Unprecedented financial challenges of FQHCs

Image source: Unsplash

"FQHCs have enjoyed over 50 years of bipartisan support and success; but over the past few years – particularly since the pandemic – our health centers have been met with new circumstances so daunting, we are forced to face the fragility of our future."
-Kris McCracken, CEO of Amoskeag Health
https://newhampshirebulletin.com/2024/07/11/unprecedented-financial-losses-at-health-care-organizations-pose-risk-to-primary-care-access-in-nh/

In the article, the author cites 4 primary factors that have contributed to unprecedented financial challenges. I am following that up with questions I have.

👩🏻‍⚕️ Workforce shortages. FQHC employees are not paid competitively enough compared to for-profit hospitals and private practices, "causing many staff to have to choose between not making ends meet and leaving nonprofit work so they can care for themselves and their families."
❓ For the staff that stay there, what motivates them to stay? Is it their loyalty to the communities served? Are there ways to overcome this and bring more physicians and other healthcare providers in? There are 47 physicians among 1053 FTEs serving 89,393 patients including 20,061 children at NH Community Health Centers who, by definition, are the most vulnerable populations of the state. That's a sizeable difference each practitioner makes in the system.

⚕ Medicaid unwinding. "Thousands of Granite Staters who were covered by Medicaid during the public health emergency have now lost that coverage, including approximately 3,000 FQHC patients."
❓ Why are Medicaid reimbursement rates so poor? Why do physician reimbursement rates continue to decrease like the 2.6% drop proposed in the 2025 CMS Physician Fee Schedule? New Hampshire Community Health Center payer mix currently is 35% Medicaid, 19% Medicare, 35% Private, and 11% Uninsured according to KFF. How do we sustain medical care for those losing their insurance?

💊 Erosion of 340B savings. "... the loss of 340B savings puts many of our patients in danger of losing access to the affordable medications they need."
❓I admit I have a lot to learn about the 340B program and why it's so controversial, but what's the alternative? Seems from my little understanding, that what started with good intentions has evolved into a program abused by many stakeholders in our payor-payee web of disaster. Nonetheless, centers like these FQHCs rely on 340B savings to keep their doors open and continue providing their patients access to medications.

☣ Response to the pandemic. "Once again, we are faced with flat budgets against this new unrelenting landscape of stubbornly increasing inflationary and operational challenges."
❓What strategies, partnerships, and advocacy efforts can help to overcome these challenges? Can a solution like Grapevyne, taking a physician-driven approach to share job vacancies be an effective service by reducing recruitment costs and improving job visibility?

There's so much work to do.