Summer 2009 What’s inside? Greetings from Chairperson (4-5) // From the Desk of the Executive Director (6) // Message from the Board of Directors (7) // Program Highlights (8-11) Institute for Nursing Centers Update (12) // Spotlight on New Programs (13-14) // Working to Eliminate Community Health Disparities (14-15) // NNCC in the News (15-16) // Data Talks (16) // Member Services and Resources (16) // NNCC Committee Updates (16-17) // On the Road with Nurse-Manages Health Centers (19-32) // The Coding Corner (33-34) // NNCC Technical Assistance (34) // Policy News (35-36) // Insurers’ Policies on Nurse Practitioners as Primary Care Providers (37-39) // NNCC’s Managed Care Contracting Project (40-41) // NNCC-Member Peer-Reviewed Articles (41) // Capstone Rural Health Center: A Leader in Technology (42-43) // International News (44) // NNCC Staff (45)
Board of Directors: Kenneth P. Miller, PhD, RN, CFNP, FAAN Chairperson
Making the Case for Nurse-Managed Care with Electronic Data Improving Chronic Care in Pennsylvania
M. Christina R. Esperat, RN, PhD, APRN, BC Immediate Past-Chair
by Grace Lee t is pretty safe to say that Pennsylvania has
practice coaches, and provider and consumer
Amy Barton, PhD, MSN Secretary
much room for improvement in the delivery
incentive alignment, starting with the Southeast
and management of chronic care. Almost 80
Pennsylvania region in May 2008. In adopting
percent of all health care costs in Pennsylvania
the Commission’s plan, Pennsylvania becomes
can be traced to 20 percent of patients who have
the first state to combine practice redesign with
chronic diseases, yet those with chronic diseases
reimbursement redesign in the management of
only receive about 56% of recommended care.
chronic care.
John Loeb, MSS Treasurer and Finance Chair Tine Hansen-Turton, MGA, JD Executive Director Susan Beidler, PhD, MBe, ARNP, BC Richard Cohen, PhD Jeri Dunkin, PhD, RN
I
Avoidable hospitable admissions for patients with
The model for improving chronic care delivery
asthma are three times higher in Pennsylvania
being adopted by the Commission is an integra-
compared to the best performing states in the
tion of the Chronic Care Model and the Patient-
nation, while avoidable hospital admissions for
Centered Medical Home concepts. The Chronic
patients with diabetes are four times higher. In
Care Model was developed by Ed Wagner of the
Phil Greiner, DNSc, RN
2005, there was $1.7 billion in potentially avoid-
MacColl Institute for Healthcare Innovation and
Denise Link, PhD, WHNP-BC, CNE, FNAP
able hospital charges for Pennsylvanians with
focuses on team-based coordination of care for
chronic disease.
patients with chronic illnesses. The Chronic Care
Sally Lundeen, PhD, RN, FAAN
In order to improve the health of Pennsylva-
Model is already being used in a number of state
James Paterno, MBA
nians with chronic diseases, Governor Edward G.
and national collaboratives such as the Health
Lenore Resick, PhD, RN
Rendell created the Chronic Care Management,
Disparities Collaborative (a HRSA implementation
Reimbursement and Cost Containment Commis-
through Federally Qualified Health Centers), and
sion (the Commission) in May 2007 as part of
Veteran’s Administration. The Patient-Centered
his Prescription for Pennsylvania health care
Medical Home concept comes from the Ameri-
reform plan. The Commission was charged with
can Academy of Pediatrics and is also becoming
developing a strategic plan for implementing a
more widely adopted across the country. It also
process to effectively manage chronic disease
features similar ideas such as team collaboration,
across the state and thereby improve the qual-
the use of decision support and clinical informa-
ity of care while reducing avoidable illnesses and
tion systems in patient care.
Nancy Rothman, RN, EdD Elaine Tagliareni, MS, RNC, EdD Donna Torrisi, RN, MSN, CRNP Rebecca Wiseman, PhD, RN
their associated costs.
