The Users' Guide to the Health Reform Galaxy

Leaving this health reform thread, now.

Maybe Jonathan Cohn has started a trend.

When we began RWJF’s health reform blog, a little over a year ago, we knew we were joining a crowded space.   But the health reform debate touched on so many of the issues that this foundation works on that not joining the conversation would’ve felt, to us, profoundly weird. 

We learned a lot from doing this blog.  It wasn’t the first blog launched from the RWJF mother ship, but it still taught us some new things about blogging in general.  Like, we knew that a ton of our grantees and partners were actively participating and informing the discussions and debates about health reform.  We know this because we were suddenly insanely busy (even more so than usual) putting out a ton of analyses and information from RWJF grantees and partners, and the blog enabled us to put add another layer of thoughtful commentary on top of the high volume of stuff coming from the RWJF fire hose.   However, we also learned that our grantees and partners, for the most part, traffic in groundbreaking research or demonstration projects, and not a lot of them have the time to quickly dash off a conversational, insightful piece.  Only a few had added blogging to their formidably impressive skill sets, and the competition for their thoughts was fierce. 

Nonetheless, we thought it was worth the try to get our own health reform blog going—and we got some good stuff.  We heard from our grantees and staff on a wide range of topics covered by the health reform debate.  We tried to stick, whenever possible, to plain English, so that our few thousand readers would be less confused, perhaps, about particular aspects of the health reform debate.   And now we’re come to a crossroads, and we’re ready to turn in another direction.  This is definitely not the end of RWJF’s blogging days—our Pioneering Ideas blog is still alive, well, and kicking—but we are calling it over for the Galaxy blog.   During the debate leading up to the passage of the law, we joined the conversation in so many ways.  But now the law is passed, and we’re gearing up to join other conversations, and will continue to inform others, with thoughtful and timely analysis and commentary.

Before I turn out the lights, some parting thoughts:

RWJF recently sent out the annual message from our President and CEO, Dr. Risa Lavizzo-Mourey.  This year, her message focused on what just happened, with respect to health reform, and what needs to happen, with respect to health reform, in the years to come.  In RWJF’s ongoing quest to explore the frontiers of interactivity and social media, this year, she invited readers of the President’s Message to submit “one-minute essays,” quick thoughts about what was on people’s minds with respect to health reform.

A ton of responses came through in response to the invite.  And while these responses were meant for Risa alone, she did share some key take-aways with some of us here from the hundreds of e-mails received.  Many respondents shared concrete, thoughtful, detailed responses that showed how people are already thinking several steps ahead about how to implement different provisions of the law.  And, she heard some anxiety in the responses, as well.  Anxiety about what’s in the health reform law, and how whether certain provisions will be implemented well, and successfully, and anxiety about what wasn’t in the law, and whether some important issues in health and health care will simply fall off the radar screen, forever.

I’ve heard a lot of anxiety about the health reform law, too, and can probably rattle off a list of my own worries to add to the mix.  But there are times when I wonder:  gosh, have we become a nation of hand-wringers, or what?  Are we all carrying a Woody-Allenesque flag about our own particular neuroses with respect to health reform?  (“How are states going to handle this?”  “Will people ever understand the benefits of the law?”  “What about public health/addiction/nursing/affordability/mental health/etcetera, etcetera?”)   The Patient Protection and Affordable Care Act, in many ways, is like one ginormous Rorschach ink blot for us all:  we interpret its many provisions according to our own perspectives and experiences, and we project our many hopes and fears onto the law because its passage was, truly, an extraordinary event. 

But I think the wide range of reactions and feelings about the new health reform law tells us another thing, too, and it is this:  a person’s health is shaped by so many different factors.  We as human beings present a vast array of health and health care opportunities and challenges:  where we live, what we eat, where we work, how we think, our genetic make-up, our insurance status, the care we receive, whether we like our doctor, whether enough doctors and nurses live in our neighborhoods, what we read on the Internet….all of these factors can shape a person's health and well-being in this society.  There are so many people out there who care about these different factors.  There are so many people in this country who want to try and influence these factors in ways that actually help people live healthier lives and get the care they need, rather than live sicker and die younger through successive generations. 

This, to RWJF, is what health reform is about.  Health reform has never been about one law, however momentous.  It’s what we do.  It’s our mission.

With that, I thank everyone who contributed to this blog, and everyone who read it, and all of the people at RWJF and elsewhere who took the time to keep it up and running.  It was fun while it lasted—now on to other things.

 

Health Reformer's Lexicon: Federally Qualified Health Centers

The Health Reformer's Lexicon is a weekly feature that will examine key words, terms and phrases in health reform and explore their meaning and orbit.

The term: Federally Qualified Health Centers (FQHCs)

The Centers for Medicare & Medicaid Services provides the following definition:

FQHCs are “safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless.

