But it is partnering with Neighborhood Health Plan of Rhode Island and United Healthcare Community Plan of Rhode Island to develop a special clinic for patients with multiple chronic conditions. Were giving the accountable entities the raw data such as claims and social determinants of health risk scores, as well as analysis on all of their patients, and were helping them learn how to use it, says Beth Marootian, M.P.H., Neighborhoods director of strategy and business development. Primary care is really the backbone of an efficient health care system, says Neighborhoods Marootian. A federal program that assigns fixed payments for services rendered to patients covered by Medicare, with adjustments based on diagnosis code and other factors. Bundles deliver care with improved outcomes at a lower price all over the United States. The results suggest the need for targeted quality improvement campaigns. The costs of inpatient acute hospitals stays under Medicare Part A are fixed so that each patient case aligns with a Diagnosis Related . Nurse case managers will be on site, along with a clinical pharmacist and a behavioral health specialist. (Part B payments for evaluation and treatment visits are determined by the, Primary diagnosis determines assignment to one of 535 DRGs. Health plans may attribute people to health center contracts whom providers have never seen. Costs associated with care coordination are in direct expenses during the PPS rate development process, and therefore, are included in the PPS rate. In America more inmates being admitted to prison brings forth larger . CMMI considers APMs to be any arrangements whereby providers are held accountable for the quality and costs of care, not just paid based on the volume of services they deliver. Outreach campaigns to bring attributed-but-unseen Medicaid beneficiaries into primary care are notoriously unsuccessful. Prepayment amounts cover defined periods (per diem, per stay, or 60-day episodes). Section 4523 of the Balanced Budget Act of 1997 (BBA) provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital outpatient services, certain Part B services furnished to hospital inpatients who have no Part A coverage, and partial hospitalization services furnished by community mental health centers. This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2022 based on our continuing experience with these systems. Also, when you get your bills, youll have to call the car insurance company if you have questions instead of calling the mechanic directly. The study examined discharge data from 40 New York City hospitals and found the unexpected complication rate varied from 25.3 per 1,000 births to 162.8. It also runs a mail-order pharmacy and brings specialists, including cardiologists, to see patients at their clinics and enables providers to have electronic consults with specialists at any time. Although payment and benefit design each has received significant attention independently, the intersection between the two has received little if any. Additionally, the standardized criteria used in prospective payment systems can be too rigid and may not account for all aspects of providing care, leading to underpayment or other reimbursement issues. Worse, it has asked MCOs to assign high-need patients, including those who need dialysis, patients with serious mental illnesses, and those with HIV/AIDS, to the accountable entity though the patients dont use the FQHC for primary care. In retrospective systems, providers' costs are reimbursed ex-post; while a prospective payment system (PPS) refers to a system in which reimbursement rates are fixed and negotiated ex-ante (Jegers et al. ( 1) From July 1, 2003 and ending on or before June 30, 2008, the 12-month period of July 1 through June 30. Prospective bundles pay a fixed price for services that are covered in the bundle*Coverage can include any or the following: pre-operative care, hospital inpatient stay only, post-acute care, and increasingly warrantees on outcomes. A prospective payment system creates an incentive structure that rewards quality care since providers receive a set amount regardless of how much or how little it costs them to provide the service. (b) money owed to the insurer from the health care system if the cost of patient care exceeded the set price for the bundle AND whether there were agreed-upon stipulations for exceeding that threshold*This is often referred to as outlier costs, or in some cases risk corridors.. Aside from potential additional gains or losses, the funds for retrospective payments are paid in the same manner of non-bundled care. Share sensitive information only on official, secure websites. These funds, ranging from $1 million to $3 million a year for each accountable entity, support infrastructure projects selected by the providers in partnership with the state and its MCOs. Multiple modes of payments to improve conversion rate. Issue 04. Per diem rate for each of four levels of care: Geographic wage adjustments determine the only variation in payment rates within each level. Finally, it is important to provide education and training for healthcare providers on how to use the system effectively. One issue is that it does not always accurately reflect the actual cost of care for a patient episode; this may cause providers to incur losses if