The financial viability of rural primary health care centers.

Feldman, Rayah; Deitz, Deborah; Brooks, Edward F.

doi:10.2105/ajph.68.10.981

Cited by 8 publications

(14 citation statements)

References 3 publications

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“…This measure is frequently used as an indicator of an organization's financial health 1,18 and may be reduced by a focus on uncompensated care, enabling services, and other services patients need, but which are not well reimbursed. 19,20 Board composition is defined categorically as the percentage of trustees at an FQHC composed of representative consumers (patients whose income is typical of FQHC patients), non-representative consumers (patients whose income is higher than most FQHC patients), and non-consumers. The methods for classifying individual trustees are based on their self-reported patient status in conjunction with the average annual income for their self-reported occupation and have been previously described.…”

Section: Methodsmentioning

confidence: 99%

“…County-level factors include a binary indicator of metropolitan area, which has been both positively 16 and negatively 22 associated with financial performance; the per capita number of active nonfederal office-based physicians, which has been negatively associated with operating margin; 23 the number of short-term general hospitals and the number of FQHCs, which may drive demand and need for care as well as represent competition for the FQHC; and several measures of county demographics (percentage male, percentage non-white, percentage Hispanic) and socioeconomic status (per capita income, percentage uninsured, percentage unemployed), which have been negatively associated with FQHC financial performance. 20 Federally qualified health center-level factors include caseload, which has been positively associated with financial performance; 16 aggregate case-mix by age, gender, percentage non-white, and income (relative to the poverty level), which are likely to have a direct effect on organizational outcomes; a measure of chronic disease burden (percentage of encounters for diabetes, asthma, and/or hypertension), which has been negatively associated with financial performance; 16 the proportion of an FQHC's caseload by insurance status, which has been both positively 16,18 and negatively associated with financial performance; 24 board size, which has been negatively associated with consumer influence; 25 the number of delivery sites an FQHC operates, which may have implications for organizational outcomes (R. Wells, J. Vasey, F. Lawrence, and R. M. Politzer, unpublished data); the number of full-time equivalent staff, which has been negatively associated with operating margin; 24 and the number of physicians as a percentage of total staff, which has been positively associated with financial performance. 16 A binary variable is included to indicate the presence of at least one physician on the board, because boards with a physician presence may operate differently than boards without physicians.…”

Section: Methodsmentioning

confidence: 99%

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Consumer Governance May Harm Health Center Financial Performance

Wright

2013

J Prim Care Community Health

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Introduction: Federally qualified health centers (FQHCs), which must be governed by a patient majority, have historically struggled to remain financially viable while caring for a disproportionately low-income and uninsured population. Consumer governance is credited with making FQHCs responsive to community needs, but to the extent that patient trustees resemble the typical low-income FQHC patient, patient trustees might lack the capacity to govern, harming financial performance as a result. Thus, this study sought to empirically evaluate the relationship between FQHC board composition and financial performance. Methods: Using data from years 2002-2007 of the Uniform Data System and the Area Resource File, and years 2003-2006 of FQHC grant applications, FQHC operating margin was modeled as a function of board and executive committee composition, the interaction between them, general time trends, other FQHC and county-level factors, and FQHC-level fixed effects. Trustees were classified as representative (ie, low-income) consumers, nonrepresentative (ie, high-income) consumers, and nonconsumers on the basis of their self-reported patient status and occupation. Results: Each 10 percentage point increase in the proportion of representative consumers on the board is associated with a 1.7 percentage point decrease in operating margin. This effect becomes insignificant if any consumers serve on the executive committee. There is no significant relationship between the proportion of nonrepresentative consumers and operating margin. Conclusions: If consumers are given leadership roles on the board, consumer governance does not harm financial performance and may be beneficial enough in other respects to justify its being required as a condition of federal FQHC funding. Without such strengthening of the provision, consumer governance appears to harm financial performance and it is unclear from this study whether it offers other benefits that are significant enough to justify this financial risk.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Consumer Governance May Harm Health Center Financial Performance

Wright

2013

J Prim Care Community Health

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“…Most of the measures were directly available from the UDS. The financial measures of stability, efficiency, and productivity were created based on industry standards, prior research, and our experience (Feldman, Dietz, & Brooks, 1978;Mullner, 1990;Mullner, Rydman, Whiteis, & Rich, 1989;Rosenblatt & Moscovice, 1982;Shi et al, 1994;Walleck & Kretz, 1981).…”

Section: Center Characteristicsmentioning

confidence: 99%

“…Programs with self-sufficiency ratios less than 1 required federal and other grants to cover their costs, generally because they served a large proportion of uninsured patients. This measure was based on a similar ratio developed by Feldman, Dietz, and Brooks (1978) and modified by others studying primary care projects (Rosenblatt & Moscovice, 1978;Rosenblatt & Moscovice, 1982;Wallack & Kretz, 1981). Grant revenue was the percentage of total revenue that came from public sources (e.g., federal, state, or local) and private sources (e.g., the Robert Wood Johnson and Kellogg Foundations) as subsidies for services.…”

Section: Center Characteristicsmentioning

confidence: 99%

Managed Care and Community Health Centers

Shi

Frick²,

Lefkowitz³

et al. 2000

Journal of Ambulatory Care Management

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This study has two objectives: (1) to examine the relationship between the involvement of community health centers (CHCs) in managed care and various center characteristics, including patient, provider, services, and financial characteristics, that are critically linked with the fulfillment of their mission and (2) to identify factors significantly associated with CHCs' involvement in managed care. Regarding the first objective, the study indicates that CHCs involved in managed care have more diversified sources of revenue and depend less on grant funding than other CHCs, and they serve a significantly smaller proportion of uninsured and homeless patients. Involvement in managed care is also associated with greater financial vulnerability, reflected in higher costs and net revenue deficits. Regarding the second objective, the study finds that CHCs have become involved in managed care largely in response to external market pressures, such as the prospect of reduced federal grant funding. Other significant factors include center size, location, and the percentage of users who are Medicaid patients.

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“…Enabling services, which include transportation, on-site child care, case management, and translation services among others, provide economic, health and social benefits to recipients, 2 but are poorly reimbursed by public or private insurance 3 and frequently eliminated when resources are limited. [4][5][6][7] Therefore, understanding how FQHCs decide which enabling services to provide is important. By law, the FQHC governing board makes such decisions.…”

Section: Introductionmentioning

confidence: 99%