Embedding a Federally Qualified Health Center in a Hospital

A health care provider listens to a patient with a stethoscope.

Institutional Systems Change at the Local Level

At a community conversation in Halifax County, North Carolina in 2018, Brian Harris, then CEO of the Federally Qualified Health Center (FQHC)—Rural Health Group (RHG)—and his team learned that 225 of their patients visited the local hospital’s emergency department (ED) a combined 3,200 times with the majority of visits taking place between the hours of 5:00-9:00 p.m. Rather than struggling to figure out how to make the clinic more accessible, RHG worked with Halifax Regional Medical Center—now ECU Health North Hospital—to establish the state’s first FQHC within a hospital ED.

A person with a mask and hat receives a vaccine.The team quickly recognized that this was harder than it sounded, due to regulatory concerns. A major barrier was the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals with EDs to provide a medical screening examination to any individual who visits and prohibits hospitals with EDs from refusing to examine or treat patients. Once in the door, the ED must serve patients and cannot divert the visit to the primary care clinic. Despite these regulatory concerns, the clinic experienced success in reaching their patients. Eventually, RHG moved out of the ED and established a freestanding clinic operated by the FQHC, but remained co-located on the hospital’s campus.

While there were concerns about the move interfering with their ability to see patients, the clinic experienced the opposite—an influx of patients. Rather than going through the ED, a separate building provides patients with a more direct route to RHG in a convenient and familiar location.

As RHG now serves more than 34,000 patients per year, Yvonne Long-Gee, current CEO, stresses that this effort is about more than location. They continue to focus their efforts on recruitment, provider and staff retention, workforce development, providing transitions in care, behavioral health, case managers, community health workers, and high-quality medical services. All assist patients in receiving access to care, such as scheduled primary care appointments prior to hospital discharge, along with evaluating social needs that impact health outcomes and inappropriate hospital readmissions.

A health care provider explains to a patient with their arms open.CEO Long-Gee notes they could not do this work alone. “Our relationship with our community partners, the local health department, pharmacies, EMS, and ECU Health North hospital results in improved health outcomes and timely access to appropriate levels of both primary and acute care,” says Yvonne.

While reflecting on the successful transition of moving the FQHC out of the ED, RHG continues to emphasize the collaborative spirit of the stakeholders involved, and the importance of improving care coordination and navigation within health systems to address the diverse health needs of their community.