california
Health Care Almanac
Financial Health of Community Clinics
September 2010
C A L I FOR N I A
H EALTH C ARE
F OU NDATION
California Community Clinics
Introduction
Community clinics are an integral part of California’s primary care and safety-net system, especially for uninsured,
<< r e t u r n to c o n t e n t s
contents
underinsured, and low-income people. Between 2005 and 2008, clinics grew in terms of revenue, patients, encounters,
Clinic Organizations, Sites, and Patients. . . . . . . . . . . . 3
and staff. At the same time, numbers of sites increased for Federally Qualified Health Centers (FQHCs), while the number
Community Clinic Sites, by Type. . . . . . . . . . . . . . . . . . . 4
of sites decreased for other types of community clinics.* This report captures key measures of clinics’ financial health from
Geographic Distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2005 to 2008.†
Uninsured Californians Served. . . . . . . . . . . . . . . . . . . . . 6
Key findings include:
Low-Income Californians Served
Patients Below 100 Percent of FPL. . . . . . . . . . . . . . . 7
Patients Below 200 Percent of FPL. . . . . . . . . . . . . . . 8
• The low-income and uninsured patients seen at California clinics are growing at a faster pace than similar
Visits, by Payer and Clinic Type. . . . . . . . . . . . . . . . . . . . . 9
populations in the state as a whole.
• Clinic operating revenue grew 22 percent, with almost two-thirds coming from patient services.
• Community clinics rely heavily on Medi-Cal and Medicare, which accounted for 89 percent of net patient service
revenue in 2008. Therefore state budget reductions have a significant impact on clinic financial stability.
• The California clinic system continues to vary widely in terms of financial strength. While one-fourth of the clinics
generate strong margins in any given year, at least one-fourth operate at a loss.
• Staffing levels are growing rapidly, particularly for support staff, highlighting increased provision of ancillary services
as well as the growing importance of clinics as employers and economic forces in their communities.
• Overall activity is increasing at the site level. Patients, visits, and staffing are all growing at a faster rate than
the number of clinic sites in the state.
• Financially strong clinics tend to be large in terms of revenue (over $15 million), serve a high number of
low-income patients, and have high reimbursement levels compared to financially weak clinics.
• Both strong and weak clinics have similar productivity and expense levels on a per-visit basis.
• The smallest clinics in terms of revenue are more likely to experience financial difficulty and have reimbursement
levels that are half that of the largest clinics.
*See Clinic Definitions on page 28 for a description of FQHCs and list of other types of community clinics included in this report.
†The full report by Capital Link, California Community Clinics: A Financial Profile, 2010, can be downloaded at www.caplink.org.
©2010 California HealthCare Foundation
Patient Income, by Clinic Type. . . . . . . . . . . . . . . . . . . . 10
Operating Revenue Mix and Growth. . . . . . . . . . . . . . 11
Net Patient Revenue, by Payer. . . . . . . . . . . . . . . . . . . . 12
Operating Revenue Mix, by Source. . . . . . . . . . . . . . . 13
Operating Margin, CA vs. U.S.. . . . . . . . . . . . . . . . . . . . . 14
Primary Care Providers and Other Personnel. . . . . . 15
Days Cash on Hand, CA vs. U.S. . . . . . . . . . . . . . . . . . . . 16
Debt Ratios, CA vs. U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Operating Revenue Mix, by Clinic Size. . . . . . . . . . . . 18
Revenue Per Patient Visit, by Clinic Size. . . . . . . . . . . 19
Net Patient Service Revenue Per Visit,
by Payer and Clinic Financial Strength. . . . . . . . . . .20
Income Level of Patients Served,
by Clinic Financial Strength. . . . . . . . . . . . . . . . . . . . . 21
Patient Age and Gender Distribution,
by Clinic Financial Strength. . . . . . . . . . . . . . . . . . . . . 22
Total Revenue Distribution,
by Clinic Financial Strength and Size. . . . . . . . . . . . 23
Salary Expenses as Percent of Total Operating
Revenue, by Clinic Financial Strength. . . . . . . . . . . 24
Operating Expense Per Patient Visit,
by Clinic Financial Strength. . . . . . . . . . . . . . . . . . . . . 25
Patient Visits Per Primary Care Provider,
by Clinic Financial Strength. . . . . . . . . . . . . . . . . . . . . 26
Clinic Type and Size, by Financial Strength. . . . . . . . 27
Clinic and Payer Definitions, Data Resources. . . . . . 28
2
California Community Clinics
Clinic Organizations, Sites, and Patients,
<< r e t u r n to c o n t e n t s
2005–2008
 Clinic Organizations
The number of patients
 Clinic Sites
Total Patients (in millions)
between 2005 and
2008, from 3.3 million
719
714
708
689
increased 9 percent
3.6
3.6
3.5
3.3
seen at California clinics
to 3.6 million. While the
number of clinic sites
grew 4 percent during
the period, the number
of clinic organizations
decreased by 11 percent.
