resources and Services Administration (HRSA). More than 16 million patients—primarily racial or ethnic minorities, low income, uninsured or covered by Medicaid—received care at more than 1,100 federally qualified and look-alike health centers in 2006, up from just more than 10 million patients in 2001, according to HRSA.

Much of the recent federal investment has gone to build health centers in additional communities, while support for existing CHCs has not kept pace with operating expense increases and patient growth. At the same time, according to the HSC study, recruiting and retaining staff members in a competitive labor market has grown more difficult, and CHCs are facing other demands, including increased quality reporting expectations, addressing racial and ethnic disparities, and preparing for public health emergencies.

"Community health centers are getting squeezed from both directions—on one side by rising numbers of uninsured people and on the other by a decline in other providers’ willingness to care for uninsured patients," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded primarily by the Robert Wood Johnson Foundation.

Charged with providing preventive and primary care, CHCs face growing problems referring uninsured and Medicaid patients—three out of four of their patients—for specialty care, according to the study.

"In the last decade, physician charity care has declined, and while most physicians still provide some charity care, demand far outstrips supply, particularly for specialty care," said HSC Senior Consulting Researcher Robert Hurley, Ph.D., of Virginia Commonwealth University, coauthor of the study with Laurie E. Felland, M.S., HSC health researcher, and Johanna Lauer, an HSC health research assistant.

The study’s findings are detailed in a new HSC Issue Brief—Community Health Centers Tackle Rising Demands and Expectations—is available here. The study is based on HSC’s 2007 site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1996.

Other key study findings include:

• In several states, funding reductions for mental health services have led to dramatic increases in mentally ill patients seeking and receiving care at CHCs. Dental care for low-income adults is another service that in a number of communities, such as Orange County and Little Rock, is available primarily at CHCs and often is limited to basic services. Nationally, the number of patients receiving mental health care at CHCs grew by almost 170 percent between 2001 and 2006, according to HRSA, while the number of patients receiving dental services grew by more than 80 percent during the same period.
• CHC directors reported increased difficulty recruiting and retaining clinical staff because they must compete with other health care providers, especially hospitals, that offer comparatively better salaries and benefits. Attracting bilingual staff also is becoming more challenging for CHCs as other providers attempt to improve cultural and linguistic competencies. Further, the general shortage of primary care physicians in many communities presents serious recruitment problems.
• Many CHCs are preparing for potential public health emergencies in their communities. In some cases, this has been a challenge for CHCs that until recently were overlooked by state and local agencies developing preparedness plans. This situation is beginning to change, however, as one respondent from Phoenix remarked, "I guess they finally realized that the neediest population will probably show up at the clinics in the case of a disaster."
• A key tactic in some communities to increase support for the safety net has been to pursue federal qualification or look-alike status for community clinics supported only with private donations and fees. In Orange County, a community with only two federally qualified health centers for a population of about 3 million, as many as five clinics are now seeking or have obtained federally qualified or look-alike health center status, which makes them eligible for enhanced Medicaid and Medicare payments. In Phoenix, obtaining look-alike status for the 11 centers sponsored by the county health authority meant a substantial infusion of new revenue.
• Attracting more Medicare and privately insured patients also is a goal for some centers, including those in Boston, northern New Jersey, Greenville and Cleveland. However, payment for care of these patients is typically less than what CHCs receive for patients with Medicaid coverage.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.