Healthcare reform is trying to address the expansion of, and greater access to, healthcare services. But experts say adding demand to an industry that already faces a growing primary care shortage, requires new delivery models.
Nurse-managed health centers (NMHC) are a viable solution, said Tine Hansen-Turton, CEO of the National Nursing Centers Consortium, vice president of Public Health Management Corp. and executive director of the Convenient Care Association.
More than 250 NMHCs exist throughout the country.
Advanced practice nurses (APNs) can easily and more affordably provide primary and preventive care in a community-based, nonprofit clinic, which would relieve the workload on primary care physicians, Hansen-Turton said.
About 80,000 nurse practitioners already provide primary care. Nurse practitioners are the fastest growing segment of primary care professionals, according to Bruce Steinwald, healthcare director for the U.S. Government Accountability Office.
Hansen-Turton said nurses are returning to school to get advanced degrees and move up the career ladder.
While there are sufficient APNs to run NMHCs, they still need legislative support. Federal and state lawmakers are introducing bills that modify current regulations to remove unnecessary barriers and enable the existence of NMHCs, said Hansen-Turton.
"Massachusetts two years ago is a great example," she said. "There were 320,000 newly insured people, but the whole system collapsed because there weren't enough providers." Hansen-Turton said the Commonwealth expanded access to healthcare but didn't address the workforce issue.
Pennsylvania Gov. Ed Rendell's healthcare reform included changing the scope of practices so APNs can run NMHCs. According to Hansen-Turton, 26 states allow nurse practitioners to run independent practices, 20 states require some physician relationship and six states impose restrictions requiring physicians to be at the practice at least 10 percent of the time.
While foundations are providing some seed funding for NMHCs, federal and state dollars are desperately needed, said Hansen-Turton. Most NMHCs are driven by nursing schools, so grants should be set up to support training and education at the university level.
"It's a big value proposition for the universities because it exposes students to community health," Hansen-Turton said.
Even if NMHCs receive public start-up grants, they still must create a sustainable business model. More than 50 percent of the people they serve are uninsured.
"As a nonprofit, this (sustainability) is the biggest challenge," said Hansen-Turton. "The average primary care encounter cost for NMHCs is 10 percent less than other types of providers. The average personnel cost for NMHCs is 11 percent less than the personnel costs for other types of providers."
Still, NMHCs are more cost-effective than emergency departments and PCPs. A report by NNCC showed a reduction in special care and prescription costs, and fewer hospitalizations.
"NMHCs see their members an average of 1.8 times more than other providers," Hansen-Turton said, which results in high patient satisfaction. "They are excellent points for primary care and disease management."