330 Clinical Grant Requirements

Promising Practice Integration

None

Health centers, both Federally Qualified Health Centers, which receive Federal funding, and Federally Qualified Health Center Look-A-likes, which do not, must meet a strict set of requirements. Included in these requirements are a set of clinical expectations that guide both the types of services offered as well as the quality of those services. While the intent of these requirements is to assure quality service to health center patients, many clinics struggle to understand how to design and manage their site to meet the requirements.

The Migrant Clinicians Network is an excellent resource to new, potential and existing grantees wanting additional assistance or information about the clinical requirements of 330 funding. In this section of our website you will find information about developing a health care plan, the very latest information on clinical performance measures, as well as many other resources to help you better manage your clinic.

If you do not find what you need on this page, you may contact MCN’s Director of Performance Improvement, Candace Kugel, CRNP, CNM, MS [1] for further guidance.

Information about the Clinical Performance Measure 

If you are associated with a Migrant/Community Health Center (M/CHC) funded by the Health Resources and Services Administration (HRSA), you may be developing some familiarity with the performance measures introduced in 2008 by the Bureau of Primary Health Care (BPHC).  Grantees are now expected to report on a set of clinical and financial performance measures in an effort to collect data that will allow for the evaluation of individual and collective performance trends over time.  The required measures are listed below.

Clinical Measures

• Quality of Care Indicators
  • Trimester of entry into prenatal care
  • Childhood (2 year old) immunization rate
  • Pap tests for adult (21 – 64 year old) women
• Health Outcomes and Disparities
  • Infant birth weight (normal vs. low)
  • Hypertension (controlled vs. uncontrolled)
  • Diabetes (adequate control vs. inadequate control)
• Additional
  • Behavioral health measure of choice
  • Oral health measure of choice

Financial Measures

• Total cost per patient
• Medical cost per medical encounter
• Change in net assets to expense ratio
• Working capital to monthly expense ratio
• Long term debt to equity ratio

For additional information about the required measures contact:

National Health Service Corps, Nursing Education Loan Repayment Program, Nursing Scholarship Program, Faculty Loan Repayment Program information CallCenter@hrsa.gov [2]
1-800-221-9393 (TTY: 1-877-897-9910), 9 am to 5:30 pm ET, weekdays (except Federal holidays)

Migrant-Specific Performance Measures

BPHC encourages grantees that receive funding for special populations (migrant, homeless, public housing) to include supplemental measures in their health care plans that allow them to monitor the health status or outcomes of services for those populations. Likewise, many health centers that serve large migrant populations have expressed an interest in developing supplemental measures that effectively reflect the unique features of both the migrant population itself and the service delivery modalities used by Migrant Health Centers. The Migrant Clinicians Network (MCN) was asked by BPHC to coordinate a work group to respond to this need and has developed a set of migrant-specific performance measures. The conclusions of that work are presented here.

The process of developing migrant-specific measures included consideration of the following questions

• What’s already out there?
• What’s the evidence?
• What do our experts say?
• What is most relevant to migrant farmworkers and Migrant Health Centers?

Selected measures are as follows:

• Preferred Enabling Services Measure: Percent of migrant patients ≥ 18 years of age with blood pressure ≥ 140/90 who are successfully referred for care.

This measure would monitor the effectiveness of enabling services by documenting the identification of patients outside of the clinic setting with uncontrolled hypertension who are entered into care. “Successfully referred” = referred and clinic visit documented.

Calculation: Farmworker patients seen outside of the clinic setting with documented BP of ≥140/90 who are 1) referred for care and 2) are seen by a provider/Total farmworker patients seen outside of the clinic setting with documented BP of ≥140/90.

• Additional Enabling Services Measures:
  • Percent of migrant women who have documented screening for sexual violence during the measurement year
  • Percent of migrant patients ≥12 years who have documented tobacco use status during the measurement year
• Preferred Environmental and Occupational Health Measure: Percent of registered farmworker patients who receive pesticide prevention education.

This measure would document how many farmworker patients receive education regarding the prevention of pesticide exposure, such as the use of personal protective equipment (PPE), proper storage and handling of pesticides, etc.

Calculation: Farmworker patients with documented pesticide prevention education/Total registered farmworker patients.

• Additional Environmental and Occupational Health Measures:
  • Percent of registered farmworker patients screened for Environmental/Occupational Health (EOH) risk
  • Percent of registered farmworker patients who receive eye protection education
• Preferred Financial Measure: Average cost per patient for enabling services.

This cost measure would provide a basis to value each enabling service individually and/or in total, allowing each grantee to determine the baseline, trends, and goals for their program. Increases in service levels per patient may result in increased “average cost per patient”, while increases in the total number of patients served within the same staffing and cost structure will result in lower “average cost per patient” indicating improved efficiency.

Calculation: Total Cost for Enabling Services / Unduplicated Enabling Patient

(or - Average Hours per Patient  X Average Cost per Hour)

• Additional Financial Measures:
  • Average Cost per Hour for Enabling Services
  • Overhead Rate – Administration and Facilities
  • Average Hours per Patient for Enabling Services

Future steps
The migrant-specific performance measures discussed here are not meant to replace the BPHC required core measures, and will not be required for MHCs. They are intended only as suggested supplemental measures for MHCs.