Healthcare for rural Americans is often inaccessible, with patients facing unique obstacles that can impede their ability to seek or receive care. These disparities in healthcare are influenced by economic, social, and cultural factors — such as lack of education, transportation, and geographic isolation.
Health inequity is a continuing issue for rural Americans. More than 50 percent of vehicular accident deaths occur in rural areas, and the risk of injury-related death is 22 percent higher than in urban areas. The increased mortality rate is likely due to the proximity of care centers and available clinicians.
Rural communities report an average patient-to-primary care physician ratio of 39.8 physicians per 100,000 people, much lower then the 53.3 physicians per 100,000 people reported in urban areas. When medical issues arise in rural America, patients face longer travel times and greater financial costs due to inconsistencies in insurance coverage.
Federally Qualified Health Centers (FQHCs) serve as a means of providing primary care to under-served rural communities.
What is a FQHC?
FQHCs are clinics that provide comprehensive primary and preventive care to patients of all ages and are required to accept all patients—regardless of their health insurance status or ability to pay. According to Definitive Healthcare clinics data, there are more than 1,300 active FQHCs in the U.S. In order to qualify for FQHC status, facilities must abide by strict operating requirements. These requirements include answering to a patient-inclusive governing board and offering services based on a sliding payment scale. FQHCs can also be equipped to provide telehealth services if specialists or other clinicians are not available nearby.
Below, we've compiled a list of the top FQHC facilities by the greatest number of total visits.
Top 10 FQHCs by Total Visits
Total # of Visits
Borrego Community Health Foundation
County of Santa Clara FQHC
Golden Valley Health Centers
Hudson River Healthcare Inc.
Manatee County Rural Health Services Inc.
Ventura County Health Care Agency
Family Health Centers of San Diego Inc.
Sea Mar Community Health Centers
Community Health Centers of the Central Coast Inc.
Fig 1 Data from Definitive Healthcare's Clinics platform based on self-reported CMS Cost Report data through November 2019. Does not include FQHC look-alikes or service sites.
It's no surprise that half of the top FQHCs by total number of visits are located in California, the state with the greatest number of active FQHCs. The state's high volume of FQHCs is likely attributed to its population size and significant enrollment in Medi-Cal — the California state version of Medicaid. According to Definitive Healthcare data, California reported 178 active FQHCs as of November 2019. Texas and New York are the next two states with the most FQHCs, reporting 73 and 63 facilities respectively.
FQHCs and telemedicine
The Centers for Medicare and Medicaid Services (CMS) FQHC benefit went into effect in 1991 and was established for services typically delivered in an outpatient clinic, but has since been modified to include telehealth services. According to a fact sheet from CMS, “FQHCs are authorized to serve as anoriginating site for telehealth services if theFQHC is located in a qualifying area.”
Telemedicine has great potential to improve care accessibility in under-served populations. A recent study from RAND Corporation, however, outlines the barriers that safety-net providers face in implementing these technologies. It states that telemedicine ishighly underutilized for originating and distant sites alike. CMS defines originating sites as the location of an eligible beneficiary at the time the telemedicine occurs and a distant site as the location of the provider issuing the service via telemedicine. Study participants point to insufficient reimbursement for telehealth services, and a lack of authorization for FQHCs to serve as distant sites in both the federal Medicare program and in select state Medicaid programs as primary causes for under-utilizing the available technologies.
Beyond that, some of the other key challengesthat stand in the way are:
Lack of buy-in from FQHC providers
Credentialing issues, and
Demographic challenges such elderly and homeless patients
While this may seem like an impossible number of obstacles, some participating FHQCs stated they are actually planning to expand their telemedicine offerings, experimenting for a range of conditions, and confronting policies. In moving forward, telehealth services need to be viewed as less of a hinderance and more as a strategy for closing rural health access shortages. Improved education for FQHCs surrounding telemedicine implementation within this remote care setting could help propel adoption.
Want to keep track of FQHCs, technology market share, and news updates with Definitive Healthcare? Are you looking to analyze specific FQHC markets to measure demand for certain pharmaceuticals based on the most common diagnoses? With Definitive’s comprehensive platform, you can:
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