The Unlearned Lessons of Failing Community Health Centers

The Unlearned Lessons of Failing Community Health Centers

As we address Community Health Centers’ central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured, we need to stay alert to these issues:

To recap:
Healthcare in America is not a looming crisis.
It is not a pending catastrophe.
American healthcare is in a state of crisis now.

Healthcare for the uninsured and underinsured is a dark waltz with disaster:

From 13 consecutive months of job loss,

To 20,000,000 people unemployed, underemployed, or working part-time,

To 54% of chronically ill giving-up necessary medical care due to lack of money, (http://www.commonwealthfund.org/index.htm

To a 1% increase in unemployment resulting in an increase of 1,000,000 people with no health insurance (Kaiser Family Foundation - http://www.kff.org/ and NewsHour – PBS -HealthBeat -http://www.pbs.org/newshour/indepth_coverage/health/uninsured/index.html

To State Medicaid denials rising - http://www.washingtonpost.com/wp-dyn/content/article/2009/02/11/AR2009021104311.html

To the U.S. economy has shedding more jobs that the total population of Chicago – Heidi Shierholz – Economic Policy Institute - http://www.epi.org/quick_takes/entry/3.5_million_jobs_lost/

If these men, women, and children do not have the money for adequate food, clothing, or shelter, how can we expect that they can afford basic, primary healthcare for pre-natal, early childhood, and chronic diseases?

This can be dealt with immediately through local Community Health Centers that are well-led, well-managed, and well-financed.

If Community Health Centers are vital to resolving the health crisis, what can Community Health Center Board members do to help their Center?

Our sense is that Boards can insist that their Executive Director immediately overcome the following four issues:

1. The lack of transparency.
2. The evolution of community health center financial statements into a dark art.
3. Financial statements as fairytales.
4. The failure of executive directors to believe, despite their mission, and demonstrate through measurable behaviors, that CHCs are established to serve all the medically underserved in its area.

1. The Lack of Transparency –

Examples:
§ An Executive Director who fails to take responsibility for errors.

§ An Executive Director who does not consistently deflect credit onto staff.

§ An Executive Director who understands all of the community health center’s monthly financials.

§ Failure to present monthly financials to the Governing Board – including cash flow statements – in advance of the monthly meeting.

§ Failure to receive accompanying explanations of those monthly financial statements.

§ Failure to receive copies of the annual outside audit with Management Letters – in advance of the monthly meeting.

§ Inability of Executive Director and Board members to understand exactly how their Center makes money (hint: it’s not through grants or loans).

Questions to ask
Are the Board the Senior Managers able to understand and monitor how their CHC makes and spends money?

Can they articulate that understanding?

Can the Board and Senior Managers articulate an understanding of Income and Liabilities in relation to Accounts Receivable (A/R) and A/R aging?

Next Post: The Unlearned Lessons of Failing Community Health Centers – Part 2: The Evolution of CHC Financial Statements into a Dark Art –