In all, 33 practices representing internal
In February 2008 the Commission delivered
medicine, family practice, pediatrics, and nurse-
to the Governor and Legislature a plan to begin
managed practices serving 176,000 patients in
regional rollouts using learning collaboratives,
Southeast Pennsylvania are participating in the
NNCC UPDATE initial rollout. Several NNCC members are
sis is on smaller scale tests that can be per-
ticipation in learning sessions, imple-
among those participating including, the
formed and evaluated rapidly. The following
mentation of the chronic care model, and
nurse managed health centers of Chil-
is an example of a PDSA cycle to test if hud-
achievement of level 1 certification by the
dren’s Health Centers of VNA Community
dles (quick meetings) improve the prepared-
National Committee for Quality Assurance
Services, Family Practice & Counseling
ness of staff to care for diabetic patients:
as a Patient-Centered Medical Home by the
Network, and Public Health Manage-
zz Plan: One morning NP and support staff
end of the first year of the rollout. Incen-
ment Corporation. Initially practices will
will huddle and go over diabetic patients
tives are paid by each participating payer
choose to focus on improving either pedi-
scheduled to come in that day
to the practice based on their proportionate
atric asthma care or adult diabetes care,
zz Do: On Wednesday morning before pa-
share (i.e. payer mix). Insurers currently
but the long-term goal is to incorporate
tients were scheduled to be seen, NP
participating include Aetna, AmeriChoice
additional chronic conditions over time.
and support staff huddled and went over
(Medicaid), Health Partners (Medicaid),
which diabetic patients were coming in
Independence Blue Cross, Keystone Mercy
practices are guided through the process
During the initial phase of participation,
that day and what their needs were.
(Medicaid), and Medicare Advantage.
of creating an aim statement which focus-
zz Study: Everyone felt that huddle was
It is anticipated that through the region-
es on improving chronic care (What is the
productive and left them prepared to see
al rollouts of the chronic care initiative,
practice trying to accomplish?), establish-
the diabetic patients scheduled that day
Pennsylvania will see improved quality
ing baseline data and outcome measures
zz Act: NP and support staff will continue
of care, reduced hospital admissions and
for tracking changes in care (How will the
to have huddles every morning for the
cost, improved access to care, improved
practice know that a change is an improve-
rest of the week and see if that helps
primary care clinician satisfaction, and
ment?), and the process of generating and
them prepare for their diabetic patients.
more support for patients with chronic dis-
implementing ideas for changes in the
To support participating practices during
eases. It is further hoped that the lessons
practice (What changes can the practice
the rollout of this chronic care initiative, the
learned can be applied to a broader, more
make that will result in an improvement?).
Primary Care Coalition (comprising of the
system-wide application.
Practices look for opportunities for change
PA Academy of Family Physicians, the PA
in the following areas that have been iden-
chapter of the American Academy of Pedi-
Resources
tified as essential elements of a health care
atrics and the PA chapter of the American
More information on the PA Governor’s health care re-
system that encourage high-quality chron-
College of Physicians) will provide prac-
form plan can be found at www.rxforpa.com
ic disease care: the community; the health
tices with access to a coach who will assist
system; self-management support; delivery
practices in transforming their practice by
More information on the Chronic Care Model and
system design; decision support, and clini-
implementing the chronic care model, data
Patient-Centered Medical Home can be found at
cal information systems.
collection and reporting, and linking prac-
www.improvingchroniccare.org
Next, practices use Plan-Do-Study-Act
tices to community resources. Practices will
(PDSA) cycles that allow change ideas to be
also participate in several learning sessions
More information on tools for improving health care
easily tested. The PDSA cycle is a way to
where they attend educational sessions
(including PDSA cycles) can be found at http://www.
test a change by developing a plan to test the
about the chronic care model, and have the
ihi.org/IHI/Topics/Improvement/Improvement-
change (Plan), carrying out the test (Do), ob-
opportunity to share with other practices
Methods/Tools/
serving and learning from the consequences
their plans for transforming chronic care.
