Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers

Abstract

BACKGROUND Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs. OBJECTIVE To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use. RESEARCH DESIGN Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries age 65 and older. SUBJECTS Beneficiaries with at least one evaluation and management (E&M) visit in 2011, categorized as FQHC users (>=1 E&M visit to FQHCs) or non-users living in the same Primary Care Service Areas as FQHC users. Users were sub-classified as predominant if the majority of their E&M visits were to FQHCs. MEASURES Demographic characteristics, physician visits, and inpatient care use. RESULTS Most FQHC users (56.6%) were predominant users. Predominant and non-predominant users, compared with non-users, markedly differed by prevalence of multiple chronic conditions (18.2%, 31.7% vs. 22.7%) and annual mortality (2.8%, 3.8% vs. 4.0%; all p < 0.05). In adjusted analyses (reference: non-users), predominant users had fewer physician visits (RR 0.81, 95% CI: 0.81–0.81) and fewer hospitalizations (RR 0.84, 95% CI: 0.84–0.85), while non-predominant users had higher use of both types of service (RR 1.18, 95% CI: 1.18–1.18; RR 1.09, 95% CI: 1.08, 1.10, respectively). CONCLUSION Even controlling for primary care delivery markets, non-predominant FQHC users had a higher burden of chronic illness and service use than predominant FQHC users. It will be important to monitor Medicare beneficiaries using FQHCs to understand whether primary-care only payment incentives for FQHCs could induce fragmented care.

Geographic Expansion of Federally Qualified Health Centers 2007–2014

“…We used primary care service areas (PCSAs v3.1, N = 7,144) as the market units for FQHCs . PCSAs were developed under a project funded by HRSA to create local primary care markets for the entire United states .…”

“…The v3.1 PCSAs were developed by aggregating 2010 Census tracts into primary care service areas based on visit patterns to primary care providers among fee‐for‐service Medicare beneficiaries . Researchers have used PCSAs as primary care markets to study primary care associated outcomes, health care policy, and program implementation . The PCSA v3.1 database includes population characteristics, primary care resources, and Medicare utilization.…”

“…We reported the proportion of FQHC service markets that were high poverty areas based on whether >20% of the area population had an income below the poverty level. The threshold of 20% of population with income below poverty level has been widely accepted and used among social scientists, demographers, the Census Bureau and several previous studies to identify high poverty areas . We also reported alternative measures relevant for populations with difficulty accessing care—proportion of population with income 100%‐200% of poverty level, median household income, proportion of families with income below poverty level, and proportion of linguistically isolated households .…”

“…In addition, we defined FQHCs’ markets by FQHC locations, not where the users of FQHCs live. Our previous study showed that in 2011, 12% of Medicare FQHC users were from PCSAs that did not contain a FQHC . Further research to identify area characteristics for all FQHC users’ residence may provide useful information about potential area care needs.…”

Shared decision‐making in the BREATHE asthma intervention trial: A research protocol

“…Federally qualified health centers (FQHC) are a type of primary care setting designated to receive enhanced Medicaid reimbursement because their patients are underserved, underinsured, and uninsured individuals who tend to receive episodic care (Chang, Lewis, Meara, Lurie, & Bynum, 2016). Asthma has a disproportionate impact on FQHC patients, with prevalence as high as 18% and asthma being a top cause of hospitalization (Drake, Lim, Mallya, & Robbins, 2009).…”