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How Georgia Athens-Clark County Can Improve Health Care for Poor Resident

Athens-Clarke County should apply for a health professional shortage area designation (HPSA) for its low-income population, which would make Athens’s application for having a federally qualified health center (federally funded FQHC) more competitive and in the long term, improve access to primary care services for low-income patients.

The 27 FQHCs in Georgia are an effective model for primary care delivery and all have an HPSA designation. Both the need for better access to primary care and the funding for an FQHC exist in Athens. Assuming the Affordable Care Act (ACA) is implemented as planned, the ACA provides an additional $11 million to fund new FQHCs around the nation.

In Athens, support for implementing this policy exists from various health providers and the Athens-Clarke Unified Government already. Medicaid patients have three options; because they are not eligible to receive care at the two free clinics, they have to find a primary care provider in Athens, seek care from an understaffed and underfunded Athens Neighborhood Health Center, or must resort to using the emergency department. Less than 40 percent of providers say they accept Medicaid patients, and even those that do will not accept more than a few (3-5) each month. Athens Regional’s Emergency Department sees 76,000 patients annually; about 80 percent of those visits are from uninsured and Medicaid patients, and about 80 percent of those are for non-emergent reasons, or reasons that could be better handled in a primary care setting. Delivering care through the emergency department for 58 percent of Athens’ population is costly, since the average emergency room visit costs $1,000, as compared to the average clinic visit of $29.3 Every year, Georgia spends $105 billion treating uninsured and low-income patients in its emergency departments. 

Analysis

Medicaid patients seen in an FQHC are 1.5 percent less likely to be hospitalized or seek ER care. Clusters in federally designated medically underserved areas (MUAs) that were served by an FQHC had on average 5.8 fewer public hospitalizations per 1,000 population over the three years than did the clusters in MUAs that were not served by an FQHC.6 If Athens-Clarke County could draft a competitive FQHC application to receive federal funding for an FQHC, which would be aided by a high priority designation score, emergency department (ED) usage rates would decrease.

The interest for having an FQHC exists in Athens, but the community level data needed to make these applications competitive needs to be collected. The same information needed to draft this application is also the information needed to perform a thorough community needs assessment of the community, which has not been done since 2008 when OneAthens, an initiative for a more prosperous Athens, was formed.

By using volunteer student interns, the cost for data collection will be minimal. Any small sum of money needed to compensate hospitals and clinics for their participation could come from small grants for which the Athens Health Network is applying. The short-term minimal investment would save money long-term by reducing inappropriate ED use.

Next Steps

The Athens-Health Network should utilize volunteer interns from the College of Public Health to collect and analyze data from Athens-Clarke County to complete the HPSA designation application for the low-income population in Athens. Further, the Athens Neighborhood Health Center and Medical Partnership should submit a joint application for an FQHC in Athens.

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