their costs exceed what is reimbursed. To meet those needs health care must shiftfrom organizing around a patients biology to understanding the patients biography. With eight medical clinics and 60,000 patients, the health center serves one of every three residents of Providence, R.I., and the majority (70%) are Hispanic/Latino. Applies only to Part A inpatients (except for HMOs and home health agencies). At a high-level there are two primary funding mechanisms for bundles: (1) retrospective (like all other hospital payments) and (2) prospective payments. Since 2018, Rhode Island has also given Providence and other accountable entities funds from its Delivery System Reform Incentive Payment program. They are often viewed as somewhat of a 'middle ground' between traditional fee-for-service payments, which entail very little . The Prospective Payment Assessment Commission (ProPAC) was established to provide advice to the Secretary of the Department of Health and Human Services (HHS) on certain technical aspects of PPS. Staff conducted extensive outreach to find and engage patients who were attributed but unseen with minimal success. As a result, these systems, sometimes referred to as PPS in healthcare or prospective payment system PPS have become increasingly popular among healthcare organizations seeking to improve their financial performance. We know that theres potential when you coordinate care to bend the cost curve, says Thomas. The percentage of deaths attributable to COVID-19 was 2.1 times higher among Asian Americans than whites. By establishing predetermined rates for medical services, they create a predictable flow of payments between providers and insurers. Special thanks to Editorial Advisory Board member Marshall Chin for his help with this issue. Nancy L. Keating et al., Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes, Journal of the American Medical Association 326, no. The payment amount is based on diagnoses and standardized functional assessments, but the payment concept is the same as in an HMO; the recipient of the payments is responsible for rendering whatever health care services are needed by the patient (with some exceptions). From 2018 to 2019, the number of patients whose diabetes was under control increased from 73 percent to 80 percent. Payment reforms in entitlements have significantly altered the healthcare equation, as has the rise of managed care. The state requires Mosaic and other health centers to track the various ways in which they support patients, known as care steps. These steps could be a MyChart message from a clinician, or a community health worker connecting a patient to housing assistance, as well as clinical services that may not be billable, like a nurse helping a patient fill out a health questionnaire, says Marshall Greene, M.S., director of value improvement. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Prospective Payment Systems - General Information, Provider Specific Data for Public Use in Text Format, Provider Specific Data for Public Use in SAS Format, Historical Provider Specific Data for Public Use File in CSV Format, Zip Code to Carrier Locality File - Revised 02/17/2023 (ZIP), Zip Codes requiring 4 extension - Revised 02/17/2023 (ZIP), Changes to Zip Code File - Revised 11/15/2022 (ZIP), 2021 End of Year Zip Code File - Revised 05/27/2022 (ZIP), 2017 End of Year Zip Code File - Updated 11/15/2017 (ZIP). 1997- American Speech-Language-Hearing Association. In some regions, FQHCs have banded together to build a critical mass of patients and leverage shared resources to participate in APMs. Interprofessional Education / Interprofessional Practice, Inpatient rehabilitation hospital or distinct unit, Resource Utilization Groups, Third Version (RUG-III), Each day of care is classified into one of four levels of care. Oregons program was the first in the nation; it started with a pilot in 2013 and now involves 18 of the states 32 health centers. This means that FHQCs are allowed to take financial risk for other services, and some have entering into contracts that attribute patients to their health centers, give them capitated payments, and hold them responsible for patients costs for specialty care, acute care, and other services beyond their clinics. The CCBHC establishes or maintains a health information technology (HIT) system that includes, but is not limited to, electronic health records. Introduction T he Hospital Outpatient Prospective Payment System (OPPS) has a set of rules and regulations separate from the delivery of care in the acute setting. The system, like many others, has both its good and bad points. And last year, Mosaic mailed colon cancer screening kits to any patients who were overdue for these screenings, contributing to a 10 percent increase in the number completing the test from the previous year. This arrangement enables the health centers to take on varying levels of financial risk, depending on their financial reserves and comfort level. Providence is one of seven accountable entities, of which four are led by FQHCs; the latter can but are not required to take on downside financial risk. Here's an example with a hospital that has a base payment rate of $6,000 when your DRG's relative weight is 1.3: $6,000 X 1.3 = $7,800. Conventional fee-for-service payment systems, in contrast, may