(Study), and determining what modifications
Participating practices are awarded
should be made to the test (Act). The empha-
significant incentives based on their par-
More information on the NCQA accreditation can be found at http://www.ncqa.org/tabid/631/Default.aspx
www.NNCC.us p 2
NNCC UPDATE
Save the Date! NNCC’s 8th Annual Conference will be held on November 5-7, 2009 We hope you will join us on November 5, 6, and 7, 2009 at the Radisson Plaza Warwick Hotel, 1701 Locust St. in Philadelphia, Pennsylvania for the 8th Annual NNCC Conference. We will be presenting information on innovative practices that improve access to health care with an emphasis on meeting the needs of vulnerable populations. We encourage you to attend the conference, share your expertise with us and learn from your colleagues in the field. The Radisson is conveniently located within walking distance to the Pennsylvania Convention Center, where the American Public Health Association’s (APHA) conference will be held on November 8, 2009. We have blocked hotel rooms from November 4-7, 2009 for conference participants to book at a reduced rate of $189 per night. Given that APHA is in town, the hotel will sell out, so we strongly advise you to book your hotel rooms now. To make a reservation, please call 1.800.333.3333 and refer to the “NNCC 2009 Annual Meeting,” or go online at www.radisson.com/ philadelphiapa. For more information on how to register and present, please contact Kate Taylor at ktaylor@nncc.us or go online to register at www.regonline.com/2009NNCC.
www.NNCC.us p 3
NNCC UPDATE GREETINGS FROM NNCC EX-OFFICO CHAIRPERSON DR. CHRISTINA R. ESPERAT
G
reetings! I would like to take you through
have greater access to primary care and well-
the highlights so we can all bask together
ness services by creating a $50 million grant
in the achievements and happenings of the past
program to support nurse-managed health
couple of years...
clinics (NMHCs). The new grant program would
The first joint conference that we conducted
be placed within the Public Health Service Act
with the Community Service and Development
and be administered by the Health Resources
Trust of New Zealand, the New Zealand Nursing
and Services Administration’s Bureau of Pri-
Centers Consortium, entitled Global Healthcare
mary Health Care. In another a major step for-
Solutions for Vulnerable Populations was a great
ward, language supporting our grant program
success. The conference was an outcome of a
was included in the historic health care reform
2005 Eisenhower Fellowship Tine had in New
legislation currently being proposed by the
Zealand, and was held in Auckland, NZ, with par-
Senate’s Committee on Health Education La-
ticipants from such far flung places as Australia,
bor and Pensions. The changes in Congress
Ireland, Pakistan, and the United States conduct-
have mage the passage of major health care
ed discussions to address access to health care
reform legislation very likely. The inclusion of
from a community action, global and healthcare
our bill language in the Senate’s reform pro-
professional perspective. Specifically, the confer-
posal may give us the vehicle we need to make
We have continued in our ongoing activities
ence’s emphasis was on population-based and
the grant program a reality. For the NNCC, this
to provide a venue for nurse managed centers
community-based healthcare along with health
represents the culmination of our years of hard
throughout the country to share information
promotion and preventive care through nurse-
work to obtain federal support for the fiscal
and resources, through formal and informal
managed and nurse-led primary care and public
sustainability of our member centers. Now we
ways. Our other committees have been very
health programs. Plenary speakers included Min-
must keep up the pressure on our legislators to
active and productive, and have contributed
istry of Pacific Island Affairs Chief Executive Colin
ensure that funding for nurse-managed health
greatly to the work of the Consortium. For ex-
Tukuitonga; Director-General of Health Stephen
centers remains a part of health care reform.
ample, the Education and Program Committee
McKernan; and Diane Robertson from the Auck-
Please stay connected to us for updates and
is working energetically on planning for our
land City Mission. The NNCC was very well rep-
alerts regarding progress of these bills.
2009 Annual Conference, which is scheduled to
resented by a delegation that included Drs. Ken
Under the direction of Dr. Nancy Rothman,
be held in November 5-7, 2009 in Philadelphia.
Miller, Mary Jo Baisch, Tom Mackey, JoAnne Pohl,
Chair of the Quality Assurance and Research
We will keep everyone updated on the details of
Kate Fiandt, Joanne Pohl, Susan Antol, and Rebec-
Committee, a two-day workshop was convened
this upcoming program as they develop.
ca Wiseman and staff from NNCC, including Tine
in Independence Foundation headquarters in
As we move along through the remainder of
Hansen-Turton, Laura Line and Molly Pebberidge.
