Federal grants help health center expansions, not operations

Washington Community health centers are seeing their patient loads steadily increase as investments from the federal economic stimulus and health system reform laws make it possible for millions more patients, many of whom are jobless and without insurance, to receive care.

But although capital investment funds from these laws offer new opportunities to improve infrastructure, several physicians who work in these centers said an adjustment to federal base grants would let them hire more health professionals and support staff. The centers continue to shoulder much of the primary care demand while preparing for a significant Medicaid expansion in 2014.

The funds “get you bricks and mortar, it hires people to do the construction, but it is not operation dollars,” said Richard Kovar, MD, a family physician and medical director of Country Doctor Community Health Centers, a federally qualified health center in Seattle. Base grant dollars are available to health centers yearly, “provided that the centers meet certain governance, quality and productivity criteria,” he said.

A White House report released on May 1 said investments from the Patient Protection and Affordable Care Act and the American Recovery and Reinvestment Act account for nearly 3 million additional patients receiving care from community health centers, up from 17 million to 20 million between 2008 and 2011. These centers will increase their patient load by an additional 1.3 million people in the next two years, the report said.

One in four adults who are low-income, employed and uninsured now turn to health centers for care, said Amy Simmons Farber, a spokeswoman for the National Assn. of Community Health Centers.

Dr. Kovar has seen the patient base in his facilities grow from 16,000 to 18,000 in the last couple of years. These patients fit the profile of the uninsured who have nowhere else to go and often end up in emergency departments, he said.

The White House findings coincided with the release of nearly ?$730 million in new health reform law funds to support 398 renovation and construction projects. The health reform law is on track to provide $9.5 billion to expand services over five years and $1.5 billion to support major construction and renovation projects at community health centers. Additionally, the stimulus package in 2009 and 2010 invested $2 billion in community center capital funds and other investments.

A. Scott McNeal, DO, is vice president and chief medical officer for Delaware Valley Community Health Inc. in Philadelphia, which operates a half-dozen sites. He said two of the facilities received a total of $1.5 million under this new round of grants, which will help with significant renovations and other projects.

However, the money wasn’t necessarily going to build enough capacity for more patients, Dr. McNeal said. “On one hand, we’re very grateful for the money we’ve received. But our organizations and many like ours are having more financial difficulties than we’ve have in the past,” he said.

Base grants are not necessarily adjusted over time, except for inflationary updates. Dr. McNeal said the situation justified funding increases in this area.

“That’s money for operations that would allow us to hire more providers and support staff for the providers,” Dr. McNeal said. “So you [have] to put that together with the fact that we are seeing many more uninsured at our locations than we had anticipated.”

The stimulus and health reform money in recent years has provided more funds for health centers to increase their capacity and meet demand. “But because of [overall] funding reductions, the growth in staffing and building and creating new access points has not been as robust as planned,” Simmons Farber said.

The Health Resources and Services Administration, which administers the base grants, declined to comment.

Dr. Kovar said his facility was able to leverage some stimulus money on a shovel-ready project “that enabled us to renovate a site, put in five new exam rooms and create a new satellite family practice residency training program.” As a result, Seattle’s Country Doctor has six new residents “who will be able to hopefully fill in the pipeline concern that’s looming on the horizon” in the form of the primary care shortage, he said.