257
240
2005
236
2006
230
2007
2008
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
3
California Community Clinics
Community Clinic Sites,
<< r e t u r n to c o n t e n t s
by Type, 2005–2008
 FQHC
The number of Federally
 FQHC Look-Alike
sites grew 28 percent
59
71
83
 Other
512
493
463
Qualified Health Center
453
422
538
between 2005 and 2008,
52
while FQHC look-alikes and
486
other types of community
clinics experienced a sharp
decline in sites.
380
226
2005
215
2006
202
2007
181
2008
Note: See Clinic Definitions on page 28 for a description of FQHCs and list of other types of community clinics included in this report.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
4
California Community Clinics
Geographic Distribution of Community Clinic Sites, 2008
<< r e t u r n to c o n t e n t s
Clinics are located
throughout the state, but
Number of Clinic Sites
 None
 21 to 100
 1 to 5
 More than 100
(Los Angeles County had 154)
 6 to 20
are more concentrated
around dense population
areas.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
5
California Community Clinics
Uninsured Californians Served by Clinics,
<< r e t u r n to c o n t e n t s
2005–2008
California’s uninsured
population grew less than
in millions
7
6
6.76
6.79
0.93
0.98
(14%)
5.83
5
(86%)
(14%)
5.81
(86%)
6.61
0.92
6.82
1.18
(14%)
(17%)
5.70
5.64
(86%)
 Community Clinic Patients
1 percent from 2005 to 2008,
 Uninsured Not Served
but the proportion served in
(self-pay/sliding fee/free care)
at Clinics
clinics increased 27 percent.
In 2008, clinics treated
(83%)
17 percent of uninsured
people, which means that
4
83 percent were not served
in a clinic.
3
2
1
0
2005
2006
2007
2008
Note: Segments may not add to totals due to rounding.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
6
California Community Clinics
Low-Income Californians Served by Clinics,
Patients Below 100 Percent of FPL, 2005–2008
The number of Californians
living below 100 percent
in millions
5.34
5.5
4.72
4.4
2.06
(44%)
4.43
2.20
(50%)
4.59
2.37
 Community Clinic Patients
of FPL grew 13 percent
 Low-Income Not Served
from 2005 to 2008, and,
(self-pay/sliding fee/free care)
at Clinics
(44%)
on average, almost half
of those individuals used
2.24
a clinic for primary care.
(49%)
During that period, the
3.3
2.2
<< r e t u r n to c o n t e n t s
number of low-income
2.98
(56%)
2.65
(56%)
2.23
2.35
2006
2007
(50%)
individuals treated in clinics
rose by nearly 15 percent.
(51%)
1.1
0.0
2005
2008
Notes: FPL stands for federal poverty level. Segments may not add to totals due to rounding.
Sources: Capital Link, California Community Clinics — A Financial Profile, 2010. U.S. Census Bureau, California Population Census, Current Population Survey’s Annual Social and Economic Supplement,
www.census.gov.
