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HomeHealth & FitnessHospitals move primary care patients to 'similar' health centers to boost finances

Hospitals move primary care patients to 'similar' health centers to boost finances

BeverlyCare in Montebello, Los Angeles County, is a federally qualified similar health center established by Beverly Hospitals. The similarly-looking hospital leased space for its main primary care and pediatric facility, which is located in Beverly Medical Plaza. A Women’s Health Clinic is 2 miles away. Corali Nakamatsu, executive director of BeverlyCare, said the similar clinic works closely with hospitals and pays to handle many administrative functions. (Heidi de Marco / KHN)
  • More and more hospitals are outsourcing often unprofitable outpatient services to the poorest patients by establishing independent nonprofit organizations to provide primary care.

    Medicare and Medicaid payments to these clinics, known as federally qualified similar health centers, All hospital fees are much higher.

    Like the nearly 1,400 federally qualified medical centers — which also receive additional funding — designated by the government as a ” “Similar” clinics are also eligible for federal programs that can help reduce costs and recruit providers. They allow clinics to get prescription drugs at deep discounts and lure doctors by making them eligible for government programs that can help pay off student debt if they work in areas with a shortage of medical providers.

    But unlike community health centers, these similar agencies do not receive annual federal grants to cover operating costs. Similar people also do not receive the financial benefit of the federal government taking the risk of their malfeasance.

  • Even though they are not part of the hospital system, many hospital-like facilities are located on or near the hospital campus There are clinics. As a result, clinics can help divert patients without urgent needs from expensive emergency rooms.

    This helps reduce losses, especially from uninsured patients who may have been using the emergency room for primary care. Converting clinics to lookalikes is also often a strategy for hospitals with high rates of patients enrolled in Medicaid, which is often reimbursed to hospitals at lower prices than commercial health plans, said Jeffrey Allen, a partner at consulting firm Forvis. “It’s a trend that’s gaining momentum,” he said.

    Losing services and offering to like-minded people, he said grants to keep them solvent. At the same time, the hospital expects many patients from similar clinics to need admission for services or specialized care to be transported to their hospital, he said.

    From 2019 to 2022, at least eight hospital systems have retrofitted existing clinics, according to a KHN analysis of federal data Or new clinics were built, which received similar designations. They include:

  • Parkview Health, a large hospital System Indiana and Ohio opened a similar health center called Alliance Health Centers in Fort Wayne, Indiana, in 2021. Hospital spokeswoman Tami Brangle said lookalike status gives the system a better way to provide care to underserved people.
    • Parrish Medical Center in Titusville, Fla., which helped open the Space Coast Health Center, is designated as a façade — as in 2022. Parrish spent $1.2 million to build a clinic that provides primary care and mental health care a few blocks from the hospital. “Many of our patients have not received primary care for years and have multiple medical and behavioral needs,” Space Coast CEO Arvin Lewis said in a statement to KHN. “We are working to improve access to care.”

    • Wabash Comprehensive in partnership with local health departments The hospital department established Wabash Community Health Center, a similar clinic near Mount Carmel Hospital in Illinois. The hospital is treating some outpatients in the emergency room, and the new facility provides mental health services and physical wellness in one place, said Danielle Stevens, executive vice president of business development at the hospital. “The intent is to expand services that are not currently available to the community through increased reimbursement,” she said.

    According to BeverlyCare Executive Director Corali Nakamatsu, Beverly Hospital in Montebello, Los Angeles County, provided a $3 million loan and donated its women’s clinic to launch BeverlyCare, which is similar to BeverlyCare. Similar people rent office space from hospitals for adult and pediatric clinics. The clinic helps patients who need follow-up care after going to a hospital emergency room. The clinic also offers patients a lower cost option than using ER.

  • Indiana Hospital Association President Brian Tabor said hospitals are sometimes wary of forming similarities because it means handing over control to a new organization. But, he said, the switch could benefit both hospitals and patients: “Hospitals are exploring different payment models to support access in rural and underserved areas, and for some, a similar state has become a real key tool.”

    Nationwide, today there are 108 similar Medical centers are operating, up from 87 in 2020. Most don’t start in a hospital.

  • Similar medical centers are overseen by a board of directors, at least 51% of directors must be patients – just like full-fledged community health centers Same. Similar health centers treat patients on a variable fee scale based on their income.

    Organizations often seek similar status from the Commonwealth

    In the Allentown, Pennsylvania area, two major health systems—St. Luke’s University Health Network and Lehigh Valley Health Network—recently converted many of their primary care clinics into similar clinics. Neither hospital would provide a spokesperson to discuss the changes, but both responded to questions in writing.

  • St. Luke’s started Star Community Health in 2018; it picked up a similar name in 2020. “Star has been able to treat a wider group of individuals who otherwise would not have access to care,” said Star CEO Mark Roberts, although he gave no details on the expansion.

    Lehigh Valley transitioned several of its primary care practices to similar status under the name Valley Health Partners Community Health Centers. Spokesman Jamie Stover said the additional funding from Medicare and Medicaid enables the clinic to expand mental health and substance use services, as well as provide help from financial counselors, social workers and clinical pharmacists.

    Lee Health, a hospital system in Fort Myers, Florida, began in 2014, bringing its more than two dozen outpatient clinics transition to a similar state. Bob Johns, senior vice president at Lee Community Healthcare, is the only full-time executive who looks alike. Others are still employed by the hospital system.

    Higher Medicaid funding helps pay for four new adult family clinics and one pediatric mental health clinic, Johns says . Part of the funding for mobile health clinics to underserved areas also comes from enhanced Medicaid reimbursement.

    A Medicaid primary care office visit can get you about $120, almost double what Lee Health would receive when it owned the clinic.

    Johns believes that similar clinics have reduced unnecessary emergency room visits at Lee Health Hospital by at least 20%. Many of those visits are from uninsured patients, he said.

    Similar people also benefit from the federal 340B program, which allows them to buy medicines at very low prices to sell to patients. The patient’s insurance company usually pays the center higher rates, while the clinic keeps the difference. Clinics can lower out-of-pocket costs for patients, but don’t have to, though Johns said Lee Health does lower drug costs for uninsured or low-income patients.

  • 340B plan-eligible hospital systems like Lee Health typically only use it for admitted patients, Johns said .

    Lookalike status also allows clinics to participate in the National Health Service Corps, a federal program that provides Clinicians working in the area of ​​​​the recipient pay student loans, he said. “It’s a great way for us to stay connected with our providers,” Johns said.

    Finding new funding to expand care for underserved people, he said . Resource,” Johns said.

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