Friday, September 11, 2009

Nurse-Run Health Centers: Real Healthcare Reform

Philadelphia Business Journal -- Nurse-managed health centers are one solution to the growing shortage of family medical practitioners. They are community-based, nonprofit clinics run by advanced practice nurses capable of delivering primary and preventive care more affordably than a larger health system, especially for low-income and vulnerable populations.

“Their true potential remains untapped,” said Tine Hansen-Turton, executive director of the Philadelphia-based National Nursing Centers Consortium. “These centers can provide the foundation for real health-care reform that will work, serving tens of millions of additional families across the United States.”


At 9/12/2009 12:02 AM, Blogger Thai said...

This issue of a shortage in primary care physicians is such b.s. for just this reason.

There is a glut of what we call mid-level providers or mlps (nurse practitioners and physicians assistants).

Add them up and we have plenty of primary care labor.

The powers with interest in the status quo just want you to believe things are bad.

Just search for yourself whether we have a glut of mlps.

At 9/12/2009 12:27 PM, Blogger The Happy Hospitalist said...

Define primary care and you define the problem. What nurse practitioners do isn't primary care that an MD can do. It's primary care that a nurse practitioner can do. That's a product of their vastly inferior training.

Now, try and place a complicated patient that I manage into the hands of a nurse practitioner with 1/10 of the training and expertise and you have a problem. It's not to say NPs are bad, they just aren't educated to do what I do in complicated situations. And to do it independently.

A lot of what I do doesn't require an MD. In fact, it can be accomplished by trained RNs without NP credentials. The problem you run into, which is an a problem of the payment models present in third party medicine (RVUs) is that the "easy care" subsidizes the complicated more expensive care. If you remove the easy care from the business model of the MDs, who are the only ones trained to take care of them, you kill the primary care model from complicated patients. They are left with no MD able to survive. They are left with no NPs trained to handle them. They end up bouncing between multiple specialists, which has been shown over and over again, the most expensive model of care.

Those who believe that NPs are the solution to primary care must realize that 50% of the population spends 3% of health care dollars. 5% of the population, those with complicated chronic disease, spend 50% of the total health care pool.

NPs are not a national solution to a problem they aren't trained to manage. If they were, all medical schools should close in favor of nursing school and the NP model of care.

And as a physician who has experienced 20,000 hours of medical school after undergraduate work and over 12,000 hours medical residency, as well as trained having trained NPs who did four years of undergraduate nursing school and experienced their "open book" NP tests and internet based programs and 1000 hours of clinical work, and it is NOT something I would ever accept for myself or my family with chronic disease.

If the solution to paying cheaply for easy care does not include a solution to pay more for the complicated care, you will end up with no solution at all.

At 9/12/2009 12:35 PM, Blogger Thai said...

Happy, I am a practicing physician as well (Emergency Medicine)

While it is true the less complex cases subsidize the more complex ones, this need not be the case.

In effect society is paying for a Lexus where it only needs a Chevy and that is inefficient.

If we want complex care I certainly agree we have to pay for it. I further agree the one size fits all system we are in right now makes this difficult to understand.

If we do not want to pay for complex care... well you (and I) have our answer.

At 9/12/2009 3:54 PM, Anonymous Anonymous said...

To answer the hospitalist this shows the fact that non group practice is an inefficient system. If all primary care is provided by large group practices it will naturally assign that to the nurse practitioner all the care that can be given there.
In addition the large group practice saves on overhead (receptionist at least can be shared)
The payment problem can be solved by moving to a capitation model like the dreaded hmo's used, so that care is delivered in the most efficient mode, letting the market make the decisions.


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