Nurse-Managed Health Clinics Provided Badly Needed Primary Care - But Without Funding, They and their Patients are at Risk
By Tine Hansen-Turton, MGA, JD, FCPP, FAAN, Chief Executive Officer, National Nursing Centers Consortium and Chief Strategy Officer at Public Health Management Corporation
Increased federal and state funding for nurse-managed health clinics (NMHC) would have positive implications for thousands of underserved patients around the nation. As Chief Executive Officer of the National Nursing Centers Consortium (NNCC), a non-profit member association representing more than 200 nurse-managed clinics throughout the country, I have spent close to 15 years advocating for the increased use of nurse practitioners and NMHCs in primary care. Our mission at the NNCC is to advance nurse-led health care through policy, consultation, programs and applied research to reduce health disparities and meet people’s primary care and wellness needs. Although I am not a nurse, I am passionate about NNCC’s mission because I have seen firsthand the life-changing impact NMHCs and nurse-practitioners can have on their patients.
When people ask me why NMHCs are so important, I often tell them the story of a woman with chronic back pain who came to the Public Health Management Corporation Rising Sun Health Center, a large NMHC network in Philadelphia. By the time she came to Rising Sun, the woman had received medication and treatment from health professionals in other settings, but her back pain had not improved. After conducting a thorough interview, the patient’s nurse practitioner found the source of the problem. The woman, who was caring for a large family, had been sleeping in a bathtub so her children could sleep on mattresses. After helping the woman develop better sleeping arrangements, the nurse practitioner referred her to social services. She was able to move to a larger rental unit in public housing, and her health problem improved.
This is just one of many examples that illustrate how providers at nurse-led NMHCs treat the whole person and assess the environment their patients live in—not just a patient’s physical condition or disease history. Providers in NMHCs also spend more time with patients. While other providers had simply tried to medicate this woman’s pain, the nurse practitioner took the time to examine the women’s living conditions. It was this extra time and expanded focus that led to the correct diagnosis of the problem.
Despite their successes, many NMHC providers endure overwhelming financial struggles on a daily basis. Like other safety-net providers, such as federally qualified health centers (FQHC) and community health centers, NMHCs see a high percentage of uninsured patients (between 30 and 60 percent). But because the majority of NMHCs are affiliated with schools of nursing, they often cannot meet requirements to become a FQHC, and therefore do not qualify for the increased federal funding that FQHCs receive to offset the cost of treating the uninsured. This lack of stable funding has caused many NMHCs to close, leaving countless patients without care.
Thanks in part to NNCC’s advocacy efforts and to the work of many of our sister nursing agencies around the country, the Affordable Care Act (ACA) of 2010 defined NMHCs in law and created a federal grant program specifically designed to fund NMHCs. In 2010, the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services, released $14.8 million in prevention fund dollars to support grants to 10 NMHCs. These grants, which were intended to increase primary care access and develop the health care workforce, have been extremely successful. The clinics receiving funding are expected to provide primary care to more than 94,000 patients and train more than 900 advanced practice nurses by 2012. However, in an effort to reduce federal spending, both Congress and the Obama administration elected not to renew funding for this program in 2011 and 2012.
The inclusion of NMHCs in law and the establishment of an NMHC grant program represented a major victory for NMHC advocates, but without funding the clinics and their patients remain at risk. The nation is experiencing a severe shortage of primary care physicians. The American College of Physicians has declared that “primary care, the backbone of the nation’s health care system, is at grave risk of collapse.”
NMHCs are in a position to build capacity by providing primary care to the underserved and are acting as clinical sites for the next generation of primary care providers. Given that the full implementation of the ACA in 2014 is expected to place further strain on available primary care providers, now is the time to invest in NMHCs—not defund them.
In its report on the future of nursing, the Institute of Medicine called for greater utilization of nurse practitioners and NMHCs in primary care, and the Robert Wood Johnson Foundation has done a great job highlighting the need to implement these recommendations. We at the NNCC believe that increasing funding for NMHCs is the only way to ensure that this goal is met. Not doing so will drive up the cost of care as more patients turn to the emergency room for care. That, in turn, will lead to poorer health outcomes for the underserved. NMHCs are already on the ground providing great care, and they are ready to assume a greater role. Investing in the model will help bring quality, affordable care to thousands of patients at a critical time in our history. We cannot afford to miss this opportunity!
Hansen-Turton is an Edge Runner with Raise the Voice, a campaign of the American Academy of Nursing that was supported by the Robert Wood Johnson Foundation. Read more about her work with nurse managed clinics here and here.