Prepping Community Clinics For The ACA
Community clinics are expected to play a key role in the implementation of the Affordable Care Act as they provide key primary care services to millions of newly insured. But a new study by UCLA researchers suggests such facilities in California's most populous county may not be properly prepared to undertake such an effort.
The study – undertaken by the UCLA Center for Health Policy Research with support from the Weingart Foundation and the California Community Foundation – discovered that 62% of community clinics in Los Angeles County were in some stage of preparation for the ACA, their level of readiness varied greatly.
Altogether, 34 community clinics were surveyed. Twenty-eight were designated as federally qualified health centers, three were FQHC “lookalikes,” which meet the same requirements as FQHCs, but do not receive additional funding, and eight were community clinics.
Only 39% of those clinics surveyed were at a high state of readiness, accomplishing four or five specific goals such as being designated as a medical home, using health information technology to a high degree, increasing quality improvement efforts, and contracting with managed care organizations.
For example, only one quarter of the clinics surveyed had formal designation as a medical home, which would allow them to provide all primary care services to patients and coordinate care beyond the primary care level. Meanwhile, 26% of the clinics may not have the internal infrastructure required to undergo the often arduous certification process, the researchers concluded.
"More people than ever before now depend on community health centers for essential health care," said Nadereh Pourat, the UCLA center's director of research who led the study. "Clinics need support to expand beyond their traditional roles and responsibilities if they are going to effectively serve new populations."
Moreover, more than 80% of the clinics surveyed have 40 or fewer managed care patients, regardless of whether they have significant numbers of managed care contracts in place.
Those clinics judged to have a high state of readiness by the survey were more likely to be larger organizations with multiple sites and large staffs, strongly suggesting that smaller clinics may struggle with ACA readiness.
“Many of these organizations do not have plans to apply for medical home recognition, do not have electronic health records, have not participated in many quality improvement
collaboratives or conducted internal initiatives, and/or have not succeeded in contracting with managed care organizations,” the report read. “These (clinics) have a smaller workforce, fewer patient encounters, and a lower percentage of patient-generated revenue.”
The survey’s authors suggested that those community clinics struggling with their readiness focus on increasing funding and revenues to improve quality, healthcare IT infrastructure and qualify as medical homes.
