A Sustainable Business Model for RW Part C

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Transcript A Sustainable Business Model for RW Part C

FQHCs and FQHC Look-alikes: A
Sustainable Business Model for RW
Part C Programs
Rebecca M. Johnson, MNPL
Mark Meye, CPA
Community Link Consulting
Your knowledgeable resource
in all things FQHC
New Access Point, Service Area Competition
Budget Period Renewal
Ryan White Grants & Program Support
FQHC and Look-alike Grantee Support & Services
Financial Management
Cost Reporting, UDS, FFR
Fee Schedule Review
Corporate Compliance / Compliance Reporting
Management / Staff / Board Training
Strategic Planning
Residency Development
IT Infrastructure Development and Support
Who’s in the room?
Why now?
Affordable Care Act
RW Reauthorization Uncertainty
Changes in HIV Disease
Objectives: By the end of the
presentation you will:
•Understand the benefits of becoming an FQHC or
•Know how the programs differ
•Know which model best supports your program
•Have basic information to begin strategic
discussions about becoming an FQHC/FQHC-LA
•Have a road map for pursuing FQHC/LA status
Federally Qualified Health
Center’s Mission
Improve the health of underserved
communities and vulnerable
populations by assuring access to
comprehensive, culturally
competent, quality primary health
care services
Ultimate Goal…
Improving health status (i.e., patient
outcomes) of all populations in the
target area served by a health center,
especially underserved.
Four Core Elements
FQHC or FQHC – Look alike
1. Reach Medically Underserved Communities
Impact: CHCs serve populations who otherwise
would not get the care they need; CHCs see
publicly insured and uninsured patients in areas
where there is a lack of providers and/or
providers willing to see this population.
2. Governing with Community Involvement
Impact: CHCs reflect the needs of the
communities they serve.
3. Treat Patients Regardless of Ability to
Impact: Community Health Centers (CHCs) are
the primary care safety net for the uninsured.
4. Provide a Comprehensive Scope of Services
Impact: No other model of primary health care service
delivery offers more services in one location or targets
more special populations through one model of care.
» Reduce/eliminate health disparities.
» Help vulnerable patients successfully manage chronic
» Save money in the health care delivery system by
keeping patients out of the hospital and ER.
Program Benefits – FQHC Only
•Grant Funding for Operations under
Section 330 of the Public Health Services
Act -- $650,000 for New Access Point
• FTCA – Federal Tort Claims Act Coverage
Additional Program Benefits
National Service Corps
Enhanced Medicaid/Medicare Rates
340 B Pharmacy Access
Program Requirements:
•Comprehensive primary care (directly or
•After hours care
•Wrap around “enabling” services
•Robust QI Program
System Requirements:
•Ability to bill third party payors
•Medicaid and Medicare electronic billing
•Financial management policies/procedures
Shared Compliance Requirements:
•Annual Uniform Data Set (UDS) Report
(similar to RDR/RSR)
•Grant Cycles (similar to Part C)
•Cost Reports
•Financial Audit (A-133)
Financial Model
Typically 80%
Buckets (i.e., programs)
Staffing Ratio Expectations
Non-Program Revenue
Other (interest, meaningful use)
Program Income
Program Income
Enhanced Reimbursement Rates
Access to Prospective Payment System wrap payment for Medicaid
Cost-based reimbursement for Medicaid
and Medicare
Medicaid Rate Setting Year
Medicaid – not intuitive
Impact – long term and potentially
340B Pharmacy
Discount drug pricing program requires
drug manufacturers to provide outpatient
drugs to covered entities at a reduced price
Benefits of 340B Program
Reported savings that range between 25-50% for covered
outpatient drugs as a result of the low 340B prices
Reduces the price of medications for patients
Expands the number of drugs on formularies
Increases the number of indigent patients served
Expands other services offered to patients by the entity –
flexible “profit” – unlike RW
Simplified Grant Accounting
Typically tied to payroll
No Double Dipping
- Charge only one grant
Applying for FQHC Grants
Needs Assessment
Services – Required and Optional
Business Plan
Rebecca M. Johnson, MNPL
Health Center Solutions, Inc.
[email protected]
Mark Meye, CPA