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Federally Qualified Health
Centers and Hospitals
Recipe for Building a Successful Relationship
Terri Hill, MSN RN
Union Hospital Clinton
• Currently, in Indiana there are 19 FQHC’s
• Newest is in Vermillion County, Indiana
• Main address is Clinton, IN, across the
drive from Union Hospital Clinton with a
satellite clinic 28 miles north in Cayuga, IN
How It All Began
• In 2005, UH Clinton had a healthy medical
staff of 10 family medicine physicians and
1 Internal Medicine physician along with 2
dedicated surgeons and a large variety of
Consulting and Courtesy medical staff.
• Physicians practices were large and
served patients in a two county, highly
rural area.
• UH Clinton had 5 of the 11 physicians
located across the driveway on campus or
across the street.
• Two more physicians were across the
street half time and half time in satellite
offices in the adjacent county.
• All physicians were active members of the
medical staff and all admitted patients to
• The next two years saw dramatic changes.
• One physician died unexpectedly in a
motorcycle crash while on vacation. He
had no partner to carry on his practice.
• One physician’s group pulled his practice
out of the local market to the main campus
in another city.
• This physician was eventually allowed to
return to the area, first on a part time basis
and then full time when his patients did not
follow him to the larger city.
• His practice numbers sustained heavy
losses through this period.
• He eventually left in 2008 to become a
hospitalist on full time basis.
• Attempts by the hospital to recruit were
• There was no magic in luring young
physicians to a rural area. As important,
there was no real draw to attract spouses
who would be satisfied with long drives for
shopping and entertainment.
• A third threat to the hospital came when 2
physicians voluntarily withdrew privileges
to align with another hospital outside our
market share area but within driving
distance for their patients on the eastern
borders of the neighboring county.
Call to Action!
• Successfully recruited one family
• Implemented a hospitalist program in
response to loss of market share to larger
hospitals who had programs.
• Began looking for partnerships that would
allow patients to remain near medical
home and in own community for services.
The FQHC-Friend or Foe?
• With the aid of the Lugar Center, the
sponsorship of a FQHC was debated.
• Our 2 county service area needed
additional physicians! Patients were
without medical homes.
• The hospital needed both the inpatient and
outpatient business that additional
providers would bring.
• Past experiences gave a basis for what
requirements were necessary for a
successful relationship.
• Focus was on cooperation rather than an
adversarial intent between a FQHC and
the hospital.
• Goal was to serve the residents of Parke
and Vermillion counties to improve health
and access to care.
• The Lugar Center submitted a grant for a
FQHC to be located in Clinton, In.
• Union Hospital Terre Haute and Union
Hospital Clinton agreed to assist in
sponsoring until the Center could go
independently forward.
• The communities from both counties
rallied in support of the birth of the clinic.
Benefits for the Hospital
• Assisted in recruitment of additional
physicians. (2 more coming this Fall).
FQHC offers:
• loan forgiveness for physicians
• no medical malpractice premiums
• clinical site for medical students and
residents to study in a rural tract.
• FQHC (continued)
Social services to assist patients in
enrolling in applicable benefits.
Behavioral health services onsite
Low cost medications which helps
keep patients compliant with
• Telemedicine consults with specialists.
• Hospital gained:
strong partnership for patient care
physicians who joined medical staff
physicians who were on call for hospital
including ER call
physicians who serve on med staff
committees in the hospital
• Hospital gained:
Transfer of employed physicians to
FQHC to reduce revenue loss
leaders. Cayuga practice became
satellite of Clinton FQHC.
Inpatient and outpatient business
Commitment to quality and patient
Advantages for Both:
Cooperative relationship.
Agreement to not compete for services.
Payment in Kind:
Remodeling for rent
Local board of directors committed to
success of hospital AND FQHC
• Support of independent physicians
Advantages continued:
• Stable group of physicians and extenders
to ensure care is available locally
• Ability to recruit quality, dedicated
dedicated physicians to medially
underserved populations and areas
• Strong partner to educate community
on health topics like stroke, heart
attack, women’s health
• The reality of geography:
Mason/Dixon line (HWY 36) in
Vermillion county
Elizabeth and Terri!!
The Wabash River between
Vermillion and Parke counties
Strong board and strong partnerships to break barriers
• Consideration of needs of both facilities:
After hour clinic to meet needs of
patients without adding financial
burden of unnecessary use of ER
Appropriate use of available health
Partnership of both with insurers and