©2010 California HealthCare Foundation
7
California Community Clinics
Low-Income Californians Served by Clinics,
Patients Below 200 Percent of FPL, 2005–2008
Nearly one-fourth of
Californians living below
in millions
 Community Clinic Patients
200 percent of FPL were
 Low-Income Not Served
treated at clinics in 2008,
(self-pay/sliding fee/free care)
10.400001
<< r e t u r n to c o n t e n t s
11.69
11.64
11.84
2.78
2.89
2.95
(24%)
(25%)
12.42
3.03
at Clinics
(24%)
(25%)
while three-fourths were
not. Between 2005 and
2008, the total population
7.800000
8.92
(76%)
8.75
(75%)
8.89
9.39
(76%)
(75%)
of Californians under
200 percent of FPL grew
6 percent while the number
5.200000
of those treated by clinics
rose 9 percent.
2.600000
0.000000
2005
2006
2007
2008
Notes: FPL stands for federal poverty level. Segments may not add to totals due to rounding.
Sources: Capital Link, California Community Clinics — A Financial Profile, 2010. U.S. Census Bureau, California Population Census, Current Population Survey’s Annual Social and Economic Supplement,
www.census.gov.
©2010 California HealthCare Foundation
8
California Community Clinics
Clinic Visits,
<< r e t u r n to c o n t e n t s
by Payer and Clinic Type, 2008
FQHCs have the highest
proportion of Medicare and
p e r c e n ta g e o f V i s i t s
Medi-Cal fee-for-service
FQHC
FQHC
Look-alike
other
7%
6%
5%
Medi-Cal FFS
48%
47%
43%
Medi-Cal Managed Care
14%
14%
9%
see the highest proportion
Medi-Cal Breast Cancer and CHDP
3%
3%
2%
of Medi-Cal Family Pact
Medi-Cal Family Pact
5%
6%
20%
Private Insurance
5%
5%
5%
All Others
17%
19%
15%
Self-Pay / Sliding Fee / Free Care
12%
7%
19%
Medicare
visits. Clinics other than
FQHCs and FQHC look-alikes
and self-pay / sliding fee / free care visits.
Notes: See Clinic Definitions on page 28 for a description of FQHCs and list of other types of community clinics included in this report; as well as definitions for specific programs included
under Medi-Cal Episodic and All Others.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
9
California Community Clinics
Patient Income,
<< r e t u r n to c o n t e n t s
by Clinic Type, 2008
FQHCs had more low-
1.2
1.0
$2,687,289
$200,815
$756,580
11%
13%
14%
9%
8%
5%
0.8
0.6
17%
21%
23%
58%
55%
 Unknown
 Above 200% FPL
 100% to 200% FPL
 Below 100% FPL
income patients than
other types of clinics. In
2008, two-thirds of FQHC
patients had incomes under
100 percent of the FPL.
68%
0.4
0.2
0.0
FQHC
FQHC Look-Alike
Other
Notes: See Clinic Definitions on page 28 for a description of FQHCs and list of other types of community clinics included in this report. FPL stands for federal poverty level.
Segments may not add to 100 percent due to rounding.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
10
California Community Clinics
Clinic Operating Revenue Mix and Annual Growth,
2005–2008
From 2005 to 2008,
2.0in billions
$1.832
$1.717
$1.599
$1.505
1.5
0.102
0.420
1.0
0.950
— 0.033
<< r e t u r n to c o n t e n t s
0.106
 6%
— 0.040
0.423
 7%
— 0.054
0.115
0.483
 22%
— 0.064
0.125
0.500
 Other Operating Revenue
 Contributions/Fundraising
 Grants/Contract Revenue
 Net Patient Service Revenue
operating revenue grew
22 percent, to $1.8 billion,
while the mix of revenue
sources remained fairly
stable. Almost two-thirds
of revenue came from
1.030
1.065
1.143
patient services and
about one-fourth from
grants and contracts.
0.5
0.0
2005
2006
2007
2008
Note: Segments may not add to totals due to rounding.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
11
California Community Clinics
Net Patient Service Revenue,
<< r e t u r n to c o n t e n t s
by Payer, 2005 and 2008
The Medi-Cal portion of
2005
net patient service revenue
2008
TOTAL: $949.90 million
TOTAL: $1.14 billion
Self-Pay/Sliding Fee/Free Care
Self-Pay/Sliding Fee/Free Care
Private
Private
grew from 52 percent in
2005 to 58 percent in 2008.
