FQHC Lament

January 27, 2009

I had a meeting Friday with two of my bosses regarding my

" productivity " for the last year and their goals for the coming year.

It was clear they were not happy with the number of patients I am

seeing because they say they are losing money on me.

Background: I started working for Southern Illinois Healthcare

Foundation in Dec 2007 in a tiny, rundown office in Belleville, IL. My

" demands " when I started were that I alone controlled my schedule and

my panel. This was done so I could implement open access and grow the

practice in a controlled manner. Appt slots are all 30 minutes. All

pts have my cell phone number. Over the last year I managed to

implement many of the things that are standard for members of the

group, and I have some hope that in the coming year HYH use will

increase dramatically. I have 2 MA's that work for me. I believe

average reimbursement for the patients I see is about $110 per visit.

During the meeting I pointed out the I was running a lean operation

from a space that no one else would want. In the last quarter I have

averaged 10-12 visits per day. I delivered 30-40 babies last year. I

supervise a NP who works at a local school based clinic. I've had

several medical students work with me. I have a good reputation with

patients and other docs in the area, which is not true of all the

other physicians in the Foundation.

My sales pitch at the meeting was that I am working on quality first

and that I thought I would ultimately get close to their goal, 15/day,

over the next 3-4 years. I believe that showing quality data will

someday prove valuable from within a FQHC; however, it's clear now

that no one within SIHF values anything other than visit numbers. I

believe this is a function of how the government pays us- per visit.

Does anyone have suggestions? Is it worth talking to local

politicians? Newspapers? Our board of directors? What arguments can

I make that might undermine the importance of visit numbers? Would

the Federal Govt really let a large FQHC fail? Aren't they funded on

a cost basis?

Sorry for the long post. Thanks for any help.

Barron, MD

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