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Chapter 7
Site Establishment
This section explores some of the more technical aspects of
situating a community health center and offers information in the
areas of:
- Practical considerations
- The Capital Link Connection
Location and Space
To determine the site and size of a health center accessibility
and projected volume must be the top issues to consider. Because the
foremost goal is to bring primary care to those who are not
receiving it, access is central to the location of a health center
site. Be sure to take stock of all options available and choose the
one that is most convenient to a majority of the target population.
Use the information gathered during needs and market assessments to
pinpoint a prime location and remember that situating centers near
other well-traveled areas (such as near major employers or shopping
centers) is often a good idea. In some cases, new access points can
be located at the spot where a health center may have existed
formerly which can be an opportune venture. Just be sure that the
location is still appropriate for the surrounding community and
investigate possible obstacles that may have led to the shut down of
the original health center.
Once a general area for the FQHC site has been selected, the
actual size of the location should be based on the expected needs of
the community and services to be provided by the CHC. Volume
projections and management/board decisions on care services must
guide this process and it is helpful to remember these common
suggestions:
- calculate space for not only examination and treatment rooms,
but also for administration, patient waiting, reception, and
record-keeping
- provide 2-3 exams rooms per care provider to facilitate
patient flow
- include a meeting room for board, staff, and community group
meetings
- if feasible, provide some space for additional expansion of
services to accommodate increasing patient populations
New-Start vs. Expansion
When initiating a new access point, there are essentially two
major ways of proceeding. Candidates can either apply as a new start
health center and begin from scratch, or collaborate and branch off
an existing CHC as an expansion site. Some benefits and challenges
of each include:
- New Start Benefits
- High level of autonomy in decision-making
- Community input and local planning takes precedence
- Location and services can be guided solely by needs/desires
of the health center
- New Start Drawbacks
- May take time to attract patients to new center
- Logistical aspects may be more difficult for starts
- Administrative responsibilities significant to handle alone
- Expansion Benefits
- could save time and effort by utilizing
- existing infrastructure and service models existing
familiarity and legitimacy in community
- BPHC gives funding preference to expansion application
- Expansion Drawbacks
- decision-making autonomy may be decreased
- coordination/collaboration with larger center may be
challenging
Regardless of the individual advantages/disadvantages listed
here, the most important thing to consider when deciding on a mode
of application is the best interest of the community. Choose the
model of application that will best serve the target population and
secure the most access to primary care services.
Non-Profit Organizational
Model
The option of incorporating into a non-profit is often the best
choice for those starting a new health center and is a natural
option for those branching off of established FQHCs. Incorporating
as a non-profit varies from state to state but the main feature is
obtaining tax-exempt status under the US Internal Revenue Code. The
two applicable non-profit status types are:
- 501(c)(3): do not pay income tax on net revenue and donations
are tax-deductible for the donor. Some restrictions on lobbying
activities exist. This is the preferred designation of the BPHC
and variations require explanation.
- 501(c)(4): Donations are not tax-deductible for the donor but
there are not restrictions on lobbying
Health Care Accreditation
Obtaining health care accreditation is a way by which heath
centers can increase their presence as leading institutions of
primary care in their communities. Accreditation services
essentially monitor the performance of health centers according to a
high level of quality standards in an effort to support the
continuous improvement of health care services. Being an accredited
institution demonstrates a commitment to top-rated health care
standards, offers an added degree of legitimacy to the community
health center, and can help to increase the CHCs edge in its market.
The main accrediting organizations for community health centers are:
- JCAHO (“Jayco”) – Joint Commission on Accreditation of Health
- AAAHC - Accreditation Association for Ambulatory Health Care
The Capital Link Connection
Capital Link is a non-profit organization that offers assistance
to health centers in accessing principal for investment in building
and equipment projects. Because Capital Link is partially funded by
the Bureau of Primary Health Care, many of its services can be
utilized free of cost by 330-funded health centers. Their assistance
spans such areas as:
- space design and planning
- business plan and proposal development
- technical help with financial and market analysis
- debt financing
- fundraising
For more on Capital Link, see your local PCA, the Capital Link
Website and their Online Brochure
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