Altogether, Medi-Cal and
Medi-Cal Episodic programs
6%
All Others
14%
5%
All
Others
10%
provided 70 percent of
patient revenues in 2008 — 6%
7%
Medicare
7%
Medi-Cal
52%
Medi-Cal
Episodic
14%
Medicare
9%
about $805 million.
Medi-Cal
58%
Medi-Cal
Episodic
12%
Notes: Medicare, Medi-Cal, and All Others include managed care. Self-Pay/Sliding Fee/Free Care includes uninsured patients. See Payer Definitions on page 28 for specific programs included
under Medi-Cal Episodic and All Others.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
12
California Community Clinics
Clinic Operating Revenue Mix,
<< r e t u r n to c o n t e n t s
by Source, 2008
In 2008, 62 percent of clinic
revenue
Percent of Total
$1,142,685,744
62.4%
$99,090,814
5.4%
$805,995,872
44.0%
Private Insurance
$60,830,466
3.3%
Self-Pay / Sliding Fee / Free Care
$69,403,194
3.8%
$107,365,398
5.9%
$500,420,348
27.3%
Federal Funds
$292,731,113
16.0%
State Programs
$70,011,252
3.8%
$137,677,983
7.5%
$125,358,667
6.8%
$63,682,699
3.5%
$1,832,147,458
100.0%
Net Patient Service Revenue
Medicare (FFS and Managed Care)
Medi-Cal (FFS, Managed Care, and Episodic)
All Others
Grants and Contract Revenue
County and Local Programs
Contributions / Fundraising
Other Operating Revenue
Total
revenue came from patient
services, and 44 percent
from Medi-Cal programs.
Grants and contracts
provided 27 percent
of revenue. Only about
7 percent came from
private insurance, self-pay,
or sliding fee payment.
(from 230 clinic organizations)
Note: See Payer Definitions on page 28 for specific programs included under Medi-Cal Episodic and All Others.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
13
California Community Clinics
Clinic Operating Margin,
<< r e t u r n to c o n t e n t s
California vs. United States, 2005–2008
The financial performance
of California community
10%
California 75th Percentile
clinics varies widely. About
one-fourth are able to
8%
(All national data shown as dotted lines.)
6%
generate strong margins in
any given year. However, the
bottom fourth operate at a
4%
California Median
2%
loss of about 2 percent or
more and have historically
performed worse than
0%
elsewhere in the nation.
–2%
California 25th Percentile
–4%
FY05
FY06
FY07
FY08
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
14
California Community Clinics
Clinic Primary Care Providers and Other Personnel,
2005 and 2008
 PCP* FTEs
<< r e t u r n to c o n t e n t s
Support personnel grew
 Support and Other FTEs
36 percent from 2005 to
 Total FTEs
2008, while primary care
17,376
providers only increased
by 13 percent. This trend
13,750
13,308
may indicate an increasing
level of supplementary
services provided to
10,087
meet the health needs
of target populations.
3,627
3,221
2005
2008
Note: OSHPD did not capture complete data on support and total full-time equivalents (FTEs) until 2005.
*PCP includes: physicians, physician assistants, family nurse practitioners, certified nurse midwives, visiting nurses, dentists, psychiatrists, clinical psychologists, licensed clinical social workers, and
other providers billable to Medi-Cal.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
15
California Community Clinics
Clinic Days Cash on Hand,
<< r e t u r n to c o n t e n t s
California vs. United States, 2005–2008
The median California
clinic had 52 days cash
120
California 75th Percentile
on hand in 2008, higher
than the national median
100
of 42 days. However, the
(All national data shown as dotted lines.)
80
bottom 25 percent had
less than 20 days, making
60
California Median
them vulnerable to any
interruption in revenue flow,
such as that caused by state
40
California 25th Percentile
budget shortfalls.
