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As one-time COVID-19 grants end, FQHCs don’t just face the ongoing challenge of recruiting the right staff, they also need new revenue to support the headcount they have already. 

In addition to the urgency of finding new funding, FQHCs also face higher staffing costs, while access to care remains level or reduced compared to pre-pandemic levels. And while individual grants and private funding continue to play a significant role in supporting various staff positions within health centers, it is crucial for organizations to adopt new workforce strategies to help them increase revenue and improve financial sustainability.

Understanding your opportunities

Understanding your revenue opportunities is the first step toward building an optimized and resilient workforce.

There are still growing opportunities for FQHCs to generate revenue through service provision and insurance billing:

• State reimbursable and allowable medical benefits: It’s essential to work with your state primary care association or a third-party advisor to maintain a detailed understanding of the current Medicaid services and reimbursable costs to maximize your opportunities. One of the most notable areas of growth in recent years is the allowability of new license types related to behavioral health and substance abuse, like associate mental health practitioners.
• Payment reform initiatives: Ongoing payment reform initiatives are opening more funding opportunities. Examples of these reforms include higher allocation pools for clinical quality measures — where payers provide additional funds if patients achieve better health outcomes — and alternative payment methodologies, in addition to clinical transformation dollars. These opportunities can create new and larger revenue streams that move beyond traditional fee-for-service models.

Once you understand your opportunities, you can optimize your workforce. Here are four strategies you can implement to help manage staffing costs and drive revenue:

1. Personnel realignment

With COVID-19 grants ending, your organization may have staff that are no longer providing revenue-generating services. If you face a funding gap for certain roles, consider evaluating how to realign existing staff with your state’s Medicaid reimbursement framework.

For example, if your organization hired a marriage and family therapist for grant-funded COVID-19 education, they may be able to transition into a billable provider role as states continue to emphasize behavioral health services. Similarly, a nurse who was hired as a COVID-19 case manager may be able to move into quality improvement or other forms of case management that can generate revenue based on quality metrics.

Identifying opportunities to leverage your existing staff in new, reimbursable roles can be a compelling strategy to managing workforce costs without restructuring or layoffs.

2. Cost-effective alternatives for patient care

Another option for serving patients while managing costs is to look for opportunities to offer equivalent or similar support with different providers.

Consider pain management: for many organizations, employing a pain management specialist may not be feasible due to both costs and hiring challenges.

Alternatively, these patients could be offered acupuncture or chiropractic services. Although these treatments are not substitutes for a pain management specialist, they can still effectively meet some of the same needs. And acupuncturists and chiropractors are typically more affordable and readily available for FQHCs.

Of course there are limitations to clinical appropriateness in these cases, and a licensed clinician should always be the final judge as to if a different service is right for your patients. However, in the context of workforce shortages and high expenses, this strategy provides a viable solution for reducing personnel costs while still responding to community needs.

3. Overseas providers

The shortage of clinicians in the United States, especially in behavioral health and family practice, is a well-known issue. One viable solution to this problem is recruiting providers from overseas. While this approach involves navigating complex requirements such as state licensure and legal dispensations, it has become an essential strategy in the post-COVID-19 workforce, especially given the benefits that extend beyond the labor pool.

Many health centers serve populations that are not best supported in English or were not born in the United States. Bringing in providers with the same linguistic and cultural backgrounds as these patients can be highly impactful for patient outcomes.

International clinicians may also come from health systems with a different workplace culture than American systems, giving them a unique perspective on the work that could ultimately benefit your organization.

4. Advanced practice clinicians, associates and more

As workforce shortages continue to become more urgent, state licensing boards and Medicaid agencies are attempting to fill the gap by making more types of non-physicians reimbursable and clinically appropriate.

For example, some states are now allowing associate clinical social workers and marriage and family therapists to practice alongside their licensed peers. Other states are expanding the scope of practice for nurse practitioners, and more and more are opening the door to other types of service extenders, such as dental hygienists.

All of these staff types will still require appropriate clinical supervision pursuant to state licensing board guidelines, but not all health centers have fully availed themselves of these types of providers. Staying abreast of what is and isn’t allowed and reimbursable in your state is critical to hiring less-expensive staff that can still provide appropriate and excellent services to your patients.

How Wipfli can help

Wipfli’s healthcare professionals provide the solutions you need to overcome your organization’s financial and operational challenges. Our team brings specialized knowledge in workforce compensation, management, compliance and licensing to help adapt workforces to modern-day challenges.

With tailored strategy and customizable support, we’re ready to help you stay ahead of regulations, enhance care quality and transform your financial performance. Contact us today and discover how we can help you build a thriving FQHC.