Federally funded community health centers provide free or low-cost care to people who might otherwise go without.
According to the most recent estimates, more than 300,000 patients received care from Georgia’s 27 federally qualified health centers, or FQHCs, in 2010.
These centers have a reputation for being no-frills places with few amenities.
That reputation may be due for an update. Though FQHCs would hardly be thought of as fancy, in some cases they offer conveniences that private practices do not.
MedLink, one of the state’s largest FQHCs, with 10 locations in northeast Georgia, has after-hours clinics for people who can’t miss work to see the doctor.
The health centers in rural regions often use telemedicine to diagnose some ailments, giving the patients access to specialists who can only be found in metropolitan areas. Some clinics use Skype or telephones to provide psychiatric services for people living in rural areas as well.
The people they serve are grateful. A nationwide study of low-income patients showed that those cared for in FQHCs are much more satisfied with their care than people who see doctors in other settings.
This is one of several important findings from the newest in a series of studies carried out by Dr. Leiyu Shi, director of the Johns Hopkins Primary Care Policy Center. He is an expert on the role the centers play in broadening access to health care and improving health outcomes throughout the population.
A model for other facilities?
Whatever it is that’s increasing patient satisfaction at these clinics may offer a lesson for providers in other settings, which will be increasingly important as the Affordable Care Act takes full effect in 2014.
The advent of the ACA and the continued alarm about the soaring costs of health care are shifting the focus from the quantity of care to its quality. For example, some provisions of the law will reward health care providers for providing better care, not for providing more services.
Another section of the law is spawning Accountable Care Organizations, designed to coordinate care and keep patients at home and not in the hospital, which is also expected to help lower costs.
“If the health center model is used as a mainstream provider, health care spending should decline,” Dr. Shi said. The study also shows that the centers’ quality of care is good – bolstering claims made by clinic administrators.
“Our goal is to provide primary health care to anybody that needs a medical home,” said Angela Rouse, director of business and community outreach for MedLink. According to Rouse, anybody includes people with no insurance, the best insurance, and everyone in between. Rouse works in MedLink’s Colbert office.
MedLink emphasizes long-term solutions over short-term fixes, said Rouse, emphasizing risk reduction and setting price expectations up front rather than waiting until a heart attack or other crisis happens.
The high level of satisfaction expressed by community health center patients surprised Shi and his team of Hopkins researchers. These clinics are not lavish by ordinary standards, and they are often found in areas where patients must overcome difficult personal circumstances, such as lack of transportation, to obtain health care.
Typically these clinics are in inner cities or extremely rural areas, where access to medical care has often been limited and sometimes non-existent.
A few years ago, MedLink conducted a patient satisfaction survey and recorded exceptionally high satisfaction scores despite long waiting times. Follow-up interviews revealed that patients were happy with the centers because of relatively modest things, such as a waiting room with air conditioning and television and a friendly staff.
“Their perception is we were meeting a need,” said Rouse. One-third of the patients at MedLink are uninsured, and air conditioning and TV are luxuries for some. Knowing this makes Rouse hesitant to put too much trust in patient satisfaction surveys.
Although Dr. Shi’s study shows high rates of patient satisfaction among community health centers, an evaluation of the care provided by Georgia’s FQHCs last year was not as favorable.
Georgia ranked near the bottom on four quality measures of care, including percentage of children who receive all seven federally recommended vaccines by age 2; percentage of adults — ages 18 to 85 — with hypertension who have their blood pressure under control; percentage of low-birthweight babies; and percentage of women — ages 24 to 64 — with at least one Pap test in the past three years.
Striving for improvement
After an article on the health centers in Kaiser Health News last April, Duane Kavka, executive director of the Georgia Association of Primary Health Care, told GHN that the 27 community health center organizations in the state are working to become ‘‘patient-centered medical homes.’’
“We’ve got to do better,’’ he acknowledged. Kavka also noted that the patients who get services at the clinic are ‘‘a population that no one wants to see.’’
Dr. Shi’s studies are ongoing, and he intends to dig deeper into patient satisfaction, so he can tell the difference between a fondness for air conditioning and actual quality-of-care measures.
He believes strongly in integrating preventive care and other services into people’s daily lives and community experience.
Rouse agrees, saying that every successful health center she can think of is actively involved with its community.
In the spacious waiting room of the MedLink Clinic in Colbert, an educational program about diabetes, a problem shared by many of the clinic’s patients, plays on a large TV screen.
Med Link’s communication strategy is simple and familiar: Knowledge is power.
“We’re the Home Depot, we’re the Lowe’s. We give you the tools, and what you build with those tools is up to you,” Rouse said.
Ian Branam is a freelance health and science writer currently pursuing a master’s in health and medical journalism at the University of Georgia. Ian has bachelor’s degrees in history and psychology from the University of Georgia. He is particularly interested in writing about public health, epidemiology, and the environment. Follow on Twitter as @ianbran6