As In-Person Visits Decrease, Community Health Centers Struggle Financially

To decrease the spread of COVID-19, doctors’ offices are opting for telemedicine appointments instead of in-person visits.

That’s leading to financial struggles for federally qualified health centers.

“The decrease in face-to-face visits is going to have a detrimental impact on community health centers across the state,” said Jean Polster, CEO of Neighborhood Family Practice, a community health center in Cleveland.

Polster estimates 25% of the clinic’s monthly revenue will be affected. A quarter of the staff members have taken a voluntary furlough through April 17.

“We’re worried about the financial impact,” Polster said. “We are hopeful that through different grant funds, the local funds in the community as well as federal grant funds, that we’ll get through this.”

One issue is that some patients do not have smart phones and are only available for telephone calls, which have a lower Medicaid reimbursement rate than video calls and in-person visits. However, Polster said video calls are set to be reimbursed at the same rate as if the patient was seen in-person.

“It is our understanding that the Department of Medicaid is going to reimburse us our regular rate for medical and behavior health visit under telemedicine — the same rate we would have had as if it was a face-to-face visit,” she said.

Not all services qualify for this rule, such as nursing face-to-face visits.

“That’s part of the reason for our reduction in revenue,” Polster said.

But Polster said she is optimistic. The health center will rely on the CARES Act, the coronavirus relief bill recently passed by Congress, which will provide 1.3 billion federal funds to community health centers across the country.

The transition to telemedicine has also posed some logistical challenges. Community health center patient populations may not have access to smartphones or other technology needed for telehealth visits.

Chad Garven, a medical provider at Neighborhood Family Practice, has helped coordinate the organization’s telemedicine workflow. He said most patients have been able to figure out the technology, but there have been some hurdles.

 “Are our medical assistants becoming tech support as the visits starts? Yes, that’s not quite in their initial job description, but to get patients the care they need, there’s a lot of extra interface with patients that it’s just different than what we were doing a month ago,” Garven said.

Polster added the telemedicine visits work well for patients who have issues getting transportation to face-to-face visits. She said the health center may opt to stick with keeping some visits virtual after the crisis is over.

“This is changing and expanding our knowledge of patients, seeing them in their home setting,” she said. “This is a view of their lives that we have not had historically.”