Federally Qualified Health Centers faced unprecedented challenges due to the COVID-19 pandemic. FQHCs struggled to keep enough patient visits on the books to survive in the early days before fighting to maintain staff levels as burnout threatened in the subsequent mass influx of vaccine-seeking patients.
HRSA-funded centers have seen the number of patients served triple over the past 20 years, with almost 29 million patients seen in 2020 alone. The pandemic provided a wake-up call and the impetus needed to drive slow-to-start telemedicine options forward; health centers provided over 28.5 million virtual visits in 2020 — an approximately 6,000% jump over the previous year.
However, challenges directly or indirectly posed by the pandemic will continue to affect FQHC pharmacists going forward. How will federally funded rural and community pharmacies meet these current and future challenges?
COVID-19 woes that impacted FQHC pharmacies
The majority of FQHC pharmacies faced a sudden and significant shift in demand for services due to the COVID-19 outbreak. This demand continued to evolve, raising new challenges on a continuing basis and contributing to stress levels across the workforce.
Changing pharmacy demands and workflows
In mid-March 2020, COVID-19 stay-at-home orders and state lockdowns started, causing a panic among patients and increasing prescription demand by nearly 15%. A growing daily prescription volume is associated with increased prevalence of burnout, and drive-through windows (a preferred option during the pandemic) can contribute to burnout risk levels.
Workforce recruitment and retention was and remains a serious issue for FQHC staff, including pharmacists. As FQHC pharmacies struggled to meet rising demands for prescriptions, changes in authorizations for 90-day fills, flexibility for “refill too soon” notifications, and new patterns of stockpiling, it became imperative to find ways to streamline workflows.
Patient scheduling can reduce pressure on pharmacy staff and make it easier to organize changing pharmacy workflows for new prescriptions, refills, drive-through, and delivery requirements.
As FQHC pharmacists also continue to be called on to devote time to vaccine clinics in FQHCs, automation can help facilitate faster completion of repetitive tasks and free pharmacists’ time for more pressing and hands-on issues.
Unpredictable and insufficient revenues
As the pandemic advanced, FQHCs and their pharmacies faced a triple threat: reduced revenues, increasing costs to operate the health center, and inadequate physical space. Health centers in non-Medicaid-expansion states also listed the high number of uninsured patients seeking care as a top challenge.
Pharmacies struggled to deal first with a lack of incoming revenues as stay-at-home orders and citizen fears forced a sharp decline (26%) in FQHC patient visits. More than a third of patient visits switched to telehealth, and pharmacies scrambled to put telepharmacy and delivery options in place to compensate for the reduction in walk-through traffic.
The pendulum swung swiftly to the other extreme as the vaccine for the novel coronavirus became widely available. Expectations for patient care went up significantly when FQHCs became a primary deliverer of the COVID vaccine, increasing demands on pharmacy staff, who were often front-line workers in FQHC vaccine clinics.
FQHCs delivered more than 10 million doses by May 9, 2021, of which 61% went to racial and ethnic minorities. Although the federal government assigned batches of the vaccine directly to FQHCs in addition to the doses provided for state distribution, the monies associated with this program did not provide enough revenue to recoup the previous revenue losses.
Rather than remaining static and depending on traditional pathways for revenue, FQHC pharmacies must work on finding new ways to increase revenue. One major opportunity is already available and ripe to be leveraged in the form of expanding telehealth options.
The advantages of virtual visits as a way to deliver all types of healthcare, including pharmaceutical care, become clearer by the day. Remote pharmacy consultations and automated prescription fulfillment will continue to present a prime way to meet new patient expectations for virtual care.
Another opportunity to maximize revenues has surfaced as the Department of Health and Human Services (HHS) continues to support rural and community pharmacies with the Provider Relief Fund. FQHCs must fully leverage HHS PRF reporting to maximize fund benefits for their pharmacies. These funds are in addition to the average 14% of FQHC revenues that come from Federal Section 330 grants, which also require rigorous reporting standards to be met.
In addition to focusing attention on reporting measures to enhance grant and relief fund access, FQHC pharmacies should improve outreach to patient populations that deliver better revenue streams, including sliding scale patients on the upper end of the scale and patients who prefer to pay out of pocket rather than use health insurance schemes. Finally, FQHCs can adopt revenue cycle management (RCM) systems to smooth the fluctuations in revenues and help maintain stability.
Ongoing challenges to 340B compounded other challenges for FQHC pharmacies during COVID, putting revenues at risk. 340B funding is critical for FQHCs to provide care, but recent challenges to the program from various quarters left many participating pharmacies concerned about their ability to remain viable.
While waiting for pending cases regarding 340B to play out in the courts, FQHCs have the opportunity to leverage the new provisions made for 340B drugs and telehealth scrips. 340B drugs can be used to fill telehealth scrips as long as the Health Resources and Services Administration’s patient definition test is met on all three applicable counts.
Lasting post-pandemic FQHC challenges and solutions
FQHC pharmacies must maintain access to patient care in the face of ongoing challenges by continuing to support the vaccination effort and testing as required, depending on the rise of variants and chronic illness associated with post-COVID infections. In addition, associated pharmacies must prepare for new compliance challenges as dictated by ongoing changes and challenges to 340B requirements and restrictions.
The right pharmacy technology partner can help FQHCs handle challenges from COVID-19 and other outside influences. TDS offers all the software and services FQHCs need to manage inventory, workflow, staffing, patient scheduling and compliance challenges, carrying the crucial mainstays of rural and at-risk populations into the future of community healthcare — contact us today.