What is a community health clinic? Obama hints at health-care access.

James Hubbard, M.D., M.P.H.

What is a community health clinic?

President Obama hinted at how he plans to deal with health-care access when he asked for significant funds to increase and update community health clinics—$155 million up front and $2 billion over two years.

I have some experience with the rural health clinic which, I think, is the country version of a community health center.  President Carter started these in the 1970s.  They are kind of a branch of Medicare/Medicaid.   The fees are figured differently and there are more hoops to go through for providers.

They can be run by a physician, nurse practitioner or physician assistant.  State regulations dictate supervision.  There is a community committee that must meet regularly and assess progress.

Medicare/Medicaid has a complicated fee schedule related to clinic expenses and the number of patients seen.  The clinics must see anyone, regardless of pay, but can charge regular fees for private pay and insurance patients.  Many clinics have a sliding scale fee schedule based on income.

As in most anything, the quality depends on the practitioners.  Many provide good, continuous preventive and primary care for people who otherwise might not get it, or would go to the emergency room.  It does nothing to change hospital or specialist care.

We have one in Colorado Springs and it’s a valuable service.  Many patients are on the waiting list to sign up.  In fact, I think that’s one of the drawbacks—long waiting times. Another thing you can expect is to be seen by a nurse practitioner or physician assistant rather than a physician.

Does anyone else have any experience with community health centers?

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14 Responses to “What is a community health clinic? Obama hints at health-care access.”

  1. Tom Rooney Says:

    I don’t have experience with community clinics Dr. Hubbard, but at the VA we do have outpatient services for veterans now with what they refer to as Community Based Out Patient (CBOC). They are used to treat minor occurrences and well care visits. Each has services with primary care, dental, optometry, pharmacy and mental health services. They even have mental health and diabetes group meetings in the evenings. It gives much more access to vets than having to come to the hospital and wait for hours just to get a script filled.

    Tom Rooneys last blog post..Don’t Worry Be Happy

  2. Steve Parker, M.D. Says:

    I’ve read that the community health clinics already in existence have a totally different fee schedule compared to private clinics, and it’s higher fees.

    For example, the pay to the community clinic for a medium-complexity follow-up office visit might be $75, but the private clinic might get $45.

    Like most government-run or government-sponsored entities, I bet the community health clinics are terribly inefficient (and costly to run compared to the private sector option).


    Steve Parker, M.D.s last blog post..Spanish Ketogenic Mediterranean Diet

  3. James Hubbard, M.D., M.P.H. Says:

    Tom, Thanks for sharing your experience. It is probably going to be similar.

    James Hubbard, M.D., M.P.H.s last blog post..How to Help a Loved One: depression, alcoholism, addiction …

  4. James Hubbard, M.D., M.P.H. Says:

    Dr. Parker,
    Haven’t heard that, but you know government run entities are going to be ineffecient and filled with layers of bureaucracy, almost by definition.

    James Hubbard, M.D., M.P.H.s last blog post..How to Help a Loved One: depression, alcoholism, addiction …

  5. ocbody.com doc Says:

    I wonder if the pay scale they set up will make it possible to even make a profit. The government seems to think that docs should work for free…at least when they pay for a lot of the plastics stuff.

  6. James Hubbard, M.D., M.P.H. Says:

    True ocbody.

    I imagine it won’t be much.

    James Hubbard, M.D., M.P.H.s last blog post..How to Help a Loved One: depression, alcoholism, addiction …

  7. Marc Wetherhorn Says:

    Dr. Hubbard:

    What you and your readers are describing are not the Federa]ly Qualified Health Centers that President Obama is supporting (and President Bush supposrted).

    Federally Qualified Health Centers are non-profit, community-directed health care providers serving low income and medically underserved communities. For over 40 years, the national network of health centers has provided high-quality, affordable primary and preventive care, as well as dental, mental health and substance abuse, and pharmacy services. They are located in areas where care is needed but scarce, and improve access to care for millions of Americans regardless of their insurance status or ability to pay. Their costs of care rank among the lowest, and they reduce the need for more expensive hospital-based and specialty care, saving billions of dollars for taxpayers. Currently, around 1,200 health centers deliver care through over 6,600 service delivery sites in every state and territory.

