Commonwealth Fund survey: community health centers closely affiliated with hospitals obtain specialty care for patients easier

Community health centers that are closely affiliated with hospitals have fewer difficulties getting their patients appointments for specialty procedures, such as X-rays, diagnostic tests, and visits with specialist physicians, according to a new Commonwealth Fund survey of community health centers. Centers without hospital affiliations reported they had more difficulty getting off-site specialty appointments regardless of a patient's insurance status.

The report, “Enhancing the Capacity of Community Health Centers to Achieve High Performance,” is a national survey of nearly 800 federally qualified health centers. It examines centers' capacity to provide high-quality healthcare and function as patient-centered medical homes.

According to Edwina Rogers, executive director of the Patient Centered Primary Care Collaborative (PCPCC), many health centers are already well on their way to becoming medical homes. In fact, she says the Department of Health and Human Services is working on a program for health centers to become homes.

“The community health centers need to become medical homes because the core piece of the healthcare solution they offer is primary care,” Rogers says. “They’re ideal candidates to become medical homes and take responsibility for whole patient care.”

She says the incentives for community health centers to become medical homes are obvious: payments and quality of care.

“Third-party payment systems are part of the problem because community health centers are only paid for episodic care and not monitoring,” she says. “What's the incentive now for preventative care after a colonoscopy, for example? They’re not paid for that. Under the medical home model, they would be.”

Community health centers serve an estimated 16 million patients who are predominantly low-income, uninsured, or insured through Medicare or Medicaid. According to the report, many community health centers already provide high-quality, well-coordinated care, but the passage of the Patient Protection and Affordable Care Act could increase demand for their services nationwide, according to Coomonwealth Fund, much as it did after Massachusetts passed comprehensive health reform.

The survey used five different medical home indicators to determine the extent to which a center functioned like a medical home. It found that 29% of centers had all five of the indicators of a medical home, 55% had three or four indicators, and 16% had zero to two.

Specifically, according to the report:

• Seventy-one percent of community health centers can usually provide patients with same-day or next-day appointments, or can usually provide patients with telephone advice on clinical issues during office hours or on weekends or after-hours.

• Seven in 10 centers have office systems that allow them to easily generate lists of patients by diagnosis (69%) or easily track referrals until the consultation report returns to the referring provider (70%).

• The more medical home characteristics a center possessed, the more likely it was to report better communication and coordination with specialty care providers and local hospitals. For example, 45% of centers with all of the attributes of a medical home are notified if a patient goes to the emergency room, compared with only 20% of centers with only a few medical homes attributes.

• Health centers with greater medical home capacity were more likely to report they have an adequate workforce and not face shortages of physicians: 43% of centers with all the characteristics of a medical home have an adequate physician workforce, compared to only 24% of centers that only have a few.

• Forty percent of health centers use electronic medical records, which is nearly the same rate as practitioners in other settings, where 46% use electronic medical records.

• Fifty-seven percent of centers reported they electronically access patients' laboratory tests results on a routine basis and 45% routinely order laboratory tests electronically.

• Thirty-five percent of clinics electronically prescribe medications, 38% use electronic systems to issue medication alerts or prompts, and 38% use computerized systems for clinical notes.

• Sixty-nine percent of centers reported that they can usually or often track ordered lab tests until the results reach clinicians. But only 46% indicate that their providers receive an alert or prompt to notify patients of test results.

• 25 percent of clinics can electronically determine which patients are overdue for tests or preventive care, and 18% usually send patients reminder notices for preventive or follow-up care.

• Almost all centers (99%) indicate that they collect and report performance data at the provider and/or practice level in order to analyze clinical outcomes and gauge patient satisfaction.

In order to put community health centers on a long-term path to high performance, the authors recommend developing a policy to urge health centers, specialty care providers, and public hospitals to formalize referral and coordination partnerships; encouraging health centers to improve office systems and processes that will enable them to function as patient-centered medical homes; reforming payment to health centers in a way that will promote patient-centered medical homes; and forwarding adoption and use of health IT.

“One of the current challenges is cost of transformation to change systems and practices to be qualified as medical home,” Rogers says. “But many community health centers are closer to being medical homes than some practices are, especially practices in rural areas.”