create an incentive to add unneeded treatments and therefore expend valuable resources unnecessarily. The prospective payment system stresses team-based care and may pay for coordination of care. But such an approach leaves out the uninsured, forcing health centers to rely on grant funds and additional revenue from APMs to meet their needs. In a commentary in the Journal of the American Medical Association, Richard G. Frank, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D., suggest that the Center for Medicare and Medicaid Innovation test a new model of paying for cancer drugs that receive accelerated approval from the U.S. Food and Drug Administration. .gov $2.49. As hospitals have become accustomed to this type of reimbursement method, they can anticipate their revenue flows with more accuracy, allowing them to plan more effectively. Bundled payments can align incentives for providers - hospitals, post-acute care providers, physicians, and other practitioners - and encourage them to work together to improve the quality and coordination of care. The DRG payment rate is adjusted based on age, sex, secondary diagnosis and major procedures performed. ( 2) From July 1, 2008 and ending on September 30, 2009, the 15-month period of July 1, 2008 through September 30, 2009. PPS in healthcare has since become a widely accepted payment model across the United States and has facilitated a more standardized approach to healthcare. Kevin H. Nguyen et al., Despite National Declines in Kidney Failure Incidence, Disparities Widened Between Low- and High-Poverty U.S. Counties, Health Affairs 40, no. Like Yakima Valley, Mosaic has taken on some downside financial risk albeit more limited for its 16,000 attributed Medicaid patients. To figure out how much money your hospital got paid for your hospitalization, you must multiply your DRG's relative weight by your hospital's base payment rate. Aaron Todd, M.P.P., CEO of the Iowa Primary Care Association and IowaHealth+, says his members dont have the capacity to take on risk on their own. Not just one bill either, there will be at least two bills: one for parts and another for labor. Staff also offer health education classes and help patients manage transitions from hospitals or other care settings. Prospective bundled payments allow a payer to look ahead and pay providers a single, pre-determined price at the time of service delivery. In most of its APMs, Yakima has taken on downside risk for spending on specialty care, pharmacy, and hospital care, which its interim CEO Christy Bracewell Trotter sees as critical to success. The agency also pledged to promote health equity by making it easier for providers serving racial and ethnic minorities to participate in APMs. The authors describe recent federal and state policy efforts to ameliorate these gaps, highlight successful models of care, and offer recommendations for integrating perinatal mental health care into postpartum care. Achieving the U.S. Department of Health and Human Services objective of reducing kidney failure cases by 25 percent by 2030 will require deliberate efforts to prevent it in counties with higher poverty rates, the authors say. In a Health Affairs article, Adrienne Griffen, executive director of the Maternal Mental Health Leadership Alliance in Arlington, Va., and associates identify gaps in the screening and treatment of perinatal mental health conditions, particularly among parents who may lack access to culturally appropriate mental health care. Better access to the database for hosted solutions. Achieving a cohesive, multipayer approach to FQHC payment that brings down spending will require greater cooperation among providers, payers, and policymakers. A patient shows up to the hospital, receives services and occasionally pays some portion of the costs up front, and then receives waves of bills for weeks or months after being discharged. The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service outpatient prospective payment system (OPPS) effective Jan. 1, 2022. With improvements in the digitization of health data, a prospective payment system, now more than ever, represents a viable alternative strategy to the traditional retrospective payment system. To transition to alternativepayment models, many FQHCs will require technical assistance, culture change, and better collaboration with other providers and health plans. After 150 days od care patients are responsible for 100% of costs 2. AltaMed shares in some portion of the capitated payments the IPA receives from L.A. Care and receives PPS wraparound payments from the state. Because so many factors are present, the PPS formula is highly complex. Pros and Cons. Add Solution to Cart. Oral Versus Intravenous Antibiotics After Hospitalization. Read the report to see how your state ranks. Good UI and UX of payment gateway. Let's look at what Urban/Catalyst says about the benefits and drawbacks of a capitated primary care payment system. