A recent report by the Dartmouth Atlas Project linked hospital readmissions for Medicare beneficiaries to inadequate post-acute care. According to the report, more than half of Medicare patients who recently left a hospital didn't see a primary-care doctor within two weeks of discharge, a factor contributing to the “revolving-door” problem.
The report focused on Medicare beneficiaries, but poor care coordination and inadequate post-acute care can lead to a revolving-door crisis for many populations. Uninsured, low-income and homeless patients are particularly vulnerable to the cycle of repeated discharges and readmissions. While various strategies have been employed to help reduce readmissions, most of the models are different variations of the same dance: improved care coordination. Today I challenge RACMonitor readers to consider a new dance partner: your local Federally Qualified Health Center (FQHC).
There are more than 1,000 FQHCs in the United States, and they have varying degrees of resources and programming. Sometimes they are awkward, inexperienced dance partners, and often they don’t have money to throw around – maybe you danced with them before and they stepped on your feet, but I bet you both still learned a few new moves. Even skeptics have to appreciate the fact that health centers have been at the forefront of many innovative forms of care. For example, health centers long have employed integrated, multi-disciplinary care models that look a lot like health homes. For hospitals, health centers can be instrumental in improving care coordination and reducing readmissions for underserved populations.
Section 330 of the Public Health Services Act provides for four types of FQHCs: community, migrant, homeless and public housing, all of which are funded by the Health Resources and Services Administration. These centers are designed to serve as the nation’s healthcare safety net program for uninsured and underserved populations.
Last year FQHCs served nearly 19.5 million patients, of whom more than a million were homeless. Some other interesting characteristics of health center patients: 93 percent had incomes at or below 200 percent of the poverty line, about 25 percent were served in a language other than English and 38 percent were uninsured (65 percent of homeless patients were uninsured). Such demographics could be worrisome for a hospital, but for health centers it’s a sign they are doing their jobs.
Hospitals can work with health centers to improve care transition for uninsured, low-income and homeless patients. Discharge workers can coordinate with health center providers to make sure that important information is relayed and that patients make it to their appointments. Hospitals can set up weekly meetings with such providers to discuss patient referrals and maybe even talk about a hospital diversion program (the subject of a future blog). Many health centers provide enabling services (outreach, translation, transportation, case management, etc.) to assist patients in accessing care. These enabling services can be invaluable for engaging clients in a proper health home and avoiding inappropriate hospital utilization.
I must agree with the good folks at the Dartmouth Institute when they say that readmissions are a sign of inadequate care coordination between hospitals and community clinicians. Both groups should be working together to improve their “moves.”
About the Author
Sabrina Edgington is the Program and Policy Specialist for the National Health Care for the Homeless Council.
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