FQHC Statistics – Growth, Region, Performance and Revenue – Federally Qualified Health Centers across USA

FQHCs as defined by Medicare and Medicaid

According to Medicare and Medicaid statutes, an FQHC is a health center that receives federal funding under Section 330 of the Public Health Service Act to provide comprehensive primary care services to uninsured and underinsured populations.

Health centers originated under the Economic Opportunity Act of 1964 as “neighborhood health centers”. Section 330 of the Public Health Service Act established the Health Center Program, which provides federal funding for health centers. It also provided federal grants to community and migrant health centers to serve the uninsured. The FQHC program of today was enacted under the Omnibus Budget Reconciliation Act (OBRA) of 1989 and expanded under OBRA of 1990. The legislation provided cost-based reimbursements to health centers for Medicare and Medicaid services specified under Section 330.

The Growth of FQHCs

In the early 1960s, there were only 8 health centers in U.S. Ever since then, the numbers have increased exponentially. By 2001, there were 748 health centers at 4,128 service sites around the nation, serving approximately 10 million individuals.

Federal funding for health centers has increased from $750 million in 1996 to $2.2 billion in 2010. The federal support has increased tremendously over the last 10 years. In 2011, there were 1,128 health centers providing care to more than 8,000 rural and urban delivery sites in U.S. and territories. Today, there are 1400 organizations with 11200 facilities serving about 25 million individuals every year.

Figure 1 - Growth of Health Centers (1980 - 2018)

Figure 1 – Growth of Health Centers (1980 – 2018)

The above chart shows the growth of health centers from the time it started in 1980 till 2018. Also, the chart shows the exponential increase in the number of patients served over the years.

FQHCs in various regions across U.S

State State Code Number of FQHCs
California CA 176
Texas TX 73
New York NY 65
Florida FL 48
Illinois IL 45
Ohio OH 45
Pennsylvania PA 44
Michigan MI 39
Massachusetts MA 39
North Carolina NC 38
Georgia GA 35
Louisiana LA 34
Oregon OR 31
Tennessee TN 29
Alaska AK 28
Missouri MO 28
West Virginia WV 27
Washington WA 27
Virginia VA 26
Indiana IN 25
Kentucky KY 23
New Jersey NJ 23
South Carolina SC 22
Arizona AZ 21
Mississippi MS 21
Colorado CO 20
Oklahoma OK 20
Kansas KA 18
Maine ME 18
Maryland MD 17
Montana MT 17
New Mexico NM 17
Wisconsin WI 17
Connecticut CT 16
Minnesota MN 16
Hawaii HI 14
Iowa IA 14
Idaho ID 14
Alabama AL 14
Puerto Rico PR 14
Utah UT 13
Arkansas AR 12
New Hampshire NH 11
Vermont VT 11
District of Columbia WDC 8
Rhode Island RI 8
Nebraska NE 7
Wyoming WY 6
Nevada NV 5
South Dakota SD 5
North Dakota ND 4
Delaware DE 3
Virgin Islands VI 3
Guam GU 2
Northern Mariana Islands MP 2

Performance of FQHCs

Figure 2 - Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

Figure 2 – Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

The above chart shows how health centers have outperformed private practice physicians in every aspect of service.

Figure 3 - Health Centers Provide More Preventive Services than Other Primary Care Providers

Figure 3 – Health Centers Provide More Preventive Services than Other Primary Care Providers

The above chart shows a comparison between health centers and other providers based on the number of patient visits for various ailments.

Figure 4 - Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

Figure 4 – Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

The above chart shows the level of satisfaction of low-income patients. Health center patients have a huge level of satisfaction as compared to other low-income patients nationally.

Financing and Reimbursements for FQHCs

FQHCs are required by law to provide services to all people, regardless of ability to pay. The uninsured are charged for services on a board-approved sliding-fee scale, which is based on a patient’s family income and size.

FQHCs are financed through a mix of Medicaid and Medicare reimbursements (with different payment methodologies), direct patient revenue, other third-party payers (private insurers), state funding, local funding, philanthropic organizations, and grant funding from the Bureau of Primary Health Care (BPHC) of HRSA of the U.S. Department of Health and Human Services (HHS).

Figure 5 - FQHC Revenues by Payer Source

Figure 5 – Financing and Reimbursements for FQHCs

The above chart shows the revenue distribution of FQHCs based on payer source.

FQHC Revenue across all regions in U.S (approx. 2018)

