As a federally-qualified community health center (FQHC), you need to show that you’re actually collaborating with your community. Yes, really.

We realize that this point may seem like it’s so obvious that you don’t need to read an entire blog article about it. But, in fact, understanding what HRSA means by “community collaboration” is critical to maintaining your FQHC status.

Requirements for collaborative relationships

 It’s east to agree that collaborative relationships are a good thing. But defining what, exactly, collaborative relationships are can be trickier. So, let’s look at how HRSA defines “collaborative relationships” in the context of FQHC requirements.

Basically, HRSA wants your health center to create and maintain ongoing collaborations with other healthcare providers in your service area. This includes nearby hospitals and specialist providers. The goal of these relationships is to provide health services that are not directly provided by your health center and to reduce non-urgent usage of hospital emergency departments. Health centers must establish relationships with others, “including with other health care providers that provide care within the catchment area, local hospitals, and specialty providers in the catchment area of the center, to provide access to services not available through the health center and to reduce the non-urgent use of hospital emergency departments” (Compliance Manual).

HRSA also wants FQHCs to collaborate with other FQHCs in your geographical area, to the extent that it is practical to do so. Other health services funded by state or federal governments are also good targets for collaborative relationships. For a fuller definition of collaborative relationships, see Chapter 14 of the compliance manual.

In essence, HRSA—much like a kindergarten teacher—wants to see that you’re playing well with others. Collaboration should be ingrained into your health center’s culture, from the top on down. If the CEO isn’t emphasizing the importance of collaboration, it won’t become integrated into your culture and philosophy.

 Demonstrating compliance when it comes to collaborative relationships

 Of course, HRSA being HRSA, they want more than just a statement that you value collaboration. As with everything else, they want concrete evidence—and lots of paper. Here are some tips for demonstrating compliance:

  1. Interact and partner with other FQHCs.

There are many things that you can and should be doing to partner with other FQHCs. If another FQHC is strong in a service that you don’t offer (or vice-versa), then create a service provision agreement so that patients have access to more services.

It’s also helpful for FQHCs to share policies and experiences with one another. This helps both of you to develop best practices and better serve patients. You might even arrange visits at other health centers. We recommend that all levels of personnel participate in these visits, from the CEO on down.

Make sure to document your collaboration activities. For example, you can write reports documenting your visits, including what actionable information you picked up from other FQHCs. You’ll need this documentation as evidence of compliance.

  1. Have robust referral agreements in place.

Although referral agreements are critical for providing comprehensive services to your patients, it’s important that these agreements are truly collaborative and ensure quality care for patients. You shouldn’t just be transferring patients to other providers. There should be policies in place for providing follow-up care, and for ensuring that patients receive high-quality care when they are referred to other providers.

Your agreements should also ensure that relationships are mutually beneficial.

For purposes of your HRSA inspection, prepare copies of your referral agreements. Be prepared to point to specific provisions that ensure high quality of care.

  1. If your health center expands the HRSA-approved scope of services, document attempts to collaborate with other providers in your area.

While expanding the scope of your services with HRSA approval is great, it’s important to make sure that you’re consulting with other health providers who serve a similar population. Whenever possible, obtain letters from other providers that discuss how these new services will impact your collaborative relationships.

Of course, that’s not always possible. In that case, you should at least document your attempts to inform other providers about your new services.

If you can do these things, that will go a long way towards demonstrating that you are in fact playing well with others—and pleasing HRSA.

To learn more about what your health center should be doing to prepare for HRSA site visits, follow us on Twitter. We make the process more bearable by covering every aspect of the process.

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