Tasks that rural health clinics can perform to improve care, revenue

There are certain clinical and administrative functions that a rural health clinic can perform that are critical to providing better value, cost and quality to patients and may increase the clinic’s revenue, an expert said.

“There are an unlimited number of uncertainties,” said Gregory Wolf, MEd, MBA, president of the health care consulting firm Lilypad, told attendees of the virtual North Carolina Department of Health and Human Services Rural Primary Care Conference. “But one thing we know for sure is that primary care is going to elevate in relevance and importance.”

Here are some tasks that Wolf encouraged clinic staff to review at least once a year:

Productivity standards

CMS only reimburses rural health clinics whose physicians and advanced practice providers (eg, nurse practitioners and physician assistants) meet specific visit quotas, Wolf said.

For a full-time doctor, this amounts to at least 4,200 visits annually, he said. Full-time advanced practice providers must conduct a minimum of 2,100 visits each year.

340B optimization

340B allows rural health clinics to receive most prescription drugs at “significantly reduced” prices, Wolf said. However, only rural health clinics that make between $300,000 and $400,000 for every 10,000 patients in net revenue qualify.

“If you do not meet this target, then make this an area of improvement,” he suggested.

Specialty care integration

Wolf noted that if 50% of a rural health clinic’s services are primary care, the clinic can also offer specialty care such as general surgery; orthopedics; ear, nose and throat care; gastrointestinal care; and neurology.

Utilizing one of these specialty options when there is a demand for it in a clinic’s service area could result in additional revenue streams, Wolf said.

Contracts and compliance

Mistakes regarding contracts and compliance, particularly when determining provider compensation, can negatively impact a rural health clinic’s revenue, Wolf said.

“COVID-19 revealed the sloppiness, inconsistency and lack of flexibility that we see in contracts with physicians and advanced practitioners,” he said.

Wolf suggested that clinics be consistent in developing and executing contracts, valuation opinions and payroll; avoid quick decisions about recruitment and retention; involve a practice administrator or physician in contract and compliance decisions; and monitor the scheduling and documentation of hours process.

Quality measurement and benchmarks

Wolf said that rural health clinics should track patients’ progress using specific quality measures to maximize reimbursement. He added that a “good starter set” of these measures includes:

• controlling adults’ BP levels;
• screening adults for tobacco use at least once every 24 months and offering tobacco cessation interventions when a tobacco user is identified;
• administering four Tdap; three polio; one measles, mumps and rubella; three Haemophilus influenzae type B; three hepatitis B; one varicella; four pneumococcal conjugate; one HAV; two or three rotavirus; and two influenza vaccines by a child’s second birthday;
• ensuring adults with diabetes aged younger than 75 years have HbA1c levels greater than 9%; and
• documenting patients’ current medications.

“Ideally, you track these by provider instead of by patient,” Wolf said. “If you don't, the very first thing you're going to hear at a staff meeting is ‘those aren't my patients.’”