In these times of intense attention to healthcare from all quarters of the US, a new study by USA Today and Kaiser Health News reporters focused on community clinics. Over the past 2 decades community clinics have developed from origins often as volunteer-run efforts, to become a vital part of what is called the safety-net. Frequently they now are the sole source of care available to over 20 million people, often as the only providers who will accept patients covered by Medicaid, and for the growing ranks of the uninsured. The sorry state of healthcare access would be far worse if it were not for community clinics. These centers will play an important role too in the reforms set to start in 2014. It is expected that many who will become newly insured by Medicaid will be seeking care at community clinics. Long woefully underfunded, clinics will be eligible to receive help from the $10 billion approved by Congress for expanding their service capacity.
The report entitled Community clinics have odds stacked against them looked at almost 1200 community clinics across the country, and ranked them based on the 6 categories of performance quality measures which federally qualified health centers (FQHCs) must report to the federal government. The categories cover care for patients with diabetes and high blood pressure, rates of screening for cervical cancer and childhood immunizations, plus timeliness of prenatal care and rates of low birth-weight babies.
Using 2010 clinic performance data obtained by FOIA request, the reporting team found wide variations in care by center, by region of the country, and between specific centers in the same city. Generally, clinics in the South performed worse that those in New England, the Midwest, and California. Overall, their survey showed community clinics not performing as well as the national averages for the study parameters .
There is more context to understanding the survey results however, that was not part of the report. The National Association of Community Health Centers issued a statement about the report which while recognizing the value of examining clinic performance, expressed concern about the wrong impressions that the media study might give:
The article disregards the better quality care that most health centers achieve when compared to care provided to other low-income patients elsewhere. However, at least the article does reveal what few Americans realize– that every health center reports on the quality of care their patients receive….
…When you compare the federal data that is the focus of the USA Today article with national data from the National Center for Health Statistics, health centers performed better than national averages for entering women into prenatal care during the first trimester, childhood immunization rates, reduced low birth rates and hypertension control…..
NACHC recently published its report Health Wanted – The State of Unmet Need for Primary Health Care in America which takes an in-depth look at the factors behind the consistent and increasing demand for community clinics, the links to social determinants of health and how funding has not kept up to meet population needs. In FY 2011 for example, only 67 out of some 1900 applications for new health center service sites were funded.
Seattle/Local Health Guide extracted localized figures from the report to create a Washington State Comparison Chart. Janna Wilson, Senior External Relations Officer for the Seattle-King County Department of Public Health shared additional concerns with me in a personal communication, about implications and lack of context for specific data used for the local news article:
The data provided for Public Health represents a small subset of the patients we see—our homeless primary care patients. This is because Public Health’s federal health center grant comes under a targeted program called Health Care for the Homeless. Our federal data report, therefore, is specific to our homeless patients per federal reporting requirements. As you know, homeless patients face barriers that often exacerbate medical and behavioral health conditions and complicate treatment plans.
While most community health center grants and programs are for the general low-income population, some — like ours — target special population groups such as homeless people or migrant workers. There is nothing in the USA Today article that provides this important context. That said, quality improvement is a big part of our program for all our patients, whether homeless or housed.