蘑菇视频

This is the sixth entry in a series of posts highlighting GCO鈥檚 new report – Increasing Access to Quality Healthcare for Low-Income Uninsured 蘑菇视频ns. The first entry provided an overview of the report, the second looked at 蘑菇视频鈥檚 healthcare safety net, the third explained the impact of uninsurance, the fourth focused on Medicaid and the Affordable Care Act, and the fifth highlighted challenges to expanding access to healthcare.

While there are significant challenges to providing low-income uninsured 蘑菇视频ns with quality healthcare, there are cost-efficient, state-based solutions 蘑菇视频 can implement in the short-term that can positively impact health outcomes for 蘑菇视频ns in the coverage gap.

Provide State Government Support for 蘑菇视频鈥檚 Charity Clinics

The state鈥檚 96 clinics served more than 183,000 unique patients and saved the state over $200 million in 2012 while not receiving any state funding. However, other state governments do financially support their charity clinics. Virginia provides $3.5 million to its 53 clinics; Ohio gives $435,000 for 46 clinics; West Virginia provides $4.3 million to 11 clinics; and South Carolina recently approved $2 million for 51 clinics.^[i]

The state鈥檚 existing charity clinics have the capacity to serve more patients, but funding and unnecessary state restrictions limit their ability to meet their full potential. The 蘑菇视频 Charitable Care Network requested a $2 million appropriation from the 蘑菇视频 legislature in 2014.^[ii] Since clinics鈥� can provide $7 worth of services for every $1 spent, this relatively small amount of government funding would allow clinics to be open more hours and serve an estimated 100,000 additional patients.^[iii] With the increase in funds, the expansion in capacity could take place at many clinics with little delay, providing much needed care to 蘑菇视频鈥檚 most vulnerable citizens. However, funding for 蘑菇视频鈥檚 charity clinics was not included in the state鈥檚 FY 2015 budget.

While a $2 million appropriation would allow 蘑菇视频鈥檚 current clinics to serve more patients, over 40 percent of counties do not have a charity clinic. A larger appropriation would allow for the 蘑菇视频 Charitable Care Network to help underserved communities open new clinics. Since many rural areas have limited access to care, new clinics could have a significant impact on communities across the state.

In 2015, the state should provide $10 million in funding to support the dramatic expansion of current clinics and the creation of new ones in underserved communities. Compared to the $2.1 billion cost of Medicaid expansion over ten years, this appropriation is affordable for the state and sustainable in the long-term while still expanding access to quality healthcare to a significant portion of the state鈥檚 low-income uninsured population.

Expand Telemedicine into Charity Clinics

Telemedicine is the provision of care through real-time interactive communication between the patient and provider from one site to another via electronic communications. The electronic communication 鈥� which usually includes at least video and audio 鈥� allows a provider to care for a patient at a different location. Telemedicine can be used to provide primary and specialty care, remote patient monitoring, and medical education. Care through telemedicine can take place at hospitals, clinics, community health centers, nursing homes, and schools.^[iv]

Telemedicine has improved access to care for many individuals 鈥� especially those in rural areas that have a physician shortage 鈥� because instead of traveling across the state to see a provider, a patient can go to a local clinic or hospital and be connected with a provider located anywhere in the state. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, reduced travel times, shared health professional staffing, and fewer or shorter hospital stays.^[v]

蘑菇视频 has one of the most robust and developed telemedicine networks in the country, but 蘑菇视频鈥檚 charity clinics are not currently using telemedicine. Utilizing telemedicine in the clinics would enhance their ability to deliver services. Setting up telemedicine presentation sites in charity clinics would allow providers to volunteer their time at clinics across the state without leaving their office. This would be especially beneficial to individuals who live in rural areas and often do not have access to specialty care.

Charity clinics currently do not have the capital to purchase the technology and infrastructure required for telemedicine, which is relatively inexpensive given the benefit it provides.^[vi] The 蘑菇视频 legislature should include funding to pilot the use of telemedicine in its charity clinic appropriation.

