Federally Qualified Health Center (FQHC)
Personal BLOG from Robert Marsh, Exec. Director and Family / Gerontological Nurse Practitioner:
Background
When I was in training at the University of Florida, one of the elective clinical rotations was at a Federally Qualified Health Center (FQHC), commonly referred to as Community Health Center. This was located in the county seat of a very rural Florida panhandle county. This facility was the only health care other than the Health Department available in the county. The Federal FQHC grant enabled this clinic to offer all of it’s services to anyone who walked in the door on a sliding scale fee schedule, and since it was the only medical facility in the county most of the residents received their health care there. In addition to the full range of family practice services, the clinic also offered urgent care, x-ray, basic laboratory testing on site, dietary and mental counseling services, ultra sound and a variety of specialists who came on a once a week to once a month schedule. Patients with Medicaid received high quality care in a private clinic setting. The patients with insurance had access to a wider range of services than would otherwise be available. The working poor could receive needed health care at a price they could afford. The staff received decent wages and benefits and even more importantly the opportunity to network and for informal consultations with other health care providers. The lack of working interactions is one of the major factors cited by practitioners for not wanting to work in rural settings.
When I was invited to start a clinic in Webster County (I moved to the ozarks in 1976 and moved to the farm I currently live on just across the county line in 1987) the goal was to eventually obtain a Federal grant and become an FQHC. There were many delays and obstacles to be overcome but FQHC status without the funds (Look-Alike) was obtained in March of 2007.
What is an FQHC?
FQHC’s are required to be non-profit organizations with a majority of the board of directors selected from the patients who use the facility. The strict Medicare audits ensure that staff reimbursement is not abused, and any related organizations can not charge more than cost for all goods and services provided to the FQHC. In the above model the “profits” derived from patients with insurance provide an additional funding source. Unless contracting with the State to provide specific services, all funding derives from insurance reimbursement, the FQHC grant and other grants and donations. To me this seems as if it is a win-win situation for everyone involved.
Why two names?
Fordland Family Medical LLC was created in 1996 as a "for profit" in order to obtain start up capital. As a new start organization Fordland Clinic was unable to obtain new start funding or loan guarantees. Fordland Clinic was created to be a successor organization; at such time that FQHC status became feasible Fordland Clinic would then purchase Fordland Family Medical for the appraised value of it’s assets. Fordland Clinic obtained 501(c) status in 1998 and providing limited services, funded primarily from private donations, until the two organizations merged in June of 2005.
Look-Alike status obtained.
In March of 2007 Fordland Clinic was designated as a Federally Qualified Health Center Look-Alike. FQHC Look-Alike's meet all the standards of a grant receiving FQHC and receive all the benefits of an FQHC except for not receiving Federal funds (these funds are used to be able to provide services on the sliding fee scale as well as to be able to provide additional health promotion services) and the free malpractice insurance that goes along with receiving Federal funds.
What's next ?
Having Look-Alike designation should make for a more competitive grant application to obtain Federal section 330 funds. This grant would bring the majority of $600,000 per year into the county each year for the initial 3 year period, and as long as Fordland Clinic continues to meet all of the standards this should continue in 5 years grants forever. The clinic is applying under a special initiative where Webster County was identified as one of the 200 poorest Counties in the US. This grant will be submitted May 23, 2007 and we will be notified in September if we will receive this grant.
How can you help?
Letters of support from patients are needed each time we submit Federal grant applications. If you feel that we offer services that would not otherwise be available, or at days / times that these services would not otherwise be available please write to us. If you have suggestions for areas of improvement, wish to ask that new services be provided, or ever had a negative experience at the clinic, please write as well so we can identify areas in need of improvement.
Robert Marsh