Boston, MA - Representatives of the state's 49 community health centers gathered at the State House to promote their work to expand access to quality, cost-effective health care for some 820,000 state residents. The community health centers, which are widely acknowledged to be a keystone of the Commonwealth's health reform success, also made the case that they are under increasing financial pressure as they work to serve more residents in need, and keep pace with system-wide changes in the way health care is paid for and delivered as mandated under state and federal health reform laws.
"Like all health care providers in Massachusetts and across the country, community health centers are being asked to change the way they organize and deliver care," said James W. Hunt, Jr, president and CEO of the Massachusetts League of Community Health centers. "Although health centers remain at the forefront of patient-centered care initiatives, they have limited access to financial resources for building and sustaining the workforce, health information technology upgrades and other infrastructure enhancements necessary for meeting the practice transformation requirements under health care payment reform."
As Massachusetts approaches full implementation of the federal Affordable Care Act, increasing numbers of patients will be seeking care at the state's 49 community health centers. This uptick in demand comes at a time when the fiscal state of health centers remains precarious. In fact, the financial trends at community health centers appear to be worsening since the centers last reported declining financial projections in a survey conducted by the Massachusetts League of Community Health Centers.
The January 2012 survey, which requested FY 11 and FY12 (projected) financial data, revealed a looming fiscal strain on many Massachusetts health centers:
- 33% of health centers reported a drop in their operating revenue between FY11 and FY12.
- 48% of health centers reported losses in either FY11 or FY12, with 41% reporting losses in both years.
- Losses for FY11 amounted to $14.6 million and are estimated to be $13 million in FY12, bringing two-year total losses to just under $28 million.
- 46% of centers reported a drop in net service patient revenue related to clinician shortages and clinician time set aside for implementing electronic medical records and new patient care initiatives.
These financial challenges have had an impact on health center operations with many centers planning to reduce staffing levels, delay expansion plans, restrict services and cut back on hours. Centers that provided survey comments cited clinician shortages (41%), inadequate grants and rates (41%), insufficient cash flow (53%) and challenges with Health Safety Net, MassHealth and commercial insurance reimbursement and billing (59%) as the most pressing issues facing their organizations.
"Community health centers, which are 80% dependent on public funding, have fewer options for restoring financial stability with the loss of the Essential Community Provider Trust Fund and more than $18 million in state prevention funding since 2008," said Hunt. "These cuts in combination with reimbursement rates that have failed to reflect the rising cost of providing care, have weakened an already delicate system of medical, mental health, dental and social services provided to vulnerable patients across the Commonwealth."
Hunt also emphasized that one-time capital investments for health centers through the American Recovery and Reinvestment and Affordable Care Acts have helped to mask growing financial challenges at health centers. "While these investments were instrumental in delaying the full brunt of the economic downturn, health centers are no longer shielded from the financial realities of long-term program cuts and underpayment," said Hunt.
As part of the event, Senator Richard Moore joined with leaders of the Massachusetts League of Community Health Centers (the League), Neighborhood Health Plan (NHP) and Partners HealthCare (Partners) to highlight a private initiative of NHP and Partners to support community health centers as they work to reduce barriers to care, increase health equity and organize care for patients in their communities.
The Partnership for Community Health will provide up to $90 million in grant funding over the next 15 years for health centers to develop and launch measurable programs that enhance health outcomes, service, efficiencies and quality of care. In its first grant round, the Partnership For Community Health will provide a total of $4.25 million in grants focused on strengthening health center business practices, workforce training and health information systems.
In this first round of funding, grants were awarded to all of the state's 49 community health centers across four categories:
Health Information Technology Reporting: For the purchase, implementation and training of staff on new information technology systems designed to enhance patient care and improve patient health through the collection and application of valid and timely health data.
Meaningful Use Training: For staff training on how to meet a core set of federally-mandated objectives for using health technology to improve the delivery of health care and the health outcomes of patients. Under the national health reform law, achieving Meaningful Use determines whether a health care organization can receive incentive payments from the federal government for care provided to Medicaid and Medicare patients.
Medical Coding Training: To assist health centers in meeting new coding requirements established by the Affordable Care Act. This funding provides clinicians with the necessary knowledge and skills for accurately documenting the complexity of care among their patient populations, and to ensure the necessary revenue to support that care.
Training and Capacity Building for Performance Improvement: To provide opportunities for health center staff teams to participate in structured Performance Improvement programs. These teams gain the knowledge and competencies critical for building and sustaining quality improvement across their organizations.
"Neighborhood Health Plan?s mission is rooted in providing better access to health care for underserved populations throughout the state," said NHP President and CEO Deborah C. Enos. "This first round of grants is vital in our effort to enhance our support for the community health centers that care for so many of our members."
"Community health centers are a cornerstone of an accessible, high-quality, and cost-effective health care delivery system, particularly for the underserved," said Gary L. Gottlieb, MD, President and CEO, Partners HealthCare. "The Partnership for Community Health is a crucial initiative that will support the state?s community health centers for years come in serving the needs of patients across the Commonwealth."
"This first round of grants will help health centers better prepare for the changes that health reform has brought, while allowing them to continue delivering their innovative care to the more than 800,000 patients they serve statewide," said the League's President and CEO James W. Hunt, Jr.
Added Hunt: "We are extremely grateful to NHP and Partners for committing these long-term resources to health centers. Equally critical is the need for state investments that provide relief to financially-distressed health centers and support rate adjustments and infrastructure enhancements for all health centers to ensure that they thrive in our emerging health care system."