Community Health Center Availability and the Use, Cost and Quality of Care for Medicaid

The number of Federally Qualified Health Centers (FQHCs) in the United States has nearly doubled and the number of FQHC delivery sites has nearly tripled over the past twenty years. Although this suggests that FQHCs are becoming a more important delivery site for some patients, little data exists that can be used to compare quality and costs of care for FQHCs versus other sites. The Uniform Data Set (UDS) from the Health Resources Services Administration (HRSA) provides some performance metrics for FQHCs, though no comparable information is available for care obtained outside of FQHCs.

We use the Medical Expenditure Panel Survey – Household Component (MEPS-HC) from the Agency for Healthcare Research and Quality (AHRQ). The MEPS-HC is a survey of individuals and their medical providers, including costs and quality measures for sampled providers. We identify FQHC visits within the MEPS-HC by matching provider information in the MEPS (name, address, phone number) to information on the universe of FQHC delivery sites available from HRSA and the Centers for Medicare and Medicaid Services (CMS’s) Provider of Services file. The goals for this work are to first provide nationally-representative estimates of the use of FQHCs during the 2000-2015 time period, and then to analyze the effects of FQHC use on costs and quality of care among Medicaid patients. In this analysis, we plan to instrument for FQHC use with the distance to the nearest FQHC, which declines differently across areas as more FQHC delivery sites are added at different rates in different areas.

Results suggest that about 14% of MEPS respondents who are on Medicaid (and not Medicare) for all of 2015 have used an FQHC at least once. Among MEPS 2015 respondents on Medicaid all year, about 17% of all provider visits are to FQHCs and about 35% of checkups done by a primary care physician or “midlevel provider” (nurse practitioner, nurse midwife, or physician’s assistant) occurred at FQHCs (compared to 15% UB 2000). Use of FQHCs is highest among Hispanics, individuals living outside of metropolitan areas, those in poor health, and those in the West. In 2015, Medicaid paid about two-thirds of what Medicare paid for checkups at FQHCs, physician offices, and hospital outpatient departments (OPDs). In 2000, before many states had implemented prospective payment for FQHCs, Medicaid payment to FQHCs for checkups was more generous than Medicare.

In 2015, the average MEPS respondent lived 4.9 miles to the nearest FQHC, down from 10.7 miles in 2000. The biggest change in distance-to-the-nearest FQHC was for Hispanics, for whom the distance decreased from 7.2 miles in 2000 to 2.6 miles to the closest in 2015. Mean CAHPS (Consumer Assessment of Healthcare Providers and Systems) quality measures were slightly lower in 2015 for FQHC users compared to non-users, though indistinguishable upon adjustment. Prior to the conference, analyses of the effect of FQHC use on measures of access to, use of, costs of, and quality of care, instrumenting for use using distance, will be available.