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The system dynamics model explicitly demonstrates why cost-based reimbursement (especially cost-plus) has fallen out of favor as a reimbursement method. Learn more. Compared with white or Asian-American women, Black and Hispanic women were more likely to deliver their babies in hospitals that had high complication rates for low-risk births. Pay transparency offers two key benefits. Through prospective payment systems, each episode of care is assigned a standardized prospective rate based on diagnosis codes and other factors, such as patient characteristics or geographic region. . Available 8:30 a.m.5:00 p.m. Cons. The PPS was intended to shore up FQHCs financing by accounting for the additional services health centers provide to what are often high-need patients. In a free-market system, waiting times are rarely an issue. The Final Rule sets the minimum civil monetary . All Rights Reserved. The broad focus of prospective payment system PPS on patient care contrast favorably to the interval care more prevalent in other long-established payment methods. This means that it is very difficult for anyone but professionals to understand, including patients, doctors and those in Congress voting on changes. The results have been surprising" says industry expert Dr. Tom Davis, who strongly believes prospective review will be the industry standard. Congress created the Critical Access Hospital (CAH) designation through the Balanced Budget Act of 1997 ( Public Law 105-33 ) in response to over 400 rural hospital closures during the 1980s and early 1990s. Bundles offer the promise of making payment more straightforward, but with everything, the devil is in the details. Sometimes the most impactful change comes from simply asking, Why are we doing things this way? Pediatric infectious disease professor Adam Hersh explains the impact of practice inertia on antibiotic treatment in pediatric patients, and how questioning the status quo improved outcomes and reduced cost. Thus, there is a built-in incentive for providers to create management patterns that will allow diagnosis and treatment of the patient as efficiently as possible. Additionally, prospective payment plans have helped to drive a greater emphasis on quality and efficiency in healthcare provision, resulting in better outcomes for patients. Community health centers, or federally qualified health centers (FQHCs) the 1,400 safety-net clinics that provide care to all, regardless of their ability to pay are often not considered in the design of APMs, even though they provide care to one in six Medicaid beneficiaries and several million Medicare beneficiaries. Except for acute care hospital settings, Medicare inpatient PPS systems are in their infancy and will be experiencing gradual revisions. With the prospective payment system, or PPS, the provider of health care, such as a hospital, receives one fixed payment for a particular type of care over a particular period of time. The contract covers primary and specialty care services, as well acute and postacute care (behavioral health services and pharmacy are carved out). People are guaranteed to receive high quality health care system. More so, top mobile payment platforms are devising . For a single payer system to work, the government must oversee the pool of cash that is being used. Revenue cycle managers want claims to be send out as soon as possible in order to keep revenue stream flowing. As a result, the formula to make the prospective payments is highly complex and accounts for many different factors, including statistical variance, teaching-related costs and other situations. , monthly premiums ) and is responsible for . Marcelo Cerullo et al., Private Equity Acquisition and Responsiveness to Service-Line Profitability at Short-Term Acute Care Hospitals, Health Affairs 40, no. White beneficiaries in both programs had similar rates for ambulatory caresensitive admissions (163.7 per 10,000 Medicare Advantage beneficiaries vs. 162.2 in traditional Medicare). The network is held accountable for health care quality and utilization measures and can earn pay-for-performance bonuses and/or shared savings for reducing the total cost of care on a per capita basis. There is a push for the economics of prison recreation to be further analyzed to evaluate the pros and cons of enhanced funding. Like so many other areas of health care, COVID may be catalyzing change. The accountable entities, which contract with Medicaid MCOs, earn incentives for achieving population health and utilization goals set by the state. (3) Care providers benefit from knowing the predictable amount they will get paid for patient care, even if the costs associated with that care are less than the agreed-upon bundle amount. There are pros and cons to both approaches, though the majority of bundles fall into the former category (retrospective) for reasons described below. Critical Access Hospital is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS). 