Philadelphia, to begin the work of developing
this year, let us continually remember our goals
We continue to work hard in the policy ad-
standards for nurse managed health centers.
as an organization: provide national leadership in
vocacy arena. Through the tireless efforts of
This effort will attempt to define, set and recom-
identifying, tracking, and advising healthcare pol-
our Executive Director, Tine, and Brian Valdez,
mend quality standards for member centers,
icy development; position nurse-managed health
Health Policy Manager, The Nurse-Managed
which can be to measure outcomes related to
centers as a recognized cost-effective mainstream
Health Clinic Investment Act of 2009 (formerly
client care elements, cost of care and nurse-
health care model; and foster partnerships with
S. 2112) was successfully reintroduced in the
managed health centers’ impact on health sta-
people and groups who share common goals.
U.S. Senate on May 20, 2009. The new num-
tus, as well as other standard elements still to be
Having these goals front and center, we will ful-
bered S. 1104 also has a companion bill HR
defined. Work on these standards will continue
fill our mission as an organization, which is to
2754 introduced in the House of Representa-
in the near future, which will hopefully culmi-
strengthen the capacity, growth and development
tives on June 8th 2009. This legislation would
nate in a set of standards that can be used for
of nurse-managed health centers to provide qual-
strengthen the nation’s healthcare safety-net
a variety of quality assurance and continuous
ity care to vulnerable populations and to eliminate
and ensure that the medically underserved
quality improvement purposes.
health disparities in underserved communities.
www.NNCC.us p 4
NNCC UPDATE GREETINGS FROM CHAIRPERSON DR. KEN MILLER
G
reetings and Happy Summer! 2009 brings
or actual provider of the care is the one who is
with it new challenges and new hope. Chal-
reimbursed. Educating legislators on the roles
lenges will always be integral to our mission
and scope of practice of both Nurse Practitio-
because without challenges there is no change,
ners and Nurse Managed Health Clinics will be
and without change there is no hope. Dr. Espe-
the first step in rectifying this wrong and will
rat in her outgoing Chair’s message reminded
also be congruent with our goals.
us of our goals as an organization, specifically:
Nurse Managed Health Clinics and nurse prac-
provide national leadership in identifying, track-
titioners represent a “safety-net” for the under-
ing and advising healthcare policy development;
served and vulnerable populations in our coun-
position nurse-managed health centers as a rec-
try. Data going all the way back to the mid-1970’s
ognized cost-effective mainstream healthcare
clearly shows that the quality of care provided by
model; and foster partnerships with people and
nurse practitioners is equal to or better than that
groups who share common goals. Keeping these
provided by our medical colleagues. In this age
goals in mind we are well positioned to work
of “designer specialties” family practice is not at
for change that will impact the healthcare that
the top of the list for medical school graduates.
we provide to the vulnerable and underserved
For the past 11 years there has been a decline in
populations in this country.
the number of US medical school graduates who
And finally, we must continue to work collab-
The current economic system and the new
choose family practice as their career choice.
oratively with all our national nurse practitioner
administration in Washington provide us the
However, during this same period of time there
organizations, as well as all other healthcare
perfect opportunity to actualize our goals.
has been a rapid increase in the number of nurse
providers who share our common goals, to en-
With the economy in a downward spiral, hun-
practitioners who choose family practice. The
sure that all people in this country have access
dreds of thousands, if not millions of people
difference between these two professions is such
to convenient, quality care, at a reasonable
will find themselves unemployed, and hence,
that we are educating 3.5 times as many family
price. We must speak with one voice so that
uninsured or underinsured. This will provide
nurse practitioners (FNPs) as compared to family
our message is heard, understood, and acted
us ample opportunity to affect healthcare poli-
practice physicians. It is primarily FNPs who staff
upon by those who control the federal dollars.
cy. As one example, the current Medical Home
these rural clinics and work in the underserved
The time is now. The new administration in
Demonstration Project, allows non-physician
areas of our inner cities. A part of our goal is to
Washington has as one of its top priorities the
providers (e.g. Nurse Practitioners, Physician
collect data to show our legislators that the qual-
revamping of our healthcare system. We are
Assistants, etc.) to provide the care as long as
ity services that we provide in our nurse man-
positioned as a profession by both our numbers
the payment goes to a physician. This is non-
aged health clinics is cost effective and deserves
and our scope of practice to be prime movers in
sensical policy. Why should one healthcare
federal support for sustainability of these clinics.
this challenge. Let us be active participants in
provider provide the service, and another be
We made some progress during the last session
this change, so that we can bring hope to those
reimbursed? We need to work with our legisla-
of congress but we must continue our efforts to
who are the most vulnerable.
tors to revise this policy so that the immediate
move this legislation forward.
www.NNCC.us p 5
NNCC UPDATE FROM THE DESK OF THE EXECUTIVE DIRECTOR TINE HANSEN-TURTON The Wheel of Progress...
