Federally funded clinics comparable to private practices, study posits

As the Patient Protection and Affordable Care Act (ACA) settles into pasture, a projected herd of 32 million uninsured Americans will be grazing industry greens for reasonable healthcare. It’s a stampede that primary care practices won’t be able to absorb in full, at least not without a little help from some semi-new friends. Enter Federally Qualified Health Centers (FQHCs) and “look-alike” clinics, the government’s latest $11 billion prize bulls for the poor and uninsured — these FQHC assemblies will receive federal funding as well as enhanced Medicaid and Medicare reimbursement while “look-alike” clinics will incur enhanced reimbursement sans federal grants under the new ACA provisions. And according to a recent study, both facilities are just as effective as their PCP predecessors.

The report, published in the August edition of the American Journal of Preventative Medicine, appraised four categories of quality measures: (1) pharmacologic management of commonplace chronic diseases, including atrial fibrillation, heart failure, coronary artery disease, asthma, and depression; (2) preventive counseling regarding smoking cessation, diet and exercise for patients at increased risk of coronary artery disease; (3) suitable use of screening tests for blood pressure, electrocardiogram and urinalysis; and (4) appropriate prescribing in elderly patients.

Results showed that in six of the 18 specific quality measures, FQHCs established more adeptness to guideline adherence than primary care physicians working in private practices, while guideline obedience for seven of the 18 measures was less than 50 percent for both the FQHCs and the PCPs. The lowest level of compliance amongst both groups was in the preventative counseling category, whereas the highest degree of compliance fell to the statin use in coronary disease. PCPs outperformed FQHCs and company on one measure and were themselves outperformed in six measures. FQHCs and look-alikes performance was comparable to PCPs with the remaining 11 measures.

"While overall adherence to guidelines varied, physicians working at FQHC and look-alike clinics demonstrated greater adherence to guidelines than primary care physicians at private practices 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," said lead investigator L. Elizabeth Goldman, MD, MCR, from the Department of Medicine at the University of California, San Francisco.

Data for the report was obtained from the National Center for Health Statistics’ 2006-2008 National Ambulatory Medical Care Survey, which amasses information regarding ambulatory medical care provided by FQHC and look-alikes and nonfederal, office-based, direct care physicians. The overall sample pool could only be traversed in broad strokes — it consisted of 31,133 visits, 22,692 of which were to private primary care physicians.

Although the study was not able to specifically attribute why the FQHCs and look-alikes performed higher in certain realms, researchers speculated on a number of aspects.

"Overall, adherence was greatest for many of the chronic disease measures, likely, in part, due to the strength of evidence supporting those measures," said Goldman. "Lower adherence to the provision of exercise counseling to adults and adolescents at high risk of coronary artery disease may be related to the lack of evidence supporting the impact of such counseling on patient health outcomes."

The fact that FQHCs often field patients insured by Medicaid or who aren’t insured at all — meaning their subspecialty care aptitude is limited — was another presumed influence on the report’s results. Patients with chronic diseases are also more apt to visit a clinic atmosphere given that type of coverage, researchers argued. The grants provided by the federal government for workforce upkeep and the extra incentive to adhere to quality measures as means for clinic expansion may also explain the FQHCs and look-alike clinics' performance in the study.  

"In the setting of healthcare reform, FQHC and look-alikes may need to accommodate many newly enrolled Medicaid recipients. Further research is needed to monitor these and other measures to assess whether appropriated funds meet the needs of these centers so that they can continue to provide quality care, and how new reimbursement models will impact the comparative effectiveness of these clinics," Goldman concluded. 

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