Although it might not be obvious on the surface, the proposed changes of the "Patients Over Paperwork" initiative could very well have far-reaching effects in the FQHC world, affecting reimbursements, quality programs, and more.
Here at FQHC Associates, we get many inquiries about starting or becoming a Federally Qualified Health Center (FQHC). We hear from a wide range of individuals and organizations, but most inquiries come from existing health care organizations who see the benefits in transitioning to an FQHC model of care, both to the community-at-large and to the organization itself.
The 340B Program has become an important source of revenue for many Federally Qualified Health Centers. Many fear that without 340B, their programs will not survive. With a draft Mega Guidance under consideration by HRSA and new CMS rules governing Medicaid reimbursement, 340B is going to change. The extent to which this will affect FQHCs is currently a matter of speculation. Meanwhile, in order to understand where this crucial program is likely headed, it is important to know where we are now, and how we got here.
Besides not dying young, one of the advantages of being around for a long time is that you gain perspective.
The chronically ill account for a huge percentage of the population. In fact, as of 2012, approximately one half of all adults had one or more chronic health conditions, and one in four adults had two or more chronic health conditions. Additionally, heart disease and cancer—both chronic diseases—together accounted for almost half of all deaths in 2010. Given these facts, is it any surprise that, in 2010, eighty-six percent of all health care spending was for people with one or more chronic medical conditions? (CDC website)
As of January 1st, 2016, Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) are able to bill for Chronic Care Management (CCM) services provided to Medicare patients using CPT code 99490. CCM refers to the non-face-to-face coordination of care for chronically ill patients.
Open Enrollment for the Health Insurance Marketplace began on November 15, 2014. After the first Affordable Care Act enrollment period, a Commonwealth Fund report (http://www.commonwealthfund.org/publications/issue-briefs/2014/jul/health-coverage-access-aca) found that the uninsured rate dropped from 20% to 15%.