The first article examines the performance of federally qualified health centers on quality of care measures, as compared to private practices. (AJPM Article) There were 18 quality measures, including drug management in common chronic diseases, prescribing for elderly patients, preventive counseling and use of screening tests. All would be considered process of care measures. The data was all from national surveys, so not the best quality, but probably reflects relative trends and performance okay. Across both the FQHCs and private practices, there was a wide range of performance. FQHCs performed better on 6 measures, worse on one and the same on 11. This performance is particularly remarkable given that many patients served by these centers have low health literacy, little or no insurance and a higher disease burden. Given these results and the cost differential, there is no reason not to insist that Medicaid recipients use FQHCs first when they are available.
Like many primary care practices, the federally qualified health centers are under pressure to become a medical home. The second piece of research attempted to ascertain the relationship between being a patient-centered medical home and operating costs for the center. (JAMA Article) About 670 centers were examined using survey data which described how closely they met the PCMH criteria and three measures of operating cost. In brief, the study found that the more completely a center operated like a PCMH, the higher its operating costs per patient were. A 10 point increase on the PCMH scale was associated with a $2.26 or 4.6% increase in per patient per month operating costs. That is not an insubstantial sum for most centers, but the potential savings in hospitalizations and ER visits could be several times this amount, if PCMH models live up to the hype. So far it is not clear from the research that they do, and that should be validated before FQHCs are pressured to incur greater operating expenses.