Location Medicaid Medicare Private Insurance Self-Pay Federal Section 330 Grants Other Grants and Contracts Other Total
United States $10,544M $1,692M $2,227M $1,004M $4,422M $2,916M $943M $23,752M
Alabama $44M $14M $13M $10M $76M $10M $2M $173M
Alaska $79M $12M $28M $9M $64M $119M $2M $316M
Arizona $257M $37M $59M $24M $78M $43M $5M $506M
Arkansas $51M $15M $18M $10M $47M $11M $1M $157M
California $2,889M $300M $205M $118M $607M $529M $272M $4,922M
Colorado $259M $30M $30M $33M $98M $88M $30M $571M
Connecticut $206M $25M $24M $8M $53M $49M $9M $376M
Delaware $10M $1M $2M $4M $12M $5M $201K $37M
District of Columbia $130M $19M $20M $3M $22M $37M $5M $239M
Florida $376M $58M $134M $59M $219M $160M $23M $1,033M
Georgia $52M $34M $39M $27M $108M $25M $6M $294M
Hawaii $87M $13M $14M $5M $26M $30M $3M $181M
Idaho $31M $15M $35M $16M $44M $24M $6M $174M
Illinois $363M $45M $116M $29M $184M $113M $44M $897M
Indiana $161M $14M $25M $14M $68M $32M $27M $343M
Iowa $63M $10M $18M $9M $40M $16M $5M $163M
Kansas $29M $9M $17M $10M $36M $14M $4M $123M
Kentucky $156M $32M $56M $17M $67M $8M $5M $344M
Louisiana $82M $14M $47M $12M $90M $32M $9M $288M
Maine $37M $32M $43M $9M $40M $8M $6M $179M
Maryland $163M $32M $45M $13M $51M $33M $29M $370M
Massachusetts $314M $91M $141M $19M $114M $246M $117M $1,044M
Michigan $268M $50M $71M $22M $119M $40M $7M $580M
Minnesota $67M $10M $14M $10M $37M $27M $3M $171M
Mississippi $33M $16M $18M $17M $72M $16M $1M $177M
Missouri $203M $21M $39M $23M $97M $39M $6M $431M
Montana $24M $8M $15M $6M $35M $10M $4M $104M
Nebraska $15M $1M $6M $7M $19M $20M $1M $72M
Nevada $23M $4M $10M $3M $18M $12M $757K $73M
New Hampshire $19M $12M $18M $4M $22M $9M $2M $89M
New Jersey $147M $11M $11M $16M $80M $60M $4M $330M
New Mexico $112M $20M $22M $18M $68M $51M $3M $298M
New York $1,099M $138M $184M $43M $243M $239M $74M $2,023M
North Carolina $69M $55M $39M $38M $120M $38M $9M $370M
North Dakota $8M $3M $7M $3M $10M $687K $1M $35M
Ohio $181M $32M $41M $15M $134M $35M $25M $465M
Oklahoma $46M $12M $18M $12M $52M $9M $2M $155M
Oregon $325M $39M $20M $12M $85M $71M $14M $570M
Pennsylvania $277M $54M $83M $17M $110M $38M $640K $588M
Rhode Island $90M $12M $15M $3M $25M $13M $2M $162M
South Carolina $79M $42M $68M $20M $79M $24M $34M $349M
South Dakota $10M $4M $8M $5M $19M $3M $2M $55M
Tennessee $66M $20M $30M $13M $78M $28M $7M $244M
Texas $335M $46M $69M $78M $245M $265M $58M $1100M
Utah $27M $9M $13M $9M $35M $25M $3M $125M
Vermont $43M $24M $26M $17M $20M $6M $7M $147M
Virginia $35M $28M $32M $20M $82M $14M $3M $217M
Washington $650M $68M $80M $44M $132M $87M $20M $1,084M
West Virginia $100M $45M $79M $24M $65M $17M $6M $338M
Wisconsin $162M $7M $24M $10M $40M $46M $3M $296M
Wyoming $1M $1M $2M $1M $7M $1M $1M $17M
American Samoa $0 $0 $0 $293K $2M $792K $0 $4M
Federated States of Micronesia $0 $0 $23K $56K $1M $143K $0 $2M
Guam $3M $8,975 $25K $139K $2M $1M $0 $7M
Marshall Islands $0 $0 $0 $29KK $527K $1M $0 $1M
Northern Mariana Islands $116K $0 $3139 $1410 $799K $0 $0 $920K
Puerto Rico $157M $22M $11M $7M $90M $8M $2M $300M
Republic of Palau $0 $0 $39K $1M $674K $50K $0 $2M
U.S. Virgin Islands $5M $776K $815K $603K $3M $4M $0 $15M

Future of FQHCs

FQHCs have had a significant growth in the past decades. The above statistical data prove that FQHCs have the potential to serve more patients thereby improving the quality of care. In order to provide quality care improve patient experience, FQHC must invest in the right technology. HealthViewX Patient Referral Management software has provided the best use cases for the major challenges faced by the FQHC.

HealthViewX Patient Referral Management Software for FQHCs

HealthViewX has completely analyzed the workflow of FQHCs. We have implemented the following features for many of our FQHC clients thus positively impacting their workflow

    • EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
    • Insurance pre-authorization automation –  There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the api-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the form automation method.  Through this, we get all payer-specific form, fill in the necessary information and send it to the insurance company via efax.
    • Intelligent Provider Match – The system has a smart search feature that enables PCPs to filter receiving providers according to their preference. The list is always up to date with the newly added specialty and imaging centers which makes it easy for the PCP.
    • To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications. By this, the physicians can get referral updates easily.
    • Referral Analytics – Customizable dashboards and reports provide information about the number of referrals sent, referrals in various status, referrals that were missed, processed and pending. It gives a clear picture for the FQHC and helps them in making informed decisions.

 

Reference

  1. Kaiser Commission on Medicaid and the Uninsured (data from the National Association of Community Health Centers and the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA)
  2. Goldman, LE et al. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine. 2012. 43(2):142-149. *Fontil et al. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians’ Offices. Health Services Research. April 2017. 52:2.
  3. 2015 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. National Center for Health Statistics. NCHS Data Brief. No. 220. November 2015. Hypertension Prevalence and Control Among Adults: United States, 2011 – 2014. National Committee for Quality Assurance. Comprehensive Diabetes Care, The State of Healthcare Quality (2016).
  4. Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 32(4): 342 – 50. Shi L, Leburn L, Tsai J and Zhu J. (2010). Characteristics of Ambulatory Care Patients and Services: A Comparison of Community Health Centers and Physicians’ Offices J Health Care for Poor and Underserved 21 (4): 1169-83. Hing E, Hooker RS, Ashman JJ. (2010). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 Jun; 36(3): 406 – 13.
  5. Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. Journal of Health Care for the Poor and Underserved. 2013; 24(1):56-66.
  6. George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, March 2018.
  7. https://www.kff.org/other/state-indicator/community-health-center-revenues-by-payer-source/?dataView=0&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D