Federally qualified health centers (FQHCs) constitute an integral part of the safety net health system in the United States. Located in underserved areas, FQHCs attract patients by offering lower cost of treatment, accepting Medicaid insurance, and providing ancillary services to address social determinants of health. Through my experience in opening an FQHC in Center City Philadelphia in June 2020, I found that FQHCs differ from private practice in four major ways: funding, scope of services offered, patient population, and management.
1. Funding. FQHCs do not turn away emergency patients who are experiencing pain, infection, or oral swelling, regardless of their ability to pay, and will offer discounts for treatment based on a patient’s income and family size compared to the federal poverty level guidelines. How are FQHCs able to offer these services? The federal government provides grants such as Section 330 funding, as well as a prospective payment system (PPS) for Medicaid reimbursement, to help reduce the cost of providing these services. When an FQHC accepts this funding, the Human Resources and Services Administration requires periodic site visits and annual reports to prove you are providing valuable services to the community. It can be difficult in private practice to be in network with Medicaid and remain financially viable due to lower Medicaid reimbursement rates as compared to commercial insurances.
2. Services offered. Each FQHC sets their own scope of service, that is, which procedures they can provide and still be financially viable. This can be comprehensive care which includes preventative and diagnostic care, restorative, non-surgical periodontal care, and extractions. Some FQHCs will offer crown and bridge, removable prosthodontics, and root canal therapy as well. Cosmetic services such as whitening and veneers or advanced specialty procedures, such as implants, are not offered. Providing emergency care is a large component of FQHCs, as treating dental emergencies in the clinic prevents patients from seeking costly care at local emergency departments. Limiting the scope of services provided is often necessary for FQHCs based on available funding.
3. Patient population. The patient demographic varies based on the location of the FQHC, however most FQHC patients differ from the typical private practice patient. For example, in our Philadelphia FQHC, the majority of our patients have Medicaid or are uninsured. Many of our patients are referred to us by specialty medical and rehabilitation programs, including treatment for HIV, substance abuse disorders, and behavioral health. Many of our adults are medically compromised and a subset of our patients reside in nearby transitional housing. In addition, FQHCs usually outreach to local schools and/or youth programs to increase access to dental care and education for children, which is a priority.
4. Management. There are many challenges in managing a successful FQHC. Budget deficits are common, as the expensive cost of providing dental care and providing competitive salaries for team members result in high overhead. Staff shortages, which also affect private practices, are compounded in recruitment of FQHC staff, many of which are unable to offer as competitive a salary as their private practice counterparts. In addition, the demand from patients far outweighs the capacity to see them which can overwhelm dental clinics, push out appointment times for patients, and result in “burn-out” for providers. Combined with an exceptionally high no-show rate when compared to private practice, it can quickly become an arduous task to manage schedules productively.
Despite the many challenges of running a successful FQHC, the rewards are many. We are able to reach non-English speaking patients because we offer translation services to make patients feel comfortable and understand the treatment we are presenting. We regularly connect patients to additional social services and medical services if needed, such as food assistance programs and stable housing programs. For example, if we see a patient with elevated blood pressure readings and that patient does not have a primary care provider, we can facilitate a warm handoff to help get the patient scheduled at our community health clinic. We are also able to arrange transportation for patients with disabilities to further reduce barriers to care.
Not to be overlooked is the educational component: many patients unfortunately never had a stable dental home and need basic oral hygiene instruction to motivate them to improve their oral health. Although there are many ways to give back in dentistry, I enjoy working with the underserved patient population because regardless of the current hardships they may be facing, many are so grateful to be receiving quality dental treatment to take away their dental pain, improve their oral health, and restore their smiles and confidence.
About the author: Dr. Raj Jutla is currently the dental director of PHMC Dental in Philadelphia, PA. A Tufts Dental graduate, his experiences include completing a GPR at the Philadelphia VA, working as a dental director at a DSO, an associate dentist in private practice, and teaching clinical dentistry at Temple Dental. He can be reached at rajvir.jutla@gmail.com.
