Policy Development: Proposing a Billing Model for Mobile Clinic Services

Abstract

Practice Problem: Mobile health clinics were established to increase healthcare access to underserved, underinsured, and uninsured populations in rural and underserved areas. All the patients visiting this metropolitan mobile health clinic are uninsured and do not qualify for health insurance. Currently, the clinic relies on annual state funding, which is subject to variations and does not generate its own revenue. This poses a significant sustainability risk for the clinic. Purpose: This policy project aims to propose a billing model that not only supports the financial viability of the clinic but also benefits the local population. Additionally, the data collected on care delivery will be utilized to advocate for the value of nurse practitioners in terms of cost and health outcomes to legislators, insurance companies, and health organizations. Method: The policy project proposes four policy options, including maintaining the current billing process, implementing a fee-for-service model based on a sliding scale fee aligned with HRSA poverty guidelines, adopting a capitation billing model, or introducing a novel payment approach. The evaluation of these policies was conducted using the CDC Policy Analysis Key Questions and the CDC Policy Analysis Table, resulting in a ranking from the most to the least feasible option. Result: The fee-for-service sliding scale fee payment model stands out as the most feasible policy. A survey was administered to patients to assess how many could comfortably afford the predetermined fee, which was set at $40 per individual, based on HRSA poverty income guidelines. The survey results show that the majority of the patients will be able to afford the predetermined fee. This data will be presented to legislators and mobile clinic stakeholders, culminating in a proposal to implement the sliding scale fee structure as a means of generating revenue. Conclusion: The project findings support the implementation of the sliding fee for service policy as the most feasible option for generating revenue for the mobile clinic.