And to promote CHCs’ long-term viability and their safety-net mission, policy makers should explore standardized, equitable reimbursement strategies.

As payor generosity is a key determinant of who healthcare providers care for and how well they are able to do so, these insights establish a critical baseline for understanding how our safety net is compensated.

3. And despite the enhanced nature of these payment rates, the vast majority of payment rates (over 80%) fail to compensate centers for the full cost of care. This is antithetical to the spirit of the law that first established the elevated rates decades ago!

2. However, rates varied significantly, with CHCs who serve more patients who identify as Black, are uninsured, or have chronic conditions receiving LOWER PPS rates. So, CHCs may actually be penalized for caring for patients with elevated needs, potentially undercutting their safety net mission.

1. Medicaid rates were on average 23% more generous than Medicare rates. This bucks broader trends in the US healthcare system and - as payor generosity is a key driver of who providers serve - is also a critical mechanism to promote equitable access to care for lower-income folks.

However, until now, it had yet to be documented how much these clinics actually get paid, how PPS rates vary across centers and states, and whether these elevated rates are generous enough to actually offset the costs CHCs accrue to provide care. Here, we uncovered some pretty striking findings:

Variation In Medicaid And Medicare Payment Rates To Community Health Centers, 2023 | Health Affairs Journal In recent years, community health centers (CHCs) have struggled to meet the needs of underserved communities because of limited resources and growing demand. Medicaid and Medicare use prospective paym...

New paper out this week in Health Affairs!

Community health centers (CHCs) have over the past few decades received elevated, prospectively-set payment rates (called PPS rates) from Medicaid and Medicare to support their mission as healthcare safety net.

Link: www.healthaffairs.org/doi/10.1377/...

3. And despite the enhanced nature of these payment rates, the vast majority of payment rates (over 80%) fail to compensate centers for the full cost of care. This is antithetical to the spirit of the law that first established the elevated rates decades ago!

Turf Wars: How Growth and Competitive Shocks Have Affected the Performance and Stability of Community Health Centers | Milbank Quarterly Community health centers (CHCs) are a critical and growing part of the health care safety net, doubling over the past 15 years to expand access to essential health care services to over 31 million pat...

ICYMI: Check out, “Turf Wars: How Growth and Competitive Shocks Have Affected the Performance and Stability of Community Health Centers,” an open-access Milbank Quarterly article by @justinmarkowski.bsky.social of the @uicpublichealth.bsky.social

The State of Rural Primary Care in the United States Rural Americans face significant barriers to accessing adequate primary care; tailored federal and state programs can help address some of these challenges.

Primary care is under strain nationwide, and rural communities are feeling it.

A new @commonwealthfund.org brief finds deepening workforce shortages and fewer options for basic care among the 60 million people who live in rural areas.

Read more ⤵️
#ruralhealthweek #ruralhealth #powerofrural

Investing in Primary Care: The Nurse Practitioner Will See You Now | Milbank Memorial Fund Decades of research confirms the safety, quality, and effectiveness of care provided by NPs, including care for complex patients, and their acceptance and approval by patients. Yet challenges remain i...

"The most recent data show that NPs comprise 47% of all US primary care clinicians and, together with physician assistants/associates (PAs) and certified nurse midwives (CNMs), comprise 52% of primary care clinicians working in community health centers." www.milbank.org/publications...

Targeted Regulations Of Abortion Providers Associated With Significant Decreases In OB-GYN Density, 1993–2021 | Health Affairs Journal Obstetricians and gynecologists (OB-GYNs) provide essential health care to women across their lifespan. Yet nearly half of US counties have no OB-GYNs, with nonmetropolitan communities disproportionately affected. Targeted Regulation of Abortion Providers (TRAP) laws, spurred by the 1992 US Supreme Court decision in Planned Parenthood v. Casey, impose regulatory burdens on abortion providers and may have influenced whether and where OB-GYNs choose to practice, which has not yet been comprehensively studied. Using a staggered difference-in-differences design and county-level data, we found that TRAP laws were associated with an average reduction of 4.67 percent in the density of OB-GYNs per 100,000 women ages 15–44 during the period 1993–2021, between Casey and the Dobbs v. Jackson Women’s Health Organization decision in 2022. TRAP laws affected both general and fellowship-trained OB-GYNs, as well as counties without abortion facilities. Concerningly, TRAP laws led to lower physician density in nonmetropolitan counties—a difference that persisted for a decade. As OB-GYN shortages are projected to worsen and TRAP laws are still in effect in twenty-four states, policy makers should consider the long-run effects of TRAP laws on women’s access to health care and their potential to exacerbate geographic disparities in access to care.

New work with a fantastic PhD Candidate Aline Vandenbroeck: we find that Targeted Restrictions on Abortion Providers are not so targeted… reshaping the whole OBGYN workforce in curious ways: www.healthaffairs.org/doi/full/10....

Community Health Centers’ Progress and Challenges in Meeting Patients’ Essential Primary Care Needs Amid major public health challenges, community health centers continue to provide millions of patients with accessible, comprehensive, and coordinated health care.

CHCs are meeting the health care moment by offering same-day care, expanding #behavioralhealth services, and scaling telehealth.

But federal funding and staffing challenges are mounting. Find out how Congress can help, and what the data show, here ⤵️

#NHCW25 #ValueCHCs

Yesterday, HHS revised its list of federal programs that many immigrants will be ineligible for to include community health centers. CHCs are a vital source of care for many immigrants; especially among those who are uninsured/on Medicaid, are Hispanic, may be undocumented, or have LEP
@kff.org

Turf Wars: How Growth and Competitive Shocks Have Affected the Performance and Stability of Community Health Centers Policy Points Community health centers (CHCs) are mandated to simultaneously maintain collaborative relationships with all other health care providers in their service area while consistently exp...

What happens when mission-driven CHCs start competing with each other? Despite policy mandates to collaborate, I find that CHCs are increasingly drawn into “turf wars” that may compromise their social mission.

Full study here: doi.org/10.1111/1468...

#HealthPolicy #CommunityHealth #CHCs #FQHCs

Alternative Payment Models and Performance in Federally Qualified Health Centers This cohort study examines whether Medicaid alternative payment models are associated with the health care quality, health outcome measures, payer mix,

New work with @jacobwswallace.bsky.social , Mark Schlesinger, and Chima Ndumele: we find significant improvements in quality of care at FQHCs w/o adverse shifts in patient composition after the introduction of Medicaid APMs. 📊 Read the study here: jamanetwork.com/journals/jam...

Opinion | How to Put ‘Community’ Back in the Mission of Community Hospitals Nonprofit hospitals are behaving in ways that seem to focus more on dollars than patients.

NON-profit hospitals — what’s in a name?

Check out my @nytimes.com oped asking nonprofit boards to come back to their mission

www.nytimes.com/2023/11/30/o...

@sangerkatz.bsky.social @dusetzinas.bsky.social @stevejoffe.bsky.social

New work with @jacobwswallace.bsky.social and Chima Ndumele: we find that despite their 50+ year history, HPSAs have had no significant impact on reducing disparities in physician density or mortality. Read the study here: healthaffairs.org/doi/10.1377/...