Healthcare in a rural Kentucky county: Choosing the right provider format

Issues: A good fit between healthcare services provided and residents' needs promotes a healthy community. The economy of one rural Kentucky County (approximately 16,500 residents) located at the Appalachian foothills is based on an unemployment rate of 11.3 % as compared to 10.4 % in Kentucky, with a cost of living lower than the national average. The county has recently been re-designated as a Health Professional Shortage Area and a Medically Underserved Area. While there is an array of specialty healthcare services in the county, maternal/child health services and assistance programs for low income patients are very limited. There are no Federally Qualified Health Centers (FQHC) or Rural Health Clinics in the County. Description: The intent of this project was to conduct a detailed analysis of which nonprofit format (FQHC, Rural Health Clinic, or Provider Based Rural Health clinic) should replace the current profit clinics to maximize increased access to medical care to uninsured individuals of the county. Basic eligibility and financial analyses were conducted on each proposed format. Lessons Learned: Registration analysis illustrated that 23% of patients were Medicaid, 28% Medicare, and 16% self-pay. Revenue analysis suggested that the FQHC would provide the most financial benefit but the provider-based rural health clinic format matched the community's needs best. Recommendation: The project provided support needed to move forward with replacing current for-profit clinics with a Provider-Based Rural Health Clinic. Implementation should allow greater medical care access to uninsured residents.