    For more information you can go to http://www.nachc.com or http://bphc.hrsa.gov/about/

    Marc Wetherhorns last blog post..Press Release: New: Funding Opportunities Under the Economic Stimulus Bill

  8. Sagan Says:

    Sounds kind of like walk-in clinics… I think those are good ideas. It’s great that Obama is focusing on health care so much more.

    Sagans last blog post..Day Three of the Sugar Challenge

  9. James Hubbard, M.D., M.P.H. Says:

    I think it may be more like developing the medical home for each person like he has mentioned in the past.

    James Hubbard, M.D., M.P.H.s last blog post..How to Help a Loved One: depression, alcoholism, addiction …

  10. Maureen Maxwell Says:

    Community Health Centers (CHCs) are non-profit or public comprehensive primary care providers with a mission to provide health care to low income working families and individuals. CHCs are also called Federally Qualified Health Centers or FQHCs. By emphasizing preventive and primary care, Community Health Centers help keep people out of the emergency room and save money. CHCs use a sliding fee scale that keeps health care affordable. CHCs are especially able to meet the needs of their communities because more than half their board members are patients. Like Dr. Hubbard, the majority of physicians at CHCs are family physicians.

    In the current economic downturn, CHCs are seeing rising demand for services. People who lose their jobs to business downsizing and closures often lose their health insurance as well. CHCs are located in high need areas with lower income populations and fewer doctors and nurses – areas that are likely to be hard hit by the recession. The need is greater than CHCs can meet alone, but they are working hard to care for their communities, working with other health care providers, and hiring additional health care providers and build or expand exam rooms when funding is available. CHCs are funded by a combination of federal, state, local and private funding and patient payments. Like everyone else, CHCs face reductions in these sources of funding in the difficult economic situation.

    President George W. Bush championed the Community Health Centers, leading an effort to increase the number of Community Health Centers in areas with little or no health care access. President Obama supports CHCs as part of the solution to the holes in the health care system because he knows the research shows that the Community Health Center system provides high-quality cost-effective health care to people who would not otherwise have it.

    Please learn more about Community Health Centers by visiting http://www.nachc.com/about-our-health-centers.cfm or http://bphc.hrsa.gov/about/. Learn more about the CHCs in Colorado by visiting http://www.cchn.org. You can find out more about Rural Health Centers, another kind of health clinic as defined in federal law, at http://www.narhc.org/home/RHC.php.

  11. James Hubbard, M.D., M.P.H. Says:

    Ms. Maxwell:
    Thanks for your interesting comments.

    James Hubbard, M.D., M.P.H.s last blog post..How to Help a Loved One: depression, alcoholism, addiction …

  12. Dr. J Says:

    I volunteered for a while at our local community health clinic. I found the experience quite rewarding, and the staff wonderful to work with. The advantage of clinics like this one, is people who otherwise would not be able to get this level of care as easily are able to have it.

    Dr. Js last blog post..Nibbles: FDA issues peanut safety guidelines, the high cost of cutting trans fat and the maple syrup shortage

  13. Diana Zulaica, LVN Says:

    Thank you Marc and Maureen for explaining what FQHCs and CHCs are. We need more people to be educated about what we are about.

    Dr. Parker and Dr. Hubbard,

    I work for a federally qualified health center in Texas and I worked for a private office before that. I don’t think it has to be a competition about which one is better. Our physicians and other healthcare providers work together with the providers in the private sector to meet the healthcare needs of the people of our community. FQHCs like ours provide comprehensive services that include behavioral, medical and dental care services. We do not depend solely on money we receive from the state and federal level. We also have patients with private insurance and we have patients who are self-pay. We also receive donations from private charity organizations. I invite everyone to look for a community health center in their area and visit them. Talk to the people in your community and you will find that we serve the patients’ needs comprehensively in a very efficient and cost-effective manner.

  14. James Hubbard, M.D., M.P.H. Says:

    Ms. Zulaica:

    Thanks for the insight and experience.

    I must admit that from your, Marc and Maureen’s comments, I really think my original summary was correct. Everyone’s comments have just made it clearer.

    One valuable thing about the centers is they can be critiqued and studied since they are not a new concept.

    Marc, I am not sure why you say what we have been describing is not the centers President Obama has in mind.

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