Federally Funded Clinics as Effective as Private Practices on Most Quality Measures

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Federally Qualified Health Centers (FQHC) and their “look-alikes” will receive $11 billion from the federal government to expand their operations in the wake of anticipated primary care shortages as an estimated 32 million people seek healthcare under the ACA, according to a study from the University of California, San Francisco.

The study finds that FQHCs, which receive federal funding and enhanced Medicaid and Medicare reimbursement, and their look-alikes, which receive enhanced reimbursement but no federal grants, are as effective as private primary care practices, and better on some quality measures. These clinics primarily serve the poor and uninsured, and there have been concerns that they provide less effective care because they are serving more medically and socially complex patients.

Researchers used data from the 2006-2008 National Ambulatory Medical Care Survey (NAMCS) conducted by the National Center for Health Statistics, evaluating quality of care using 18 previously established quality measures. The sample consisted of 31,133 visits, 22,691 to private primary care physicians and the remaining to FQHC and look-alikes. They found that physicians working at these federally funded clinics demonstrated greater adherence to guidelines than PCPs on six of 18 quality measures and, except for diet counseling in at-risk adolescents, similar adherence on the remaining measures despite providing care to patients with limited or no insurance and a higher burden of comorbidities.

The study evaluated the following four categories of quality measures:

  • Pharmacologic management of common chronic diseases, including atrial fibrillation, heart failure, coronary artery disease, asthma, and depression;
  • Preventive counseling regarding smoking cessation, diet and exercise for individuals at high risk of coronary artery disease;
  • Appropriate use of screening tests for blood pressure, electrocardiogram, and urinalysis; and
  • Appropriate prescribing in elderly patients.

Adherence to guidelines for seven of 18 measures was less than 50 percent for both FQHC and look-alikes and private practice physicians, with the lowest adherence for preventive counseling and the highest for statin use in coronary disease. FQHC and look-alikes demonstrated higher performance across the pharmacologic management of chronic disease and appropriate use of screening tests categories.

Researchers attributed the clinics’ higher performance to a number of factors, including the fact that patients at FQHC and look-alikes are more likely to be insured by Medicaid or uninsured, with limited access to subspecialty care. Those with chronic diseases may be more likely to be managed in the clinic. Federal grants to develop stable, locally recruited workforces, and expand clinic capacity often require participation in quality improvement and performance measurement, and may also contribute to the study’s findings.

Source: Elsevier, July 10, 2012

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