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In what may be an effort to draw more revenue from a service not known for profitability, Oregon Health & Science University says it is considering whether to seek Federally Qualified Health Center status for its Scappoose family health clinic.
FQHCs, as they are known, are safety-net providers that get enhanced reimbursement from the federal government for their outpatient care.
They are also generally subject to more federal control. Many clinicians and residents at the Scappoose clinic—which sees thousands of patients annually—signed letters to OHSU leaders last fall expressing wariness about the effect the change might have on their ability to offer services the federal government frowns upon.
“While FQHC designation may appear to offer financial advantages, the conversion carries serious and immediate risks (particularly to reproductive health access, abortion care, and clinical autonomy) within a county that already faces extreme healthcare shortages,” said one such letter, sent Oct. 17 from numerous OHSU faculty at the clinic to leadership, and later reviewed by WW. “These risks are amplified by ongoing federal uncertainty and the potential policy shifts outlined in Project 2025.”
A separate Oct. 30 letter signed by residents at the clinic also opposed the change, expressing fears that the FQHC conversion would narrow their scope of practice and educational opportunities “by not allowing us to provide abortion care, safe miscarriage management, and possibly limiting gender affirming care, access to contraception and other potential unforeseen limitations.”
OHSU, in a statement to WW, said it sought to expand services, not restrict them, and that it was committed to thoroughly evaluating the potential change with clinicians and staff. It added that any transition to an FQHC would occur in conjunction with a plan to continue to provide the services.
“OHSU is fully committed to continuing to provide full-scope reproductive health care in Columbia County,” it said.
A variety of services fall under the reproductive health care umbrella. Those most common at the Scappoose clinic are pap smears, pelvic exams and family planning consultations, OHSU says. Services also include birth control, like IUD placements. OHSU says that, were the clinic to become an FQHC, all such services would be able to continue without restrictions on funding.
Abortion is another story. FQHC cannot use federal funds to provide abortion services, OHSU acknowledges, but it says that there are alternative ways to deliver the services, since the clinic is part of the larger OHSU network.
The discussion carries on as many in OHSU is working to turn around massive financial losses. It also comes as its sizable Family Medicine department expresses concerns about the university’s decision to remove their longtime chair—a widely-respected primary care champion—from her position. OHSU leaders have given no public explanation for the move, but say they remain committed to the cause of family medicine.
FQHCs are not new to OHSU. It’s Richmond Health Center in Southeast Portland has FQHC status, as does the East Portland Community Health Center on the campus of Adventist Health Portland.