I
not laid the groundwork throughout the U.S. in
n a recent trip to Disney World I went on the
positioning the advanced practice nurse to be at
Wheel of Progress. It was Walt Disney’s favorite
the forefront of the debate. Without your sacri-
ride and the most popular one for years. Wheel
fice and hard work over the past many decades,
of Progress takes you through time and shows us
the private sector would not have been as aware
how our life improves over time.
of the role of nurse practitioners and how they
During these tough economic times, we all
can expand access to care.
know that the need for accessible, affordable
Now, the best part of being on the policy
health care for all Americans has never been
radar is that key organizations start paying at-
greater. These days everyone reports frustra-
tention to you. Our new Obama Administration
tions about accessing much-needed health-
has said nursing will play a critical component
care services. All around the nation, policy-
in health care reform, and we will make sure
makers are feeling the consumer pressure to
nurse-managed care is on their radar. Don’t
get access when they want to and when it is
miss Dr. Keckley’s recent report from the Delo-
convenient to them, and they are taking notice
itte Center for the Future. He predicts what you
about the role advanced practice nurses and
already know, that the future of primary health
nurse practitioners can play in improving ac-
care lies with nursing.
and Alexander and Representatives Capps and
cessible, affordable, high quality care. For the
If you haven’t already, pick up a copy of Clay-
Terry to establish a nurse-managed clinic pro-
first time in history policymakers are seriously
ton Christensen’s latest book, “The Innovator’s
gram under the Bureau of Primary Healthcare,
talking about using advanced practice nurses
Prescription.” It provides an incredible insight
Health Resources and Services Administration.
as the solution to alleviating the burden on a
into the architecture of a disruptive innovation in
In addition to progress on the policy front,
strained system, which many now publicly call
healthcare, how disruptive innovations are game
a lot of new and exciting programs are being
a broken system of care or a “non-system” of
changers, and I think you will see how the nurse-
implemented in nurse-managed centers. We
care. This time the nurse’s role is talked about
managed and nurse-led movement has been a
are reporting on many of these programs and
in a much broader sense. Nurses have gradu-
disruption to traditional primary care. We would
services we provide, and I hope you take the
ated from being good enough to take care of
not have seen all the progress in the advanced
chance to read the Update.
the vulnerable, to taking care of everyone!
practice movement without many of you being
That’s progress, as Walt Disney would have
the for-runners and mavericks for change!
said, in the Disney World ride, he was most proud of “The Wheel of Progress”! While the buzz is not directly about us or nurse-managed health centers, I strongly be-
Finally, I want to thank Sormeh Harounzadeh, who was our Independence Blue Cross
Also look for other key studies from RAND,
nurse intern and our wonderful co-editor of
Health Affairs and the California Healthcare
this Update. Sormeh wrote about her experi-
Foundation, where the role of nurse practitioners
ence at the National Nursing Centers Consor-
in primary care roles is being clearly explored.
tium, and there is nothing more gratifying than
lieve that all of you were one of the main cata-
It is also an exciting time for the National
to read about your work through someone
lysts for this change. There would most likely not
Nursing Centers Consortium. For the first time in
else’s lenses and know you have awakened
be a retail clinic movement, had so many of you
history, a bill was introduced by Senators Inouye
their passion. Enjoy!
www.NNCC.us p 6
NNCC UPDATE Message from the Board of Directors
W
e are very pleased to report the NNCC has
• Genuardi’s Family Foundation
continued to see significant growth in staff
• Pew Charitable Trusts
and programs that support nurse-led health care.
