BOSTON — Community health center care providers urged legislators Tuesday to enact reform provisions that would shore up access to primary care and ensure the centers fulfill their mission of providing medical access to all regardless of legal status or economic standing.
The members of the Massachusetts League of Community Health Centers attending a legislative briefing Tuesday offered both short- and long-term solutions to address mounting problems plaguing the medical care providers used by thousands of state residents.
The chief operating officers, managers and leaders of the centers located throughout Massachusetts gathered at the State House to alert legislators to the issues and to support legislative fixes.
Increasingly long wait times, lack of staff, loss of alternative health care providers due to the shuttering of services at hospitals and the loss of private medical providers are all factors in the crisis facing the centers. Centers are also bracing for the impact of the for-profit failures, a reference to the Steward Health Care crisis. The group that owns eight Massachusetts hospitals filed for bankruptcy last month and proposes to auction off its facilities.
Both funding gaps and staffing shortages contribute to longer wait times for patients seeking for medical care.
“As patients wait for longer and longer periods for to see a primary care physician, their morbidity and mortality grow as their health status declines,” said Susan West Levine, CEO of the Lowell Community Health Center.
The centers are seeking a cash infusion of $75 million from legislators as well as some policy changes — simple legislation, they say, that would address certain corrupted revenue streams. Other policy initiatives, which include student loan forgiveness for medical and support staff and facilitating the licensing procedure for medical providers educated abroad, would ease some of the financial pressure on the centers.
Concerning to the centers is what they dubbed as a reinterpretation of the federal 340B mandate established by Congress in 1992 to lower the cost of certain medications. The centers propose the state Legislature direct drug manufacturers already participating in the pricing program with health care providers be also required to include community health centers as partners.
The proposed changes in the price negotiating program would not cost Massachusetts any money, they said, as the cost is absorbed by the pharmaceutical companies. If enacted, the proposed legislation would take on pharmacy benefits managers who deny price negotiations to community centers or that siphon off savings for their own benefit.
30 states enacted legislation
About 30 states have already enacted legislation addressing both the pharmaceutical issues as well as gaps in the reimbursem*nt rates between what the federal government mandates states to pay providers for patients using Affordable Care Act insurers and what commercial insurers decide to pay.
“It is absolutely critical to health care in Massachusetts and nationally,” said Ruby Pazenatti of the Edward M. Kennedy Community Health Care system, with centers in Worcester, Framingham and Milford. “At the end of the day, vulnerable populations will be unable to access to primary care and critical care services without the funding.”
The state, Pazenatti said, must grow access to health care as it faces the crisis in private and for-profit health care providers.
Jay Trivedi of the Upham Corner Health Care in Dorchester said centers across Massachusetts are struggling to fill vacancies as the job market continues to grow.
“We have 400 people on a waitlist for primary care and 500 on a waitlist for dental care,” Trivedi said, adding his center is struggling to fill more than 20 vacancies this year.
Other advocates told similar stories of long waitlists: 1,200 in Brockton at the Brockton Neighborhood Health Center, where the list had peaked at 1,900 patients at one time.
The center is facing additional pressure from the shuttering of Brockton Hospital due to a fire, the closure of Compass Medical and the possibility that Good Samaritan Medical Center will close in the near future. The facility is one of the eight hospitals in the financially floundering Steward system.
“We have new patients every day,” said Susan Joss, CEO of the Brockton center. “We’re feeling the impact of the Steward crisis. Their staff is leaving for other jobs, they no longer perform colonoscopies, mammograms, bone density testing, they have closed oncology and hematology."
Hospitals bleeding staff
“Now we’re facing the lack of obstetric coverage at Good Sam, Brockton is closed, and South Shore (Health) is working beyond capacity,” Joss said, predicting that pregnant women will soon be laboring in emergency rooms ill-equipped to provide skilled birthing attention.
The community centers help divert patients from using emergency rooms for their primary care, which places additional burdens on emergency medical providers and degrades health outcomes and health equity.
“The role of the community health centers has been as a safety net,” said Lou Brady, president and CEO of Family Health Center of Worcester. “We care for the most vulnerable populations, regardless of their ability to pay for care. We offer comprehensive and wholistic care.”
The FHC offers medical, dental and behavioral health care. It also serves as an outreach to the community’s unhoused population, meeting people where they are located. The center also provides care in schools.
About 80% of the patients who seek medical attention at the Worcester center are MassHealth subscribers. While the state reimburses the center for its patient visits, commercial insurance providers pay less.
“The federal government sets the state reimbursem*nt rate; commercial providers are allowed to set their own rates,” Brady said, adding that they are significantly lower than the state rate. He urged lawmakers to address the shortfall and pass legislation that would require commercial companies to match the state reimbursem*nt rates.
At the Outer Cape Health Center, more than 50% of patients seeking medical attention have commercial insurance, said Dr. Damian Archer, CEO of the center. His facilities sees roughly 18,000 patients and logged 70,000 individual “billable events” in 2023.
His center is the only medical provider on the Cape as private practitioners close their doors or go to direct pay or concierge services.
A survey conducted by the Massachusetts Medical Society and quoted by Levine indicates one in four physicians plan to leave the profession and the Center for Health Information and Analysis indicates that there is a 17% vacancy rate of physicians in community centers. More physicians are leaving that entering the profession, Levine said.
