How Financial Support During the COVID Crisis Affected the Federally Qualified Health Center Workforce


Description:

Description of Research Study: When the COVID crisis took hold in the US in early 2020, federally qualified health centers (FQHCs) had to quickly modify the way they deployed their health workforce to ensure patients had access to COVID testing while maintaining continued access to high quality primary care. Facing possible closures, even temporarily, spurred policymakers to provide access to emergency funds. This study examines what funds were made available to FQHCs, estimates how much FQHCs received during the crisis to date, and how receipt of funding relates to any modifications in FQHC staffing, including the use of virtual services and ensuring access to care for patients, as well as ensuring their safety. 

Purpose and Policy Relevance: The coronavirus disease (COVID-19) has brought a crisis to safety net providers across the United States. One large network of safety net providers includes federally qualified health centers (FQHCs) funded and authorized under the Section 330 of the Public Health Services Act and administered by the Health Resources and Services Administration (HRSA).i FQHCs serve over 28 million patients, primarily from underserved, low-income populations.ii The 1400 FQHCs provide critical primary care access as well as mental health and dental services across approximately 12,000 delivery sites in rural and urban areas.iii At least one in ten delivery sites were temporarily closed due to COVID-19 risk, and often in areas of critical need during the crisis.iv  

Several sources of funding emerged to support FQHCs during the COVID-19 crisis. The Coronavirus Aid, Relief, and Economic Security Act of 2020 (CARES Act) established the Provider Relief Fund, which has been allocated in “tranches” according to select characteristics of providers. For example, $15 billion was allocated to providers serving Medicaid/CHIP beneficiaries and $10 billion was allocated to rural providers. The general goal of these funds has been to provide financial protection to providers resulting from loss in patient revenue. In addition, supplemental funds were provided to support the purchase of COVID personal protective equipment (PPE) and testing supplies as well as to support the expansion of the use of telehealth.v FQHCs have been eligible to receive funding from a combination of sources. Despite this support, there is concern that the funding is not sufficient to prevent FQHCs from permanently closing and to serve areas in most need.vi  

This study aims to identify the sources and amount of funding received by FQHCs during this crisis, and how funding may have affected deployment and safety of their workforce to ensure continuous access to care for patients during the crisis. 

Design and Analysis: 

Study Questions:  

  • RQ 1: What have been the sources of COVID-related funding that FQHCs were eligible to receive since the start of the crisis, and what was the estimated amount received by each FQHC? 

  • RQ 2: How has COVID-related funding varied by 2019 FQHC characteristics such as funding level, patient case mix, location, services offered, and workforce mix? 

  • RQ 3: What, if any, relationships exist between COVID-related funding and FQHCs’ ability to remain open, serve a diverse community, provide virtual services, obtain adequate PPE and testing, and ensure the safety of their workforce? 

Study Design: This study is a retrospective analysis of FQHCs reporting in the 2019 Uniform Data System (UDS) with at least one response per month to the Health Center COVID-19 Survey.  

Approach: For RQ 1, we will develop a database with information on the amount and source of COVID-19 funding based on available federal datasets. We will identify which programs FQHCs were eligible for based on published criteria, which will assist in identifying the number of payments/programs FQHCs were qualified for in order to understand how the total payment was derived. Providers are identified by the facility name, city and state. The resulting database from RQ 1 will be merged with 2019 UDS based on facility name using a “fuzzy match” algorithm and manual matching for remaining low-scored matches to address RQ 2.vii This data will then be merged with responses from the COVID-19 Data Collection Survey Tool (approximately 70-80% response rate) based on grant number to address RQ 3. 

Assuming every FQHC received at least some funding (which preliminary analysis supports), we will calculate the amount of COVID-19 funding per patient and then categorize FQHCs into quartiles based on distribution of funding per patient. We will summarize patient and facility characteristics (including staffing) across funding quartiles. Similarly, we will determine whether federal funding is associated with FQHCs level of telehealth capabilities, COVID testing capacity and staffing capacity. 

Limitations: Funding such as from the Provider Relief Fund relied on application for funding and were not automatic, so an eligible provider may not have submitted an application to receive payment. Also, data are available on the total amount provided under the Provider Relief Fund but without detail on the source of funds and how many payments were allocated. A limitation of the UDS is that data are reported at the center level rather than at the delivery site level. UDS also restricts information on total staffing and source of revenue. 

Data Sources: For COVID-related funding, example sources of data include the CARES Actviii (e.g., Provider Relief Fund including General Distribution or Targeted Funds, FEMA Supplemental Fund), FY20 Coronavirus Emergency Supplemental Funding for Health Centersix, and FY20 Expanding Capacity for Coronavirus Testing Supplemental Funding for Health Centers.x Other potential sources of funding include the Payment Protection Program (PPP),xi Health Care Enhancement Act, and other foundation funding. FQHC patient and center characteristics will be obtained from the 2019 UDS. We will use weekly responses (approximate response rate of 70%) from the HRSA COVID-19 Data Collection Survey Tool, which includes data such as number of COVID tests, whether the center is temporarily closed, percent of visits that are conducted via telehealth, and percent staff available.xii  

Human Subjects Research: This study is not considered human subjects research due to the use of publicly available data reported at the site level. 

Page Break  

Timeline:  

Study 7-3: How Financial Support During the COVID Crisis Affected the Federally Qualified Health Center Workforce 

Month 

10 

11 

12 

Identify data sources for funding and create database 

Merge/clean weekly COVID data 

Merge funding dataset, weekly COVID data, and UDS 

Generate variables of interest and conduct analysis of datasets  

Draft and edit manuscript for publication 

Submit deliverables to NCHWA, and post on UW HWRC website 

Present findings at conferences 

 

Funder:

HRSA: HWRC Allied Health

 

Status:

In Progress