1.) Health center services are offered at  one or more delivery sites and are required to be available to all people in  the center’s service area. Services must be provided regardless of  patients’ ability to pay. II for additional information on HRSA’s process  for awarding health center grants.) HRSA uses UDS data to monitor aspects of health center and overall  program performance. Therefore, the agency is considering both revising the  measures it uses to assess need and increasing the relative weight of need  in the award process. 2.) At the same time, the number of eligible new access point applications  increased by 28 percent. Combined with the decrease in new access point  funding, this resulted in a decrease in the proportion of applicants that  HRSA funded—from 52 percent of fiscal year 2002 applicants to 20 percent  of fiscal year 2004 applicants. From fiscal year 2002 through fiscal year 2004,  HRSA funded 334 new access point grants and 285 expanded medical  capacity grants, representing about half of the initiative’s 5-year goal of  providing 630 new access point grants and 570 expanded medical capacity  grants. HRSA’s Process for Assessing Need for New Access Point Grants Has Changed

The process HRSA uses to assess the need for services in a new access  point applicant’s proposed service area has changed since the beginning of  the President’s Health Centers Initiative. Number of New Access Point Grantees Varies Widely by State, but HRSA Lacks Reliable Information on Delivery Sites

The number of health centers receiving new access point grants varied  widely by state during the first 3 years of the President’s Health Centers  Initiative. For example, in its  fiscal year 2005 performance plan, HRSA reported funding 3,588 delivery  sites in fiscal year 2003, consisting of 3,317 delivery sites operating in fiscal  year 2001 and 271 new access point grants funded in fiscal years 2002 and  2003; however, some of the new access point grants represent more than  one delivery site. As a result, HRSA underestimated the number of new  program delivery sites operating in fiscal years 2002 and 2003. HRSA Has Increased the Role of Performance Measurement in Monitoring and Improved Its Collection of Health Center Data

HRSA’s new tool for periodic on-site review of health centers—the OPR  performance review—focuses on monitoring individual health centers’  performance on selected measures, including health outcome measures. While the OPR review evaluates the performance of individual health  centers, it generally does not provide standardized performance  information for the Consolidated Health Centers program as a whole, and  HRSA is using other tools to collect information that could help measure  overall program performance. HRSA Has Taken Actions to Improve the Completeness and Accuracy of Its Uniform Data System

Since our previous report on the health centers program in March 2000,  HRSA has taken steps to improve the UDS data collection and reporting  process by trying to ensure that all Consolidated Health Centers program  grantees report to the system and that the information they report is  complete and accurate. To improve the accuracy of UDS data on the number and location of health  center delivery sites, for 2004, HRSA revised the instructions to grantees  for identifying their delivery sites. Health Centers Often Face Challenges Securing Specialty Care for Patients

In addition to providing comprehensive primary and preventive health care  services, most health centers receiving Consolidated Health Centers  program grants provide specialty care on site or have formal arrangements  for referring patients to outside specialists for care. HRSA has indicated that it is not confident that its award process for new  access point grants—which is intended to meet this challenge—has  sufficiently targeted communities with the greatest need. Continued attention to such efforts could improve HRSA’s ability to  evaluate its success in improving the health of people in underserved  communities. We continue  to believe it is important that HRSA collect and report accurate data on the  number and location of all delivery sites funded by the program so that  agency officials and the Congress will have the information they need to  monitor the program’s progress in increasing access to health care and to  make decisions about managing and funding the program.
Why GAO Did This Study

Health centers in the federal Consolidated Health Centers program provide comprehensive primary health care services at one or more delivery sites, without regard to patients' ability to pay. In fiscal year 2002, the Health Resources and Services Administration (HRSA) began implementing the 5-year President's Health Centers Initiative. The initiative's goal is for the program to provide 1,200 grants in the neediest communities--630 grants for new delivery sites and 570 grants for expanded services at existing sites--by fiscal year 2006. GAO was asked to provide information on (1) funding of health centers and HRSA's process for assessing the need for services, (2) geographic distribution of health centers, and (3) HRSA's monitoring of health center performance.

What GAO Found

Competition for Consolidated Health Centers program funding increased over the first 3 years of the President's Health Centers Initiative, and HRSA's process for assessing communities' need for additional primary care sites is evolving. Program funding, which primarily supported continuing health center services, increased from fiscal year 2002 to fiscal year 2004. However, funding for new access point grants, which fund one or more new delivery sites, decreased by 53 percent during this period. At the same time, the number of applicants for these grants increased by 28 percent. As a result, the proportion of applicants receiving new access point grants declined from 52 percent in fiscal year 2002 to 20 percent in fiscal year 2004. In fiscal years 2002 through 2004, HRSA funded 334 new access point grants and 285 grants for expanded services at existing sites. While HRSA includes an assessment of communities' need for services in its process for awarding new access point grants, agency officials indicated that they were not confident that the process has sufficiently targeted communities with the greatest need. Therefore, the agency is considering changes to the way it assesses community need and the relative weight it gives need in the award process. The number of health centers receiving new access point grants varied widely by state--from 1 to 57--during fiscal years 2002 through 2004, but HRSA lacks reliable data on the number and location of health centers' delivery sites. Although HRSA uses data on the number of delivery sites to track the progress of the Consolidated Health Centers program, it is not confident that grantees are accurately identifying delivery sites funded by the program. Furthermore, in its reporting, HRSA counted each new access point grant funded in fiscal years 2002 through 2004 as a single delivery site, although some represent more than one site. HRSA needs to collect and report accurate and complete delivery site data to give the agency and the Congress data they need to make decisions about the program. HRSA has increased the role of performance measurement in its monitoring of health centers and has improved its collection of data that could help measure overall program performance. In 2004, the agency began to use a new process for on-site monitoring of health centers that focuses on each center's performance on measures tailored to its community and patient population. However, the new review generally does not provide standardized performance information that HRSA can use to evaluate the health center program as a whole. The agency is using other tools to collect health outcome data on patients that could help measure program performance. Continued attention to such efforts could improve the agency's ability to evaluate its success in improving the health of people in underserved communities. In addition to developing these data collection tools, HRSA has taken steps to improve the accuracy and completeness of its Uniform Data System, a data set that HRSA uses to monitor aspects of the health centers' performance. For example, HRSA provided grantees with more detailed instructions on how to identify their delivery sites.