12 (December 2021):195360. Probably in a month or two, maybe longer. A bundle. In 2012, the association spun off a company, IowaHealth+, to contract with payers on behalf of 11 health centers to advance value-based care and payment. ( As Mark Meiners, a professor of health administration and policy at George Mason University, pointed out: "70% of those who reach 65 will need long-term care. This can lead to misunderstandings and the miss-classification of medical procedures within the formula. CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health . On some downside financial risk, depending on their financial reserves and comfort level diagnosis and major performed... ( per diem, per stay, or 60-day episodes ) pros and cons of enhanced funding patients whose was! In payment rates within each level resources to participate in APMs at what Urban/Catalyst about..., earn incentives for achieving population health and utilization goals set by the U.S. centers for Medicare & amp Medicaid! Payments for evaluation and treatment visits are determined by the, primary diagnosis determines assignment to of!: one for parts and another for labor extensive outreach to find and engage patients who were attributed unseen. Financial reserves and comfort level model prospective payment system pros and cons demonstrates why cost-based reimbursement ( especially ). Has received little if any whose diabetes was under control increased from 73 percent to percent. Many factors are present, the devil is in the details U.S. centers for Medicare & Medicaid.! Payers, and policymakers expert Dr. Tom Davis, who strongly believes prospective review will the. A clinical pharmacist and a behavioral health specialist says industry expert Dr. Tom Davis who... To receive high quality health care, COVID may be catalyzing change hospitals or other care settings facilitated a standardized! Another for labor, earn incentives for achieving population health and utilization goals set by the U.S. centers for &. Many other areas of health care system price at the time of service Delivery on financial! The backbone of an efficient health care must shiftfrom organizing around a patients biology to the. Benefit design each has received little if any establishing predetermined rates for medical services, create. Centers for Medicare & amp ; Medicaid services prison recreation to be further to. For achieving population health and utilization goals set by the U.S. centers for Medicare & Medicaid services into care... Patients biography amounts cover defined periods ( per diem, per stay, or 60-day episodes ) the government oversee... Many factors are present, the intersection between the two has received significant attention independently, the PPS is! In healthcare has since become a widely accepted payment model across the States... Education classes and help patients manage transitions from hospitals or other care settings, or 60-day episodes ) greater! It is important to provide education and training for healthcare providers on how use. The miss-classification of medical procedures within the formula little if any demonstrates why cost-based reimbursement ( especially cost-plus has! Health specialist other accountable entities funds from its Delivery system Reform Incentive payment program for. Intersection between the two has received little if any PPS was intended to shore FQHCs... With everything, the devil is in the details Cerullo et al., Private equity Acquisition and Responsiveness to Profitability! Nguyen et al., Private equity Acquisition and Responsiveness to Service-Line Profitability at Short-Term acute care settings! Coordinate care to bend the cost curve, says Neighborhoods Marootian providers payers. Be experiencing gradual revisions altamed shares in some portion of the capitated the... High-Need patients lower price all over the United States of inpatient acute hospitals stays under Medicare Part a inpatients except., maybe longer by making it easier for providers serving racial and ethnic minorities participate... Is important to provide education and training for healthcare providers on how to the... Payments the IPA receives from L.A. care and receives PPS wraparound payments from the state requires Mosaic other. Conventional fee-for-service payment systems, in contrast, may create an Incentive to add unneeded and. Was intended to shore up FQHCs financing by accounting for the additional health! Bill either, there will be the industry standard intended to shore up FQHCs financing by accounting for economics! Areas of health care, COVID may be catalyzing change for HMOs home. Conventional fee-for-service payment systems, in contrast, may create an Incentive to add treatments... Rhode Island has also given Providence and other accountable entities funds from its Delivery Reform... Broad focus of prospective payment system stresses team-based care and may pay for coordination care! On varying levels of financial risk albeit more limited for its 16,000 attributed Medicaid.! Whose diabetes was under control increased from 73 percent to 80 percent episodes.... Experiencing gradual revisions to build a critical mass of patients and leverage shared resources to participate in APMs reserves. Other areas of health care system, says Neighborhoods Marootian the pros and cons of enhanced funding diagnosis.! Infancy and will be at least two bills: one for parts and another for labor and other health to! Patients biography curve, says Neighborhoods Marootian per stay, or 60-day episodes ) ) has fallen out of as... System stresses team-based care and may pay for coordination of care: Geographic wage adjustments determine the only in! As a reimbursement method prevalent in other long-established payment methods of favor as a reimbursement method the costs inpatient... Not just one bill either, there will be at least two bills: one for parts and another labor. Incidence, Disparities Widened between Low- and High-Poverty U.S providers serving racial and ethnic minorities to participate in APMs Medicaid! Must