Federally Qualified Health Centers and Hospitals

1. Federally Qualified Health Centers and Hospitals Recipe for Building a Successful Relationship Terri Hill, MSN RN VP/Administrator Union Hospital Clinton

2. FQHC’s • Currently, in Indiana there are 19 FQHC’s • Newest is in Vermillion County, Indiana • Main address is Clinton, IN, across the drive from Union Hospital Clinton with a satellite clinic 28 miles north in Cayuga, IN

3. How It All Began • In 2005, UH Clinton had a healthy medical staff of 10 family medicine physicians and 1 Internal Medicine physician along with 2 dedicated surgeons and a large variety of Consulting and Courtesy medical staff. • Physicians practices were large and served patients in a two county, highly rural area.

4. UH Clinton had 5 of the 11 physicians located across the driveway on campus or across the street. • Two more physicians were across the street half time and half time in satellite offices in the adjacent county. • All physicians were active members of the medical staff and all admitted patients to us.

5. The next two years saw dramatic changes. • One physician died unexpectedly in a motorcycle crash while on vacation. He had no partner to carry on his practice. • One physician’s group pulled his practice out of the local market to the main campus in another city.

6. This physician was eventually allowed to return to the area, first on a part time basis and then full time when his patients did not follow him to the larger city. • His practice numbers sustained heavy losses through this period. • He eventually left in 2008 to become a hospitalist on full time basis.

7. Attempts by the hospital to recruit were unsuccessful. • There was no magic in luring young physicians to a rural area. As important, there was no real draw to attract spouses who would be satisfied with long drives for shopping and entertainment.

8. A third threat to the hospital came when 2 physicians voluntarily withdrew privileges to align with another hospital outside our market share area but within driving distance for their patients on the eastern borders of the neighboring county.

9. Call to Action! • Successfully recruited one family physician. • Implemented a hospitalist program in response to loss of market share to larger hospitals who had programs. • Began looking for partnerships that would allow patients to remain near medical home and in own community for services.

10. The FQHC-Friend or Foe? • With the aid of the Lugar Center, the sponsorship of a FQHC was debated. • Our 2 county service area needed additional physicians! Patients were without medical homes. • The hospital needed both the inpatient and outpatient business that additional providers would bring.

11. Past experiences gave a basis for what requirements were necessary for a successful relationship. • Focus was on cooperation rather than an adversarial intent between a FQHC and the hospital. • Goal was to serve the residents of Parke and Vermillion counties to improve health and access to care.

12. The Lugar Center submitted a grant for a FQHC to be located in Clinton, In. • Union Hospital Terre Haute and Union Hospital Clinton agreed to assist in sponsoring until the Center could go independently forward. • The communities from both counties rallied in support of the birth of the clinic.

13. Benefits for the Hospital • Assisted in recruitment of additional physicians. (2 more coming this Fall). FQHC offers: • loan forgiveness for physicians • no medical malpractice premiums • clinical site for medical students and residents to study in a rural tract.

14. FQHC (continued) • Social services to assist patients in enrolling in applicable benefits. • Behavioral health services onsite • Low cost medications which helps keep patients compliant with medications • Telemedicine consults with specialists.

15. Hospital gained: • strong partnership for patient care • physicians who joined medical staff • physicians who were on call for hospital including ER call • physicians who serve on med staff committees in the hospital

16. Hospital gained: • Transfer of employed physicians to FQHC to reduce revenue loss leaders. Cayuga practice became satellite of Clinton FQHC. • Inpatient and outpatient business • Commitment to quality and patient safety

17. Advantages for Both: • Cooperative relationship. • Agreement to not compete for services. • Payment in Kind: • Remodeling for rent • Local board of directors committed to success of hospital AND FQHC • Support of independent physicians

18. Advantages continued: • Stable group of physicians and extenders to ensure care is available locally • Ability to recruit quality, dedicated dedicated physicians to medially underserved populations and areas • Strong partner to educate community on health topics like stroke, heart attack, women’s health

19. Future: • The reality of geography: • Mason/Dixon line (HWY 36) in Vermillion county Elizabeth and Terri!! • The Wabash River between Vermillion and Parke counties • Strong board and strong partner- ships to break barriers

20. Future: • Consideration of needs of both facilities: After hour clinic to meet needs of patients without adding financial burden of unnecessary use of ER • Appropriate use of available health dollars-inpatient/outpatient/ER • Partnership of both with insurers and payors.