20
0
FY05
FY06
FY07
FY08
Note: Days cash on hand means the number of days of operating expenses (less depreciation) that can be met with available cash and liquid investments if no additional revenue were
received. For efficient operation, it is generally recommended that clinics have at least 30 to 45 days of cash on hand.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
16
California Community Clinics
Clinic Debt Ratios,
<< r e t u r n to c o n t e n t s
California vs. United States, 2005–2008
Most clinics operate with
very low leverage — carrying
1.2
California 75th Percentile
little debt relative to assets.
This suggests that clinics
1.0
(All national data shown as dotted lines.)
have not invested heavily
in buildings, technology,
0.8
and equipment or that
clinics have relied on grants
0.6
and cash reserves to fund
0.4
California Median
capital projects.
0.2
California 25th Percentile
0.0
FY05
FY06
FY07
FY08
Note: The leverage ratio measures a clinic’s total liabilities in relation to its net assets. It is generally recommended that the ratio not exceed 2.5 to 1.0.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
17
California Community Clinics
Operating Revenue Mix,
<< r e t u r n to c o n t e n t s
by Clinic Size, 2008
total revenue
100
The largest clinics in terms
of annual revenue earned
(in millions)
$80
6%
$150
5%
16%
14%
$606
4%
7%
36%
80
24%
$996
5%
22%
— 3%
 Other Operating Revenue
 Contributions/Fundraising
 Grants/Contract Revenue
 Net Patient Service Revenue
70 percent of their revenue
from patient services.
Medium-size and small
clinics earned only a little
29%
more than half their revenue
70%
60
on patient care, relying more
heavily than larger clinics
55%
40
52%
on grants/contracts and
53%
contributions/fundraising.
20
0
Smallest
(< $2 million)
Small
($2–4.9 million)
Medium
($5–15 million)
Large
(> $15 million)
Note: Segments may not add to 100 percent due to rounding.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
18
California Community Clinics
Revenue Per Patient Visit,
<< r e t u r n to c o n t e n t s
by Clinic Size, 2005–2008
Large
(> $15 million)
Median revenue per patient
Medium
($5–15 million)
Small
($2–4.9 million)
visit for the large clinics was
Smallest
(< $2 million)
more than double that of
the smallest in 2008. The
$120
$100
$80
$60
$94
$91
$82
$106
revenue per encounter
$95
dropped $9 from 2005 to
2008 for the smallest clinics,
$78
while it rose $12 for the
largest ones.
$59
$50
$40
$20
$0
FY05
FY06
FY07
FY08
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
19
California Community Clinics
Median Net Patient Service Revenue Per Visit,
<< r e t u r n to c o n t e n t s
by Payer and Clinic Financial Strength, 2005–2008 Average
Medi-Cal
The clinics ranked as
$120
Medi-Cal
Managed Care
$101
financially strongest had
$143
higher reimbursement per
patient visit for all payers.
$117
$93
$85
Medicare
Medicare
Managed Care
$92
$42
$83
$77
Private Insurance
 Financially Strongest
 Financially Weakest
$71
$64
Medi-Cal
Episodic
All Others
$49
Self-Pay/Sliding Fee/
Free Care
$39
0
30
$62
$53
60
90
120
Notes: See Payer Definitions on page 28 for specific programs included under Medi-Cal Episodic and All Others. The community clinics were ranked and tiered into five groups (quintiles) based
on overall financial performance. The highest or financially strongest (top 20 percent) and the lowest or financially weakest (bottom 20 percent) were then analyzed to examine factors that may
affect the financial performance and financial condition of these cohorts. For more information, see the Methodology section of the full report by Capital Link at www.caplink.org.
150
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
20
California Community Clinics
Income Level of Patients Served by Clinics,
by Clinic Financial Strength, 2008
80
Clinics rated as financially
477,292
477,292
14%
8%
4%
100
6%
<< r e t u r n to c o n t e n t s
 Unknown
 Above 200% FPL
 100% to 200% FPL
 Below 100% FPL
15%
strongest treated a relatively
larger share of the lowestincome Californians than
did the financially weakest
clinics.
