One of the things that sets Community Health Centers (CHCs) apart from the rest of the health care industry is the capacity to charge patients based on their ability to pay. Health Centers are required to evaluate the effectiveness of the sliding fee discount program in reducing financial barriers to care at least every 3 years. This is done by collecting utilization data to assess whether patients within each of the CHC’s discount pay classes are accessing health center services. However, gathering this information can be challenging for health centers.

Gathering data by Sliding Fee Discount (SFDP) pay class has its own unique challenges. Some practice management systems do not have clear reports to capture this information. I suggest that the health center have a conversation with their vendor and make sure that reports can be generated by each level. For example, if your SFDP has 4 levels A – D, you would need to be able to present data for level A, B, C and D. While it is important to ensure that patients falling below 100% Federal Poverty Guidelines (FPG) are accessing care, it is equally important to ensure that all patients at all levels are accessing care as well. In the event you are unable to generate adequate reports from your PM system, think about other reports that have similar information, for example UDS Table 4 Socioeconomic indicates users based on FPG.

There is also the requirement that you gather information from the patient’s perspective. You can do this through staff and board user input, focus groups, and surveys. However, it is important to realize that while you can use staff and board input, you will need to have other sources of information available as well. Focus groups are an effective way to gather information; these meetings should be properly documented, and the details shared with the board of directors. You can also utilize other surveys to gather information, however, simply adding questions about the sliding fee discount program with no discussion does not meet the minimum standards. 

Health centers have successfully demonstrated compliance by initiating a “Sliding Fee Survey.”  This captures the patients who participate in the program at all levels, which would be indicated on the survey. With simple questions it is possible to determine if the SFDP creates a barrier to care. Sample questions include:

1. How did you hear about the Sliding Fee Discount Program?
2. How satisfied are you with the eligibility screening process for the Sliding Fee Discount Program?
3. Do you believe your fees are fair compared to the services you received?

This data should be tabulated and presented to the board of directors for discussion.

It is clear that gathering information in order to evaluate the SFDP creates challenges for health centers. There are many ways to gather information to support the evaluation of the program. It is up to the health center to determine the most effective way to gather this information.