Under the supervision of certified medical professionals, like doctors and psychologists, FQHCs offer primary care and preventive services, such as screenings for cholesterol, visual acuity and hearing; prenatal care; immunizations; and mental and nutritional evaluations.

Funded through the Health Centers Consolidation Act, FQHCs must be public or private nonprofit organizations. To receive the designation and qualify for grant funding, they must meet a number of other requirements.

Care can be provided in a number of settings: at health centers, at patients’ homes or elsewhere in the community, and must be provided to all patients regardless of their ability to pay for it.

FQHCs Payments are determined using a sliding fee scale. And as our Health Reform GPS also notes,

… because of their location and high level of treatment of the uninsured, FQHCs receive special payment rates from Medicare, Medicaid and CHIP and are eligible for special supplemental payments from exchange-participating health insurance plans. 

Why it matters: Federally qualified health centers provide care to millions of uninsured, underinsured and non U.S. citizen populations. As access to care expands through health reform, so too will the need for safety net providers. To do so, the federal government will need to work closely with the states to connect people to services and address the primary care workforce shortage.

According to a Health Affairs article, it is estimated that FQHCs will provide care for twenty million people in 2010, about 40 percent of whom will be uninsured. 

Roots: The Economic Opportunity Act of 1964 called for “neighborhood health centers,” which spurred the creation of the first two centers–one in the Mississippi Delta and the other in Boston–in 1965. These early models were based on similar ones in South Africa and also inspired by the American civil rights movement and a growing need to address national poverty issues.

The federal government continued to increase its support for health centers, and eventually created a reimbursement designation–the Federally Qualified Health Center benefit, in 1991. 

More recently, thanks to the support of President Bush’s Health Center Initiative, federal grants for FQHCs increased from $1.1 billion in 2001 to $2.2 billion by 2009, and the number of patients who received care doubled in number. 

Where the term appears: The Patient Protection and Affordable Care Act calls for the establishment of “Teaching Health Centers,” which include FQHCs; it also calls for support to help address the primary care workforce shortage, especially in rural and underserved areas.

The bill also contains $11 billion in funding for health centers, over a period of five years, starting in 2011. According to the National Association of Community Health Centers,

$9.5 billion of this funding will allow health centers to expand their operational capacity to serve nearly 20 million new patients and to enhance their medical, oral, and behavioral health services. $1.5 billion of this funding will allow health centers to begin to meet their extraordinary capital needs, by expanding and improving existing facilities and constructing new sites.
 
Previous Lexicon entries include:
- Value-Based Purchasing
- High-Risk Pools
- Bundled Payments

From a doctor's point of view: making billing better, for better care

James E. Bailey, M.D., M.P.H., is a practicing internal medicine physician, director of the Healthy Memphis Data Center and a professor of medicine at the University of Tennessee Health Science Center.  In this post, he riffs on a topic covered by a recent RWJF-supported study, about how streamlining billing procedures will increase efficiency and help improve the quality and cost of health care.

Between the recession and new health reform law, Americans have been thinking a lot about what health care costs. I’ve heard many stories of patients and their families suffering because of the cost of getting care. I also know many primary care doctors and hospitals that do their best to provide everyone the care they need most are finding it difficult to keep their doors open. Again and again, I’ve seen how the health care people receive is often of poor quality, despite its high, and rising, cost. Sadly, Americans end up getting expensive, sometimes even dangerous procedures they don’t need while their most essential health care needs are overlooked.

The health reform debate tended to focus on big, divisive issues—and rightly so. Real change in our health care system will require hard choices to be made by everyone. But there is another big issue—not quite as divisive but nonetheless worth our attention—which is the system’s misuse of time.  Any physician can speak of large amounts of time—and frustration—spent dealing with administrative issues such as billing. As a doctor, I want most to spend my time with my patients. And so every minute I spend on administrative tasks is one less minute I have for seeing patients. And instead of an efficient system that empowers doctors to best do their work, we’ve created a time hog that dictates the priorities of our practices, inhibiting us from doing what we are called to do as physicians—provide care for those who need it.

This is why reform efforts must address issues like the simplification of billing and paperwork. A new study from RWJF's Changes in Health Care Financing and Organization initiative, “Saving Billion of Dollars—And Physicians’ Time—By Streamlining Billing Practices” suggests that it is possible to streamline the billing process, increase the quality of care and eliminate some unnecessary costs. The study examines the U.S. system of billing third-party payers for health care services, arguing that the system of third-party payment is excessively cumbersome, complicated and costly. We spend about twice as much on the billing bureaucracy in America than in any other country in the world.  While it is unlikely that we will be able to eliminate third-party middlemen from the system any time in the near future, there is much that can be done now.