Panel Paper: Community Health Center Availability and the Use, Cost and Quality of Health Care

Thursday, November 7, 2019
I.M Pei Tower: Majestic Level, Vail (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Sandra Decker, Agency for Healthcare Research and Quality

Although most physician practices in the United States are private, the number of Federally Qualified Health Centers (FQHCs) and FQHC delivery sites has nearly doubled and tripled, respectively, over the past 20 years. Although this suggests that FQHCs are becoming a more important delivery site, little data exists that can be used to compare quality and costs of care for FQHCs versus other sites. The Uniform Data Set from the Health Resources Services Administration (HRSA) provides some performance metrics for FQHCs, though comparable information for care obtained outside of FQHCs is generally unavailable. The goals for this work are to provide nationally-representative estimates of access to and use of FQHCs as well as comparisons of cost and quality of care in FQHCs and other delivery sites.

We use the Medical Expenditure Panel Survey – Household Component (MEPS – HC), a survey of individuals and their medical providers, including costs and quality measures for sampled providers. We identify FQHC visits within the MEPS-HC by matching provider information in the MEPS (name, address, phone number) to information on the universe of FQHC delivery sites available from HRSA and the Centers for Medicare and Medicaid Services Provider of Services file.

FQHCs became more accessible during the 2000-2015 time period. In 2015, the average MEPS respondent lived 4.9 miles to the nearest FQHC, down from 10.7 miles in 2000. The biggest change was for Hispanics, for whom the distance decreased from 7.2 miles in 2000 to 2.6 miles in 2015. The percent of the population using FQHCs increased significantly from 2000 to 2015, with about 7% of the population having at least one FQHC visit in 2015. Those on Medicaid were mostly likely to have used an FQHC, consisting of 14% in 2015. About 35% of primary care checkups among Medicaid recipients took place at FQHCs in 2015, compared to only about 15% in 2000. Use of FQHCs is highest among Hispanics, individuals living outside of metropolitan areas, those in fair or poor health, and those in the West.

In 2015, Medicaid FQHC payment generosity relative to Medicare appeared to be similar for FQHCs and physician offices. In both settings, Medicaid paid about two-thirds of Medicare. In 2000, before many states had implemented prospective payment for FQHCs, Medicaid payment relative to Medicare was more generous for FQHCs compared to physician offices.

Mean CAHPS (Consumer Assessment of Healthcare Providers and Systems) quality measures were slightly lower in 2015 for FQHC users compared to non-users, though indistinguishable upon adjustment for observed patient characteristics.

During the past 15 years, availability and use of FQHCs has increased substantially. Available measures of quality of care suggest similar quality of care for FQHCs users compared to non-users. In the past, Medicaid payment appear more generous to FQHCs compared to other sites, though appears similar currently. Ongoing analyses consider the effects of FQHC use on quantity, quality and costs of care in Medicaid instrumenting for FQHC use using distance.