Toward a new framework for FQHCs: Promoting and facilitating a culture of compliance through public health

Issue: FQHCs face ever increasing scrutiny and accountability as regulatory agencies combat fraud and push for improved health outcomes. In FQHCs where resources are scarce, there is a need to make unique compliance challenges manageable by systematically integrating processes to improve quality and accountability. Adopting a Public Health framework can facilitate this process. Description: The Health Resources and Services Administration (HRSA) conducts routine site visits to assess an FQHC’s compliance with key program requirements (need, service, management and finance, and governance), helping to identify areas for performance improvement. The goal of this project was to create an organized system that consolidated necessary documentation and resources for the HRSA site visit at HealthPOiNT Community Health Center in Bryan, TX. This system, guided by the core functions and essential services of Public Health, established a coordinated process, which informed appropriate monitoring and oversight to ensure meaningful outcomes for the site visit. Lessons Learned: Conceptualizing compliance through a public health perspective proved valuable. The three core functions and ten essential services provided a structured framework in assessing compliance with key program requirements and presented additional opportunities for risk assessment and performance improvement. Recommendations: Implementing and sustaining an effective compliance program is critical to ensuring optimal performance and operational efficiency. Compliance programs must be sensitive to four key factors: the size of the health center, complexity of operations, budgetary and staffing constraints, and prior compliance history. There are untapped opportunities, such as this one to apply the Public Health framework in understanding compliance standards.