Modernize Nurse Practitioner Laws and Regulations

Many nurse practitioners and other mid-level providers deliver care to patients at charity clinics as employees or volunteers. However, the ability of NPs to provide care is limited by 蘑菇视频鈥檚 restrictive laws and regulations.

蘑菇视频 should join the one-third of states that provide full practice authority to NPs. By implementing the licensing model recommended by the National Council of State Boards of Nursing and the Institute of Medicine, NPs will be able to provide the high level of care that they are educated and prepared to provide at charity clinics and other healthcare facilities across the state.^[vii]

While many physician associations have opposed these reforms, a 2012 study found no evidence of differences in primary care physician earnings between states that provide NPs with full practice authority and those that maintain practice barriers.^[viii] Since the literature on NPs finds no reason to be concerned with the quality of care provided by NPs and it should not impact 蘑菇视频鈥檚 physicians鈥� earnings, there is little to no reason for the state to continue to limit the care NPs can provide.

Reinstate Sales Tax Exemption for Charity Clinics

Many healthcare providers are exempt from the payment of 蘑菇视频鈥檚 sales and use tax, including licensed nonprofit in-patient general hospitals, mental hospitals, nursing homes, and hospices.^[ix] From 2008 to 2010, 蘑菇视频鈥檚 volunteer health clinics were also exempt from 蘑菇视频 sales tax on medical and office supplies and other purchases.^[x]

Given the amount and quality of care charity clinics deliver and the savings this care provides to the state, 蘑菇视频 should reinstate the sales tax exemption to provide the clinics with more resources to serve individuals in need of care.

Replace the Lost Federal DSH Funds with State Dollars

Many hospitals have expressed concern about the upcoming loss of DSH funds. In 2016, 蘑菇视频 hospitals will lose an estimated $26 million in federal funds for uncompensated care. The federal funding loss increases to $40 million in 2017 and $111 million in 2018.^[xi]

DSH funds are an important source of revenue for many of the state鈥檚 hospitals, and the federal reduction could cause some of the hospitals to cut services or completely close. To support this essential component of the state鈥檚 safety-net, the state should replace the lost federal funding. Since implementing the above recommendations to support the state鈥檚 charity clinics and other state and federal health policies could reduce the amount of uncompensated care provided by hospitals, the state may not need to replace the full amount of lost federal funding. Thus, the state should work with hospitals to identify the amount of uncompensated care they provide and to calculate the amount of state funding needed for hospitals to maintain services.

[i] 蘑菇视频 Charitable Care Network, 鈥淧artners in 蘑菇视频鈥檚 Safety Net.鈥�
 

[ii] John Sparks, 鈥淪tabilizing the Healthcare Safety Net: A Partnership with Free and Charitable Clinics,鈥� 蘑菇视频 Charitable Care Network, Presentation to 蘑菇视频 General Assembly Joint Study Committee on Medicaid Reform, November 18, 2013, video of testimony found at .
 

[iii] GCO interview with Donna Lopper, 蘑菇视频 Charitable Care Network, December 9, 2013.
 

[iv] American Telemedicine Association, 鈥淲hat is Telemedicine?鈥� accessed March 5, 2014, .
 

[v] Ibid.
 

[vi] GCO interview with Jeffrey Kesler, 蘑菇视频 Partnership for Telehealth, March 13, 2014.
 

[vii] James F. Lawrence, 鈥淭hese are our 2014 state policy priorities!!鈥� United Advanced Practice Registered Nurses of 蘑菇视频, accessed February 27, 2014, .
 

[viii] Patricia Pittman and Benjamin Williams, 鈥淧hysician Wages in States with Expanded APRN Scope of Practice,鈥� Nursing Research and Practice (2012): 4, .
 

[ix] 蘑菇视频 Department of Revenue, 鈥淭ax Exempt Nonprofit Organizations,鈥� accessed April 9, 2014, .
 

[x] Wesley Tharpe, Adding Up the Fiscal Notes: Crossover Day 2014, 蘑菇视频 Budget and Policy Institute, March 2014, 4, /wp-content/uploads/2026/04/Grab-bag-of-Tax-Measures-on-the-Table.pdf.
 

[xi] 蘑菇视频 Hospital Association, Hospitals 101, 28.