The Business of Establishing an Academic Nurse-Managed FQHC
The purpose of this presentation is to discuss the transformation from an academic nurse managed health center (NMHC) to a federally qualified health center (FQHC). The presentation is intended to fulfill these aims: 1) to discuss the importance of transformation for fiscal sustainability, 2) to convey pertinent operational aspects for transformation within academic institutions, and 3) to demonstrate how the dual mission of serving the healthcare needs of the community and building the future nursing workforce fuels integrated, high quality care.
Rationale/Background
There are over 250 NMHC in the United States. Of those, approximately 13 have been designated as federally qualified, and half are linked to academic institutions. NMHC have been nationally recognized as organizations that provide primary care or wellness services to underserved and/or vulnerable populations in conjunction with other entities, such as healthcare centers, educational organizations, and/or social service agencies (NNCC, 2011).
NMHCs that exist as FQHCs in co-application with universities need to establish a distinct 501c3 with organizational bylaws, and co-applicant agreements that delineate roles and responsibilities for the community governing board of directors. The beauty of this arrangement lies with the dual mission of these separate but connected bodies. Workforce development is harbored within these centers through training, recruitment, and retention efforts. The centers provide a rich learning environment, predicated on caring and built upon evidenced based practice. Population health and wellness is enhanced through integrated healthcare delivery systems.
In order to be a FQHC, an organization needs to receive grants under Title 42, formerly known as Section 330 of the Public Health Service Act. FQHCs uniquely qualify for enhanced reimbursement from Medicare and Medicaid, which is imperative to cover the cost of care required for the populations served. Base funding through the Human Resources Services Administration provides a sound infrastructure for care coordination and nursing expertise through an integrative approach. FQHCs are mandated to offer a sliding fee scale based upon federal poverty guidelines and individuals cannot be turned away for an inability to pay. FQHCs are required to have robust, ongoing quality assurance programs and report outcome data annually, efforts that inherently enhance population health.
Outcomes achieved/documented
The organization transformed from a NMHC to a nurse managed FQHC in June of 2012. Documented outcomes include:
- Fiscal Sustainability and cost containment
- Comprehensive, integrated primary and behavioral healthcare
- Workforce development
- Adoption, implementation, and use of an electronic health record
- Attestation for meaningful use
- Development of partnerships with local stakeholders
- Faculty, staff, and student engagement in the business operations
- Clinic expansion
- Improvement in health outcomes and patient satisfaction
Conclusions
Pursuing FQHC designation is a viable pathway for fiscal sustainability. HRSA program requirements are designed to optimize healthcare delivery systems through infrastructure development, accountability, and community involvement. Academic nursing centers are poised to venture into this transformation for they are the innovators and experts in improving population health. The dual mission for academic, nurse managed FQHCs creates an optimal, sustainable healthcare delivery model to achieve the triple aim.