Safety-net, “neighborhood” health centers date back to Johnson’s presidency and his War on Poverty. Those were the catalyst for what we now call Federally Qualified Health Centers (FQHCs), and today 1,368 of them have been established in the United States. But when you factor in FQHC Service Sites and Look-Alikes (similar providers that do not receive the same government funding), that number is over 14,000.
FQHCs are health centers that provide comprehensive care in underserved and rural areas. “It can be an underserved area geographically or an underserved population,” Sharon Beatty said. Beatty, now retired, spent years managing private, hospital-owned, and independent non-profit practices in Texas, Kansas, and New Hampshire. She has also served on various advisory councils and boards to address health and human services issues faced in rural environments.
Beatty helped drive the formation of an FQHC in Plymouth, New Hampshire. “There are a massive number of requirements to get this designation,” she said. However, the advantages are significant.
In addition to the Section 330 grant funding FQHCs receive from the Health Resources and Services Administration (HRSA), one of the biggest benefits is enhanced Medicare and Medicaid reimbursements. These allow FQHCs to serve vulnerable populations without experiencing many of the financial struggles rural hospital systems often face.
An example can be found in Grantsville, West Virginia, which has a population of around 500 people. In 1983, the Minnie Hamilton Health Center formed there, honoring the memory of local nurse Miss Minnie Hamilton, who dedicated her life to caring for others. It expanded into an FQHC in 1987.
“Although Grantsville was home to Calhoun General Hospital, which provided surgical, emergency room, and acute care services, there was only one family care physician for the entire service area,” said Brittany Frymier, director of business development for Minnie Hamilton.
While the center helped to provide broader care for families into the 90s, the sudden closure of Calhoun General deepened Grantsville’s existing healthcare strains, including financial and transportation barriers. With the closure, the closest emergency care was over an hour and a half away by ambulance, over the rough terrain of West Virginia. This became even more treacherous during extreme weather conditions, like flooding, snow, and ice.
Knowing the real danger of living within such a healthcare desert, the community came together with state and federal representatives to discuss a new model, and Minnie Hamilton underwent a sizeable expansion. Today, the Minnie Hamilton Health System (MHHS) is a non-profit serving 21,000 patients annually, offering cost-efficient services to the region’s residents through practices like patient sliding fees.
MHHS provides comprehensive services, ranging from a critical access hospital and community health center to school-based health sites and a nursing home unit. Since the early 2000s, MHHS has also offered dental care. “We are the only provider in the Grantsville area, despite having a high percentage of tobacco use among our adult population,” Frymier said. In addition, MHHS provides school-based oral health clinics to ensure young residents receive important preventative care.
Without Minnie Hamilton, “There would be no services available in the Grantsville area,” Frymier said. Fortunately, through collaboration within MHHS’ practices, as well as outside organizations, like the county health department, that’s not the case. “We would like to see all healthcare organizations working together for the good of the patients,” Frymier said.
For many rural areas, a collaboration between FQHCs and existing rural healthcare entities has been a solid answer to financial quandaries and service gaps. For example, in small or remote communities, obstetrical services are often the first to be cut when a hospital is struggling.
This can have a devastating effect on the region, prompting fewer young families to move to the area and rippling out into the local economic ecosystem. For rural places where attracting and retaining young people is already a struggle, this kind of healthcare gap amplifies the problem.
A report from Capital Link, a non-profit that works with health centers and primary care associations to plan for sustainability and growth, looked at cases in which FQHCs and rural health systems entered into collaboration to solve this kind of challenge. In most successful cases, FQHCs were able to strategically take over some critical services while the local hospital retained others.
However, the same report also noted examples in which limited planning or communication led to overlap in services and other technical friction. “As rural communities continue to experience financial stress in their health care delivery systems, it’s critical that health centers and hospitals increase their capacities and collaborate,” the report said.
Successfully staffing the healthcare system also remains a major concern for remote areas, like Grantsville, where hiring medical professionals is an “extremely difficult challenge,” Frymier said. In addition to the inflation of compensation in skilled professions, “We are faced with recruiting to an area with limited broadband access, nonexistent public transportation offerings, and a proverbial healthy food desert,” she said.
However, the increased reimbursement model of an FQHC, as well as the potential student loan repayment gained by working for a federal entity, can go a long way toward attracting talent. “That’s a huge advantage,” Beatty said. In addition to doctors and nurse practitioners, there are also the nurses, medical assistants, and lab technicians, who once employed, hopefully, choose to live locally. “It can be a boon to a rural community,” Beatty said.
Her best advice to communities interested in seeking FQHC status is to connect with someone who has done it before and knows how to navigate the system. “It’s kind of an art form,” she said. But once you’ve received the designation, “There’s all kinds of help to keep healthcare in your community,” she said.
Caroline Tremblay writes stories for The Daily Yonder and Radically Rural, a two-day summit on key rural issues Sept. 21-22 in Keene, New Hampshire. For more information, go to www.radicallyrural.org