Modern Healthcare June 1, 2017
The 1,400 federally qualified health centers across the U.S. are an essential source of primary care services for approximately 24.3 million low-income individuals. Yet they are limited by a volume-based reimbursement model that prevents them from participating in outcomes-based care approaches.
Medicaid pays the centers a flat rate. Called the prospective payment system, the model ensures these centers are paid for all of patient visits at a fixed amount. The system was enacted in 2000 to help FQHCs struggling to stay afloat from mediocre Medicaid payments.
But this model is anchored by in-person visits—even for minor ailments like blood pressure checks—raking up Medicaid spending, limiting services and draining the providers who work at the safety-net centers.
These shortcomings have encouraged...
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