20%
73%
60
60%
40
20
0
Financially Weakest
Financially Strongest
Notes: FPL stands for federal poverty level. The community clinics were ranked and tiered into five groups (quintiles) based on overall financial performance. The highest or financially strongest
(top 20 percent) and the lowest or financially weakest (bottom 20 percent) were then analyzed to examine factors that may affect the financial performance and financial condition of these
cohorts. For more information, see the Methodology section of the full report by Capital Link at www.caplink.org.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
21
California Community Clinics
Patient Age and Gender Distribution,
<< r e t u r n to c o n t e n t s
by Clinic Financial Strength, 2008
The financially strongest
Financially Weakest
 Male  Female
25%
Financially Strongest
 Male  Female
20%
clinics saw more children
and women of child-bearing
age than other clinics
in 2008.
15%
10%
5%
0%
<1
Year
1–4
Years
5–12
Years
13–19
Years
20–34
Years
35–44
Years
45–64
Years
65+
Years
Note: The community clinics were ranked and tiered into five groups (quintiles) based on overall financial performance. The highest or financially strongest (top 20 percent) and the lowest or
financially weakest (bottom 20 percent) were then analyzed to examine factors that may affect the financial performance and financial condition of these cohorts. For more information, see the
Methodology section of the full report by Capital Link at www.caplink.org.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
22
California Community Clinics
Total Revenue Distribution,
<< r e t u r n to c o n t e n t s
by Clinic Financial Strength and Size, 2008
Clinics that are the strongest
 Small (< $5 million)
 Medium ($5–15 million)
 Large (> $15 million)
100
27%
80
be larger clinics with more
than $15 million in revenues.
45%
60
40
financially are more likely to
33%
31%
40%
20
24%
0
Financially Weakest
Financially Strongest
Note: The community clinics were ranked and tiered into five groups (quintiles) based on overall financial performance. The highest or financially strongest (top 20 percent) and the lowest or
financially weakest (bottom 20 percent) were then analyzed to examine factors that may affect the financial performance and financial condition of these cohorts. For more information, see the
Methodology section of the full report by Capital Link at www.caplink.org.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
23
California Community Clinics
Salary Expenses as Percent of Total Operating Revenue,
by Clinic Financial Strength, 2005–2008 Average
<< r e t u r n to c o n t e n t s
On average, the financially
 60th Percentile
 Median
 40th Percentile
strongest clinics were more
likely to have lower salary
expenses as a percent of
Financially Weakest
total revenues, from 2005
76%
to 2008.
75%
72%
Financially Strongest
72%
69%
68%
0
10
20
30
40
50
60
70
80
Note: The community clinics were ranked and tiered into five groups (quintiles) based on overall financial performance. The highest or financially strongest (top 20 percent) and the lowest or
financially weakest (bottom 20 percent) were then analyzed to examine factors that may affect the financial performance and financial condition of these cohorts. For more information, see the
Methodology section of the full report by Capital Link at www.caplink.org.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
24
California Community Clinics
Operating Expense Per Patient Visit,
<< r e t u r n to c o n t e n t s
by Clinic Financial Strength, 2005–2008 Average
The financially strongest and
 60th Percentile
 Median
 40th Percentile
weakest clinics had similar
expenses per encounter,
on average, from 2005
Financially Weakest
to 2008. However, the
$144
strongest clinics had higher
$135
reimbursement rates.
$116
Financially Strongest
$151
$137
$126
0
20
40
60
80
100
120
140
160
Note: The community clinics were ranked and tiered into five groups (quintiles) based on overall financial performance. The highest or financially strongest (top 20 percent) and the lowest or
financially weakest (bottom 20 percent) were then analyzed to examine factors that may affect the financial performance and financial condition of these cohorts. For more information, see the
Methodology section of the full report by Capital Link at www.caplink.org.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
25
California Community Clinics
Patient Visits Per Primary Care Provider,
<< r e t u r n to c o n t e n t s
by Clinic Financial Strength, 2005–2008 Average
Productivity does not appear
 60th Percentile
 Median
 40th Percentile
to significantly influence
financial performance.
The highest and lowest
Financially Weakest
performing clinics had
3,401
similar numbers of visits per
3,244
primary care provider, on
2,798
average, from 2005 to 2008.
