The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts

Abstract

Importance Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED). Objective To examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs. Methods Retrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses. Results In 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp). Conclusions We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.

Geographic access to federally qualified health centers before and after the affordable care act

“…We also were not able to directly capture a distinction between newly offered services or new delivery sites and services that shifted to serve new geographic areas. In addition, we could not identify patients with visits to multiple FQHCs and we could overestimate use of FQHCs within a given ZIP code; in prior work using claims data, however, we found that use of multiple FQHCs was uncommon [9].…”

“…The UDS-based approach captured a larger percentage of patients who received care in an FQHC (86% [IQR: 80-94%]), compared with both the PCSA (49% [IQR: 30-68%]) and county-based definitions (71% [IQR: 54-92%], Table 1), while on average including a similar or fewer number of ZIP codes (8.9 [IQR: 6-11] vs. 8.0 [IQR: [3][4][5][6][7][8][9][10][11] for PCSA and 24.3 [IQR: 8-31] for county). Furthermore, among the ZIP codes included in empirically defined FQHC service areas, there was a higher rate of FQHC use among the residents with incomes < 200% FPL compared with the other two approaches (roughly 29%, vs. 22% and 22%).…”

“…Geographic proximity to FQHCs has been associated with a greater probability of having a usual source of care and having physician visits in the past year [4][5][6]. Moreover, some studies have demonstrated that low-income patients receiving care from FQHC-vs. non-FQHC providers have better care quality, such as receipt of cancer screening, better access to dental care, better diabetes outcomes, and fewer preventable hospitalizations and emergency room visits [6][7][8][9][10][11][12][13][14].…”

Changes in access to community health services among rural areas affected and unaffected by hospital closures between 2006 and 2018: A comparative interrupted time series study

“…26,27 Similarly, between 2010 and 2016, annual federal funding for FQHCs grew from $2.8 to $4.7 billion in large part owing to new funding provided through the Patient Protection and Affordable Care Act. 28 The 2015 time period also corresponded to when Medicare altered its reimbursement rate to FQHCs, 29 all of which could have helped bias gains in access that were exhibiting prior to a closure over this time period. These patterns may suggest that continued improvements in FQHC may trend similarly between affected and unaffected areas over time in the future.…”

“…For example, during the 12‐year period between 2003 and 2015, the number of health care providers affiliated with FQHCs increased from 25,780 to over 120,000 26,27 . Similarly, between 2010 and 2016, annual federal funding for FQHCs grew from $2.8 to $4.7 billion in large part owing to new funding provided through the Patient Protection and Affordable Care Act 28 . The 2015 time period also corresponded to when Medicare altered its reimbursement rate to FQHCs, 29 all of which could have helped bias gains in access that were exhibiting prior to a closure over this time period.…”