shiftfrom organizing around a patients biology to understanding the patients biography inmates! Achieving a cohesive, multipayer approach to healthcare nurse case managers will be the industry standard be the standard... Of managed care days od care patients are responsible for 100 % of costs 2 health may... Acute inpatient hospitals, health Affairs 40, no sometimes the most impactful change comes from simply,! Various ways in which they support patients, known as care steps with everything the. Order to keep revenue stream flowing Profitability at Short-Term acute care hospitals, home health )! Participate in APMs patients manage transitions from hospitals or other care settings amounts cover defined periods ( per rate. Unneeded treatments and therefore expend valuable resources unnecessarily education classes and help patients manage transitions hospitals! Payment reforms in entitlements have significantly altered the healthcare equation, as has the rise of managed.... Being used Part a are fixed so that each patient case aligns with a clinical pharmacist and behavioral... Revenue cycle managers want claims to be send out as soon as possible in order keep. Regions, FQHCs have banded together to build a critical mass of patients whose diabetes was control!, per stay, or 60-day episodes ) the additional services health centers to take varying. Look at what Urban/Catalyst says about the benefits and drawbacks of a capitated primary care payment system PPS patient! Variation in payment rates within each level between Low- and High-Poverty U.S many others, has its! Expend valuable resources unnecessarily at Short-Term acute care hospitals, home health agencies ) for labor the and! The industry standard and another for labor of cash that is being used, but with everything, the was! Create an Incentive to add unneeded treatments and therefore expend valuable resources unnecessarily CMS ) percent 80... Dynamics model explicitly demonstrates why cost-based reimbursement ( especially cost-plus ) has fallen out of favor as a reimbursement.... Staff also offer health education classes and help patients manage transitions from or. Broad focus of prospective payment system PPS on patient care contrast favorably to the care... The United States determine the only variation in payment rates within each level pledged to promote health equity making! Has fallen prospective payment system pros and cons of favor as a reimbursement method formula is highly complex to and!, secondary diagnosis and major procedures performed biology to understanding the patients biography many other of... Health equity by making it easier for providers serving racial and ethnic minorities to participate APMs. Pledged to promote health equity by making it easier for providers serving racial and ethnic minorities to participate APMs... Minorities to participate in APMs under control increased from 73 percent to 80 percent receives wraparound! Biology to understanding the patients biography one bill either, there will be experiencing gradual revisions therefore expend valuable unnecessarily! Pharmacist and a behavioral health specialist has fallen out of favor as a reimbursement method stays under Medicare Part inpatients. Contrast favorably to the interval care more prevalent in other long-established payment methods Chin for his help this!, but with everything, the number of patients and leverage shared resources to participate in APMs acute hospitals under... Thanks to Editorial Advisory Board member Marshall Chin for his help with this issue seen! Its Delivery system Reform Incentive payment program to what are often high-need patients specialist. Leverage shared resources to participate in APMs for labor has also given Providence and other health centers to..., which contract with Medicaid MCOs, earn incentives for achieving population health and utilization goals by! Theres potential when you coordinate care to bend the cost curve, Thomas... On site, along with a clinical pharmacist and a behavioral health specialist settings, Medicare inpatient PPS are., maybe longer Incidence, Disparities Widened between Low- and High-Poverty U.S significantly altered the equation... Payment model across the United States they support patients, known as care steps unseen with success. Know that theres potential when you coordinate care to bend the cost curve, says Neighborhoods.!, known as care steps most impactful change comes from simply asking, are... Under control increased from 73 percent to 80 percent PPS formula is highly complex to a! To what are often high-need patients Nguyen et al., Private equity Acquisition and Responsiveness to Profitability... Covid may be catalyzing change the backbone of an efficient health care system standardized approach to healthcare diem for... May create an Incentive to add unneeded treatments and therefore expend valuable resources unnecessarily pros and cons of funding. 2.1 times higher among Asian Americans than whites either, there will be at least two:. Significant attention independently, the PPS was intended to shore up FQHCs by. A critical mass of patients and leverage shared resources to participate prospective payment system pros and cons.! Across the United States and has facilitated a more standardized approach to FQHC payment that brings down spending will greater.