Financially Strongest
3,416
3,258
3,017
0
500
1000
1500
2000
2500
3000
3500
Note: The community clinics were ranked and tiered into five groups (quintiles) based on overall financial performance. The highest or financially strongest (top 20 percent) and the lowest or
financially weakest (bottom 20 percent) were then analyzed to examine factors that may affect the financial performance and financial condition of these cohorts. For more information, see the
Methodology section of the full report by Capital Link at www.caplink.org.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
26
California Community Clinics
Clinic Type and Size,
<< r e t u r n to c o n t e n t s
by Financial Strength, 2008
Clinic type does not
Clinic Type
appear to significantly
Clinic Size
Financially Strongest
Financially Strongest
influence financial
performance. The strongest
Financially
Weakest
Financially
Weakest
28%
10%
and weakest performers
24%
45%
62%
31%
of clinics by type.
Small
Other
23%
FQHC
Look-Alike
10%
have similar percentages
(< $5 million)
Large
27%
with performance; larger
(> $15 million)
FQHC
67%
However, size does correlate
40%
clinics are more likely to be
Medium
financially strong.
($5–15 million)
33%
Notes: See Clinic Definitions on page 28 for a description of FQHCs and list of other types of community clinics included in this report. The community clinics were ranked and tiered into
five groups (quintiles) based on overall financial performance. The highest or financially strongest (top 20 percent) and the lowest or financially weakest (bottom 20 percent) were then analyzed
to examine factors that may affect the financial performance and financial condition of these cohorts. For more information, see the Methodology section of the full report by Capital Link at
www.caplink.org.
Source: Capital Link, California Community Clinics — A Financial Profile, 2010.
©2010 California HealthCare Foundation
27
California Community Clinics
<< r e t u r n to c o n t e n t s
Clinic Definitions
Federally Qualified Health Centers (FQHC) “Section 330” clinics
receive federal grants to help cover the costs of providing care
to those who cannot afford to pay. “Look-Alikes” do not receive
these grants but are eligible for cost-based Medicare and
Medi-Cal reimbursement. “Other” community clinics included
in this report: nonprofit Rural Health Clinics; free clinics; and
other licensed safety-net clinics, including family planning and
school-based clinics.
Payer Definitions
Medi-Cal Episodic
• Breast Cancer Programs, including the Breast Cancer Early
Detection Program and the Breast and Cervical Cancer
Treatment Program
•
•
Children’s Health and Disability Program (CHDP)
California Family Planning, Access, Care and Treatment
(Family PACT)
All Others
• County Indigent / CMSP / MISP
•
•
•
•
•
•
Healthy Families / State Children’s Health Insurance
Program (SCHIP)
Data Resources
Authors
Falayi Adu, Jonathan Chapman, Mohamet Diop, Amy Harbaugh,
Laura Koundinya, Joe McKelvey, and Tony Skapinsky, Capital Link
The results and analysis in this report are based on two major
data sources: California’s Office of Statewide Health Planning
and Development (OSHPD), and the Internal Revenue Service
(IRS) Form 990 data. The national health center financial trend
data comes from Capital Link’s database of audited financial
statements, mostly consisting of data from FQHCs.
All licensed health care clinics in California are required to
submit an annual report to OSHPD that includes financial,
utilization, and patient demographic information. The reporting
period covers one calendar year (January to December).
This report applied a screening methodology to each OSHPD
annual data set to include only those clinics providing
comprehensive primary care services, resulting in a clinic list
that varied in each year of the analysis. For more information,
download the report, California Community Clinics — A Financial
Profile, 2010, at www.caplink.org.
f o r m o r e i n f o r m at i o n
California HealthCare Foundation
Expanded Access to Primary Care program — patient collections (EAPC)
San Diego County Medical Plan
Los Angeles County Public Private Partnership
1438 Webster Street, Suite 400
Oakland, CA 94612
C A L I FOR N I A
H EALTH C ARE
F OU NDATION
510.238.1040
www.chcf.org
Alameda Alliance for Health (Family Care)
Other County Payers
©2010 California HealthCare Foundation
28