Strengthening the Sustainability, Capacity, and Long-Term Viability of UPC
Expanding Health Care Coverage
May 9, 2008
Universal Primary Care (UPC) is a critical safety-net provider in the Southern Tier region of New York State.
UPC has filled a gap in access to care for this region’s population of historically uninsured and underinsured individuals, serving more than 13,000 patients a year. Of these 13,000, approximately 40% either are enrolled in Medicaid or Medicare or are uninsured; more than 60% live below 200% of the federal poverty line. UPC originally operated as a hospital-owned clinic until it was restructured into a 501(c)(3) charitable clinic in 2004. UPC was unable to secure federal Section 330 funding that would provide start-up operating capital, and was forced to rely on affiliating hospitals to provide a line of credit for its operating budget. As a result, UPC quickly incurred heavy debts. With support from NYHealth, UPC took significant steps to manage its debts and develop a sustainable model to ensure the growth and continuation of services to its patients.
UPC hired a specialized rate negotiator to work toward increasing its current Medicare reimbursement rate of 105% to the national average of 125%. The rate negotiator first targeted increases with UPC’s major payers, and then moved to those payers who also represent a significant portion of UPC’s business. UPC also hired a practice management consultant to review its current operational model and provided guidance on a more effective and sustainable model. The consultant also examined grant program participation and improvement of quality assurance programs to increase the reimbursement received in pay-for-performance programs. UPC also used funds to serve as a bridge payment for vaccine and medical supply vendors until a decision was made regarding UPC’s application for new Section 330 funding from the Health Resources and Services Administration.