A particularly bad cut

There are a lot of budget cuts to get upset about these days, but this one really struck a (dissonant) chord (from today’s WaPo): Community health centers hit hard by Washington deficit cuts.

I recently gave a talk to the administrators, doctors, and nurses who run these centers, and in preparing, I was reminded of how their model was “bending the health-care cost curve” long before anyone even knew there was such a curve (they save the health system about $25 billion a year). And their model is that much more effective in that they achieve these cost savings while serving a much poorer and sicker population than that seen by the typical health clinic or hospital (72% of the folks they serve are poor, about 40% are uninsured, about that same share are on Medicaid; see here).

In fact, when the health care law was coming together, the administration recognized the importance of the CHCs (community health centers) in efficiently serving a tough population, and built a significant boost for them into the Affordable Care Act.

Most recently, according to the WaPo:

Rather than handing out $250 million to establish new patient-care sites to serve more than 2 million additional people, as originally expected, the Obama administration gave $29 million to 67 nonprofit organizations that will serve an additional 286,000 patients.

The funding cut was a result of a federal budget compromise in March to keep the government running. That agreement reduced federal spending by nearly $80 billion, including a $600 million trim in funding for ongoing operations at existing health centers.

Some of that trim got put back but the centers have not been able to expand to meet the increase in need generated by job and income losses in the recession, much less get ready to ramp up for the influx of newly covered patients under the health care bill.

One of my main interests in the CHCs was how they provide quality care less expensively than pretty much any other players in the game. It looks like it they do it with:

–Health care homes—consistent point of service

–Management of chronic disease (hypertension, diabetes, asthma)

–Preventive services

–Avoiding hospitalization and emergency room use

–Low operating margins

The WaPo piece provided a few examples of what we’re losing here:

A dental exam room at FoundCare Health Center in West Palm Beach, Fla., will remain unused four days a week because there’s no money to hire a dentist.

Triad Adult and Pediatric Medicine in Greensboro, N.C., might face a repeat of last winter when more than 700 adult patients were put on a months-long waiting list for care, and the center had to stop taking new pediatric patients because of a lack of doctors.

Heartland Community Health Center in Lawrence, Kan., will have to continue to tell patients they must wait at least two months for an appointment.

It’s another in a truly troubling and destructive set of examples of how we have solutions to our biggest problems staring us in the face, yet we turn away from them. When future historians look back on our era and try to figure out what went wrong, they’ll be forced to conclude we were either highly dysfunctional or highly masochistic. Or both.