Workforce shortages are placing increased pressure on community health centers (CHCs) across the U.S., with more than 70% of such centers surveyed reporting primary care physician, nurse or mental health professional staffing gaps.
Other challenges such as persistent funding gaps, rising mental health and substance abuse treatment needs, and changes in Medicaid enrollment have also added to the workload for such centers, according to a new Commonwealth Fund survey.
That said, such centers, also known as federally qualified health centers, continue to provide “accessible, comprehensive, and coordinated healthcare” to more than 30 million patients annually, the report authors said. Of those 30 million, 20 million people are low income, 17 million are people of color, 15 million are covered by federal programs such as Medicaid and 16 million are uninsured.
“Community health centers provide essential health care services to more than 30 million people every year,” said Joseph R. Betancourt, M.D., president of the Commonwealth Fund. “They operate under enormous pressure because of inadequate funding, growing workforce shortages, and increasing demand for their services. Despite these obstacles, these centers continue to deliver timely, high-quality care.”
The data back up such claims.
CHCs, of which there are 1,368 operating in more than 15,000 service sites, offer timely appointments (88%) with 93% of centers offering expanded hours for patients. Fully 96% of the centers offer telehealth services, almost four times as many as the last such survey in 2018.
“Significantly” more of the centers are also offering substance abuse treatment and medication-assisted treatment services than back in 2018, according to the report.
Challenges abound
As well as such challenges as the shortage of labor and funding gaps, CHCs also face difficulties in coordinating patient care.
Only a quarter of community-based organizations, which coordinate with CHCs over patient care, for example, report back to the CHCs on patient updates.
Most CHCs also have difficulty in obtaining specialist care for their uninsured patients and Medicaid enrollees.
While 41% of the CHCs said they faced difficulty referring patients to specialist care in a timely manner, that number rose to 73% for patients who are uninsured or on Medicaid.
Congress can better support CHCs by addressing the various issues threatening continued good operations, the report authors said.
Such steps should include reauthorizing and expanding the Community Health Center Fund, a key source of funding for the centers that is set to expire at the end of 2024.
In addition, Congress can address increasing labor shortages by offering incentives for health workers to operate in medically underserved areas, including rural settings.
CHCs must also have continued access to telehealth, which can be done by more closely aligning telehealth reimbursement with in-person care reimbursement. Federal flexibilities allowing CHCs to expand telehealth during the pandemic are also set to expire at the end of this year.
“They are an essential lifeline for millions of Americans who otherwise might not be able to get care, and they deserve to be supported,” said Celli Horstman, lead study author, referring to CHCs.
The survey sent questionnaires to all 1,368 CHCs with 766 responding between October 2023 and April 2024.