For stakeholders like Robert Boyd, the economic fallout for hospitals from the COVID-19 pandemic is causing him to brace for the possibility that providers who sponsor school-based health centers may look at reducing their investments in such programs as a means of cutting costs.
"In the short term are we going to lose some school-based health centers, probably," said Boyd, who serves as president of the not-for-profit advocacy and consulting organization, School-Based Health Alliance. "That's just an economic reality."
But many healthcare providers say they remain committed to sponsoring school-based health clinics in spite of the economic downturn.
"These are long-term plays in the community," said Carol Paret, chief community benefits officer at Houston-based, Memorial Hermann Health System. With an annual operating budget of approximately $5 million, Memorial Hermann operates 10 school-based health centers and three mobile dental clinics serving more than 80 schools across five school districts. "There's been no consideration during this time that we were going to look at cutting funding for these operations."
Memorial Hermann's clinics are freestanding facilities located on school campuses that were able to stay open for in-person visits during the pandemic. That's been essential in the effort to meet the needs of students and their families by allowing individuals to come to receive free food and cleaning supplies being distributed by the clinic, Paret said.
Dr. Maureen Connolly, medical director of the school-based and community health program at Henry Ford Health System in Detroit, said having exterior-door access to their more than a dozen school-based clinics has allowed them to remain open for in-person visits by both students and community members.
When Michigan Gov. Gretchen Whitmer ordered a shutdown of all of the state's K-12 school buildings back in April, much of Henry Ford's clincial staff were re-deployed to respond to the coronavirus as the health system received an influx of cases.
As cases have decreased, many of the clinics have since reopened while schools have remained closed, which has required the health system to do some outreach to let patients know they can visit.
"It's required a lot of flexibility and creativity," Connolly said. Outreach efforts have included phone calls to families, email reminders, and the use of its virtual patient portal.
While Henry Ford and Memorial Hermann have been able to open their school clinics to patients, most health centers have been forced to find different ways to continue providing care since they are embedded within shut down school buildings with no exterior entrance access points.
Amy O'Malley, director of the school-based health center program at Loyola University Chicago's School of Nursing, said the school-based health centers site it runs within suburban Proviso East High School has been closed since March after the school was shut down due to the pandemic. The program, which receives resource support from sister health system Loyola University Medical Center, has been able to use the health system's electronic medical record system to conduct telehealth visits while sending out notices to students through the school's communications app.
"We have these two great system in place, which ended up really helping us to be able to keep connected with the kids and then as well to provide these telehealth services," O'Malley said.
Serving children from pre-K through high school, school-based health centers have become an increasingly important point of care for primary care services, with the number of clinics doubling since the 1990s from 1,130 to more than 2,500 by 2017, according to a 2019 Health Affairs study.
While the number of hospitals and medical centers that sponsor some type of school-based health center program has increased from more than 290 in 1999 to more than 460 in 2017, the overall share of program sponsored by hospitals has shrunk over that time. Hospital-sponsored school-based health centers decreased from making up 33% of all clinics in 1999 to 20% by 2017.
Federally qualified health centers have been the biggest drivers of growth in school-based health centers for more than a decade. Community health centers now sponsor 51% of school-based health centers compared to just 19% in 1998. The increase in FQHC sponsorship in school-based health centers coincided with community health centers receiving two decades of federal funding during the Bush and Obama administrations to expand their services.
While community health centers receive much of the government grant support, most of the funding hospitals use to support their school-based health centers comes out of their tax-exempt community benefit funds, which is tax-exempt.
"That's a funding source that doesn't exist for hospital systems," Boyd said. In light of the economic situation facing many hospitals, Boyd said he expected current growth trends to continue.
"Do I expect more hospitals are going to go into school-based health, I don't know," Boyd said. "Do I see more federally qualified health center going into the schools, absolutely, because they have incentives and access to federal resources the hospitals just don't have ."