Providing Specialty and Primary Care to Underserved MS Patients through a Federally Qualified Health Center (FQHC)

Background: FQHCs are generally well-suited to meet the primary care needs of underserved patients, including patients insured through Medicaid or Medicare, patients without insurance, and undocumented patients. In part, this is because FQHCs receive enhanced reimbursement from Medicaid and Medicare as well as other financial benefits. While well-suited to meet the primary care needs of the underserved, many FQHCs lack specialty care services. For underserved patients with MS, this may result in decreased access to specialty care. However, the laws governing FQHCs are flexible, therefore specialty care such as neurology, may be added to an FQHC’s scope of services. To do this, an FQHC must submit a narrative to the Bureau of Primary Health Care indicating that the specialty care qualifies as “additional health services,” as defined by federal law. This is possible if the specialty care is “necessary for the adequate support of the primary health services” and the target population needs the specialty.

Objectives: To offer subspecialty and primary care services to underserved patients with MS in a cost-effective manner through an FQHC.

Methods: Working through a large FQHC (MCPN) and in collaboration with a variety of organizations, we obtained and expanded the scope of services to include MS specialty care. The MS Clinic consists of an interdisciplinary team made up of a neurologist (from a nearby academic MS specialty clinic, the Rocky Mountain MS Center), physician assistant, registered nurse, physical therapist and care coordinator. The entire MS-specialized team is part-time, but subspecialty clinicians are available by phone for urgent matters. Primary care is provided by full-time FQHC clinicians.

Results: In the last year alone, approximately 150 patients, who would otherwise have had difficulty accessing MS experts, disease-modifying treatments, MRIs, or physical therapy services, were able to receive these and other services at reduced or no cost. The clinic serves as a medical home for our patients to ensure management of primary care needs in an effort to reduce comorbidities. The MS Clinic is funded, in part, by the Rocky Mountain MS Center and the National MS Society to provide additional services such as education classes and physical therapy.

Conclusions: FQHCs may broaden their scope of practice to include subspecialty care. Further, patients who may not otherwise have access to specialty care can receive primary and coordinated specialized care in the same facility.