| | Statement of Community Clinics Initiative
This statement is submitted for
the record on behalf of the Community Clinics Initiative (CCI), a unique
collaboration between the Tides Foundation and The California Endowment, that began
in 1999 to provide resources, evidence-based programming and evaluation,
education and training to support community health centers and clinics. Through
information sharing and major grants, CCI acts as a catalyst to strengthen California's community clinics and health centers to improve health outcomes in underserved
communities. The state's community clinics offer high quality, low- and
no-cost care, often in rural and inner city areas, providing a lifeline for
millions of uninsured and underinsured Californians.
Over the past 5 years, CCI has invested close to $48 million
to support Community Clinics and Health Centers throughout California to
strengthen their information management capacity for more effective use of
technology tools to improve business efficiencies, improve patient health
outcomes, and advocate for health needs in communities throughout the state. Over
time, CCI has funded and supported through technical assistance, the
development of basic technology systems in clinics, such as software, hardware,
connectivity, staffing and training to more than 90% of clinics and health
centers.
We would like to share with you information about our work
in California and we share the lessons that we have learned in the hopes that
they can help inform the national conversation around HIT.
Through programs and grants in
technology, capacity building and leadership, CCI ensures that clinics remain
vital partners in building healthier communities. Grantees encompass 90
percent of California's community clinics and regional consortia, securing
CCI's role as a major player in the field. Individual awards enable clinics to
convert to electronic medical recordkeeping, improve or expand patient
facilities, use software to share data among clinics in a network, or train its
staff in fundraising. These enhanced capabilities allow clinics to better
track health status, care for more patients, achieve diverse revenue sources,
reduce administrative costs, expand opportunities for shared learning and
collaboration or advocate for community health needs.
It is clear that patient safety, health care quality
(especially for populations with chronic diseases), efficiency, and cost
savings can be improved through the effective use of clinical information
technology. And, while technology alone cannot address all of the quality and
efficiency problems, its adoption is associated with changes in how care is
provided.
As community clinics and health centers have become more
technology “savvy” and the capacity in clinics, for data collection and data
analysis more mature, we see the potential for the proliferation of technology
enabled quality improvement in the field.
The California experience has taught us a lot about what it
takes for community clinics and health centers to successfully implement HIT.
We also are learning that when they have the appropriate resources and support,
community clinics can be leaders and innovators in using technology to improve
health outcomes.
As we observe the increasing momentum for HIT at the federal
level, we find that appropriate understanding and consideration of the unique
HIT needs of community clinics are not being addressed. Unless careful
attention is paid to realistic HIT strategies for these clinics, we are at risk
for having HIT increase rather than decrease the disparities in care. We need
to take steps to ensure that the patients in community clinics have the same
benefits of technology that will be available to patients outside the safety
net.
Most important is the need for creative strategies to
finance the significant up front investment costs for HIT in clinics. Current
strategies promoted by the Administration and spearheaded by Dr. David Brailer
are market driven and rely heavily on the private sector and assumed return on
investment. While there is skepticism about this approach for the broad health
care universe, it seems clear that reliance on these market forces will
certainly fail community clinics. We believe that there is little if any
financial return on these investments for CCHC’s, and in fact, most will incur
financial losses and potentially even see a decrease in access if resources are
diverted to pay for these systems. We already know that the financing
mechanisms of community clinics, which rely heavily on Medicaid reimbursement
and public grant programs, make direct return on investments for clinics
unlikely. If cost savings do occur, they occur downstream from the clinic,
benefiting hospitals and payers such as Medicaid through lower costs for acute
care, in-patient stays and emergency room visits.
As interest in new HIT legislation in the Congress grows, we
would ask you to keep in mind several important opportunities:
- We need mechanisms to ensure that cost savings are driven back
upstream to the clinics to help fund HIT investment.
- It seems logical that the HIT and the Medicaid debate be joined.
Investments in HIT have the potential to make the delivery of community based
health care more efficient and to improve health outcomes through the
improvement of quality of care.
- Funding for technology must be based on the true costs of
technology innovation. As we have described, the costs of hardware and
software are only a small portion of the true organizational costs. Some
estimates suggest the cost of EHR implementation ranges from $20,000-$50,000
per physician.
- Most current legislation suggests special attention be given to
specific classes of providers, such as private practices. We encourage you to
grant similar status to community based clinics.
- Many HIT bills propose establishing loan funds to finance HIT
investment. While loan funds have the potential to be important resources
for community clinics, they must be structured to address clinics’ unique
financing and reimbursement mechanisms. Specifically, grant funds should
be made available to finance the up-front costs necessary for planning;
underwriting criteria must take into account the financial structures of
clinics and payers such as Medicaid need to recognize ongoing IT costs and debt
service payments in setting reimbursement rates.
We hope you will use CCI as a
resource in the days and months ahead. Because of the work we have done, we
have the experience and resources to be good partners in this conversation
around HIT. And we hope together we can reach safety net communities in
clinics and health centers to bring HIT into their lives and improve their
level of care.
Should you have any questions, please contact:
Ellen Friedman, Vice President and Managing Director or Jane Stafford, Senior Program Officer, Community Clinics
Initiative
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