April 13, 2015

New Report: Community Health Center Data Capture Incomplete in Electronic Health Record Systems, Potentially Affecting Reimbursement

A new study raises fundamental questions about how to quantify and reimburse the true value of care associated with the community health center model. The  report, from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, based at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University, assesses the feasibility and usefulness of combining electronic health record (EHR) information with federal cost report data as the basis for developing or evaluating reimbursement rates for community health centers.

The study found that the combined data fall short of providing the information necessary to either develop new payment rates or evaluate existing community health center payment rates. For example, the EHR systems did not consistently or uniformly account for the cost or value of services such as translation, transportation to clinics or to specialists, counseling and other services known as enabling services that help low-income patients get the services they need to stay healthy. In other words, the data needed for alternative payment methods focused on value rather than cost is not routinely being captured by current EHR systems, or is in a form that makes it difficult to use, such as scanned notes from providers.

Under Medicaid and Medicare, health center payments are required to reflect the encounter-based costs associated with meeting the healthcare needs of underserved patients. While health centers generally can report on key quality measures, it is unclear the extent to which their federal cost reports or cost-accounting systems adequately capture or document performance or scope of service. Consequently, the advent of value-based payment models has proven challenging.

The authors recommend tailoring EHR products to better capture the unique services provided by health centers and their management of high-risk patients. Fully moving to new reimbursement models will also require health centers to adapt workflow to ensure that additional critical information is properly entered as structured data and not as scanned notes or other hard-to-quantify documentation. The findings were developed based on a pilot program in two community health centers.

Under federal law, community health centers must serve underserved communities or populations and provide a unique set of primary care and preventive health services, with additional ancillary services as appropriate and necessary.  In 2013, approximately 1,300 health centers cared for nearly 23 million low-income patients, providing some 90 million visits across 9,300 service sites nationwide.

The report, “Can Electronic Health Records Systems Support New Payment Methods for Health Centers,”  was co-authored by researchers at Geiger Gibson, the RCHN Community Health Foundation, and the Community Health Care Association of New York State.


The Geiger Gibson/RCHN Community Health Foundation Research Collaborative in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at the George Washington University. It focuses on the history and contributions of health centers and the major policy issues that affect health centers, their communities, and the patients that they serve. Learn more at http://publichealth.gwu.edu/projects/geiger-gibson-program-community-health-policy.

The RCHN Community Health Foundation is a not-for-profit operating foundation established to support community health centers through strategic investment, outreach, education, and cutting-edge health policy research. The only foundation in the U.S. dedicated solely to community health centers, RCHN CHF builds on a long-standing commitment to providing accessible, high-quality, community-based healthcare services for underserved and medically vulnerable populations. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship. For more information, visit www.rchnfoundation.org.

About Milken Institute School of Public Health at the George Washington University: Established in July 1997 as the School of Public Health and Health Services, Milken Institute School of Public Health is the only school of public health in the nation’s capital. Today, nearly 1,534 students from almost every U.S. state and more than 45 countries pursue undergraduate, graduate and doctoral-level degrees in public health. The school also offers an online Master of Public Health, MPH@GW, and an online Executive Master of Health Administration, MHA@GW, which allow students to pursue their degree from anywhere in the world.