SANFORD — Much has been talked about, reported on, tweeted and posted on Facebook since the city of Portland released its budget proposal, which includes the transition of health care services from the India Street Public Health Center to the Portland Community Health Center.
What hasn’t been part of the conversation thus far, however, is that the Portland Community Health Center is part of a statewide network of 20 federally qualified health centers, which provide comprehensive, high-quality primary and preventive care to about 200,000 Maine people (or 1 in every 7).
Last year marked the 50th anniversary nationally of the federally qualified health centers, which were born out of the civil rights and anti-poverty movements of the 1960s. At their core, the community health centers, like the one in Portland, have a mission to provide open, equal and affordable access to all who come through their doors, regardless of insurance status, ability to pay, race, religion, ethnicity, town of residence, gender or sexual orientation.
By law, community health centers must be in federally designated high-need areas, known as “medically underserved areas.” Community health centers are also required to provide a broader and more integrated range of services than other types of providers in order to remove barriers to care for rural, elderly, low-income, disabled and non-English speaking individuals through transportation, interpretation and case management support.
In order to help cover the costs of the federally mandated services, the U.S. Department of Health and Human Services provides modest but critical base grant funding, as well as a bundled rate of reimbursement for patients who have Medicaid (known in Maine as MaineCare) or Medicare health coverage.
Some mistakenly refer to this bundled rate as an “enhanced rate,” but what community health centers are eligible to receive is, in fact, a fairer rate of payment for services. The India Street clinic is not eligible for the federal base grants or the fairer Medicaid and Medicare reimbursement rates because it is not designated as a federally qualified health center.
So the city of Portland, not unlike other cities and states across the country, is exploring ways to maintain or enhance essential, locally based health care services, while simultaneously finding ways to address budgetary challenges through efficiencies and leveraging other available sources of funding.
Everyone agrees that the India Street clinic and its dedicated staff have been vitally important to their patients and the community. The decision to propose moving its services must not have been an easy one for the city, which has included funding in its budget to sustain the clinic’s operations for over 15 years. Should the City Council vote to move this initiative forward, services will not be eliminated and access will not be diminished. Quite the contrary: The Portland Community Health Center is well prepared, and has the capacity to meet the unique needs of their patients.
The most progressive and innovative feature of the community health center model is that patients have a direct and meaningful voice in decisions about every aspect of their operations, management and range of services offered. This is achieved in a number of ways.
By law, the governing boards of all of the community health centers across the country – including Maine’s – must have at least 51 percent of its members represented by its patients. Some centers go above and beyond that requirement by having a patient advisory committee comprised of only patients, which provides recommendations to the governing board.
Additionally, patients are strongly encouraged to complete patient satisfaction surveys at regular intervals. The sole purpose of collecting this information is to enable the community health centers’ boards and staff to monitor patient experiences so that improvements can be made where and when necessary. Patients from the India Street clinic have articulated very well the importance of the patient-provider relationship – and at the Portland Community Health Center, those connections are equally valued and respected.
It is healthy in any democratic process for the merits of all policy proposals to be weighed carefully and debated, as long as facts drive the public discourse. My colleagues at the Portland Community Health Center are immensely proud of their staff, and are deeply committed and integral to the patients, families and communities they serve. The same is true of all of Maine’s federally qualified health centers.
Regardless of how this issue gets resolved, it is important for the entire community to come together and make sure the patients’ needs are met.
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