• Children’s Health Fund
This newsletter captures some of these success-
• Institute for Nursing Centers
es. At the core of our success is the willingness
• The Philadelphia Foundation
of everyone in the Consortium to share learning
• The American Legacy Foundation
with one another. The majority of our programs
• Mercy Hospital of Philadelphia
have sprung out of best practices from individual
• The Robert Wood Johnson Foundation
health centers that decided to share the programs
• William Penn Foundation
with the NNCC and make them available to col-
• The Beck Institute for
leagues around the country. We are very fortu-
Cognitive Therapy and Research
nate to have supportive funders. Special thanks
• The Connelly Foundation
to the following partners for funding support:
• The 25th Century Foundation
• Independence Foundation
• The Edna G. Kynett Memorial Foundation
• The U.S. Environmental Protection Agency
• St. Christopher’s Foundation for Children
• The U.S. Department of Health and Human
• The U.S. Department of Health
Services, Region III • The U.S. Centers for Disease Control and Prevention • The U.S. Department of Housing and Urban Development • The U.S. Health Resources and Services Administration • The Pennsylvania Department of Public Welfare
and Human Services Region 3
We also want to send our thanks to the cor-
• The Philadelphia Department of Recreation
porate sponsors of Students Run Philly Style.
• The Tasty Baking Foundation
They are: Philadelphia Distance Run, CMF As-
• The Saucony Run for Good Foundation
sociates, Fast Tracks Running Club, Kohl’s Inc.,
• Claneil Foundation
CIGNA Foundation, PREIT Associates, D’Lauro
• The Douty Foundation
and Rogers, Brandywine Realty Trust, The Goff
• The Pennsylvania Department of Community and Economic Development
Program, Klehr Harrison, Philadelphia Insurance Company, University of Phoenix, Resource
• The Pennsylvania Department of Health
• The Honickman Foundation
Capital, Intelliscan, Dilworth Paxson, Stockton
• The Philadelphia Department of Public Health
• The Barra Foundation
Real Estate Advisors, The Sporting Club at the
• The District of Columbia Department of Health
• The Lenfest Foundation
Bellevue, Stradley Ronon, Tri-State Multisport
• The United Way of Southeastern Pennsylvania
• Public Health Management Corporation
Association, Berwind, and Eastern Janitorial.
• The Van Ameringen Foundation
• The Samuel P. Mandell Foundation
• Irene and Kenneth Campbell Foundation
• The South Florida Health Foundation
well as private, corporate, and individual donors.
• Chartered Health
• The Hagan Foundation
We appreciate them all for their ongoing sup-
• E. Rhodes and Leona B. Carpenter Foundation
• Phillies Charities, Inc.
port. We are also grateful for our dedicated staff
• Women’s Way
• Boscia Family Foundation
and member center and community volunteers
• Susan G. Komen for the Cure
• DMS Children’s Foundation
who continue to work tirelessly and demonstrate
• GlaxoSmithKline
• Harold A. and Ann Sorgenti Foundation
their commitment to our vision and mission.
Finally, we thank all NNCC member centers, as
www.NNCC.us p 7
NNCC UPDATE NNCC Programs Health Promotion, Wellness and Training Program Highlights:
A
pproximately 50% of the funding
First Steps Autism
through PHMC affiliate sources and a
NNCC raises through grants goes
Spectrum Disorder (ASD) Program
grant from the CDC. In addition to the
directly to member health centers. In ad-
In December NNCC received a Pew Fund
CDC-funded work in the Haddington area,
dition, all services provided at the NNCC
capacity building grant to develop the First
the program’s classes are incorporated
directly benefit its member nurse-managed
Steps for Autism program, our family-cen-
with Go Red for Women Philly. Over 500
health centers. Along with the support of
tered, home visiting program for families
people participated in the programs.
member centers, over the past nine years,
with a child suspected or diagnosed with
NNCC has successfully developed several
an autism spectrum disorder. The $23,133
Lead Free Philly
signature health promotion programs, such
grant allows the NNCC to bring together
The NNCC completed this grant from the
as Lead Safe Babies, an in-home primary
stakeholders in southeast Pennsylvania
Environmental Protection Agency that en-
prevention program to prevent lead poi-
to brainstorm research and practices for
sured that newborns and their caregivers
soning in children; Asthma Safe Kids, an
early intervention services to families; a
in Philadelphia are connected to lead poi-
in-home asthma management and trigger
national scan of research and practices;
soning prevention resources. The NNCC’s
reduction program; the Beck Fellowship
as well as program development and plan-
Lead Outreach Referral Manager worked
which trains Certified Registered Nurse
ning for developing the most effective and
closely with the City of Philadelphia’s
Practitioners in use of cognitive therapy;
efficient program for helping low-income
Childhood Lead Poisoning Prevention Pro-
Healthy Homes, an indoor environmental
families receive the services they and their
gram with data from a birth database of
health hazard assessment program, To-
children need.
all caregivers of newborn babies in Phila-
bacco Cessation, which offers adults coun-
delphia. In 2008, over 25,000 letters were
seling to end tobacco use, Autism home-
Healthy Homes for Child Care
sent to families with newborn babies to
visiting, and Students Run Philly Style, a
With the signing of the American Recovery
inform them of lead prevention services
long-distance running and mentoring pro-
and Reinvestment Act, we were pleased to
available to them. Over 700 families were
gram for youth.
see the U.S. Housing and Urban Develop-
referred into the Lead Safe Babies pro-
The following are program accomplish-
ment Agency fund two proposals submitted
gram. In addition, reminder postcards are
ments in 2008:
last fall: one, the Healthy Homes for Child
sent to all families once their babies reach
Care grant with the City of Philadelphia’s
nine months of age to remind them to have
Asthma Safe Kids
Childhood Lead Poisoning Prevention
their children tested for lead. At the end of
NNCC announces a new and exciting
Program, and the District of Columbia’s
the grant, CLPPP planned to carry forward
partnership with Keystone Mercy Health
Department of Health. We are partners in
the campaign themselves. However, with
Plan to reduce emergency department
both of these grants and the funding will
city budget cuts (and no renewal funding
utilization for children with asthma. In
allow us to continue important work and
from the EPA), the program was eliminat-
this $81,847, one-year pilot, a NNCC staff
support the staff involved.
ed. This great resource of families is cur-
member works with families who fre-
rently not being utilized. We hope it will be
quently visit the emergency room for their
Heart and Soul
child’s asthma. Through this expansion of
The NNCC continued to operate the Heart
the Asthma Safe Kids program, our staff
and Soul program, a cardiovascular risk
Lead Outreach Program
member will act as an asthma coach for
reduction program, administered in select
In this two year grant, NNCC staff educated
the family to ensure parents are following
health centers, PHMC programs and af-
2,763 caregivers, far exceeding the prom-
their child’s asthma action plan and visit-
filiates, and the local community. For the
ised 2200 educated. We currently have a
ing their primary care provider regularly.
2008 fiscal year, funding was expanded
six month extension into March 2009 to
renewed in the future.
www.NNCC.us p 8
NNCC UPDATE complete grant spending and additional
Councilman Jim Graham.
outreach in the DC community. In 2008
education workshops. We received this U.S.
This groundbreaking bill will require
staff reached over 1,800 at-risk families
Department of Housing and Urban Develop-
landlords and property owners to test all
through home visits, community health
ment funding in late 2006 to launch a cam-
rental properties for lead if an incoming
center workshops, health fairs and em-
paign to raise awareness of the dangers of
tenant has a child less than 6 years of age
bassy seminars for new citizens. NNCC
lead poisoning to children in hard-to-reach
or is pregnant. It is the first time the na-
continues to seek funding to expand this
communities in Philadelphia. This program
tion’s capital has adopted such far-reaching
program to member centers nationally.
supports the efforts of Lead Safe Babies of
public health policy and proactive environ-
NNCC, and the Child Lead Poisoning Pre-
mental testing. “Before this law, the policy
Lead Safe Homes Study
vention Program (CLPPP) of the Philadel-
of this city was essentially to use children
The study, funded by the U.S. Department
phia Department of Public Health (PDPH),
to test the safety of homes in the District,
of Housing and Urban Development to de-
providing referrals from all over Phila-
like sending canaries into a coal mine,”
termine appropriate lead poisoning inter-
delphia. Over 830 people were referred to
said Newton. “This law turns the page
ventions and their impact, ended this fall.
home visiting/remediation offered by NNCC/
on that policy, giving at-risk families the
The study recruited, enrolled, and collected
CLPPP, more than 200 of these in 2008.
chance to determine if their new home is
data on over 300 low-income newborn ba-
safe before they move into it. It’s a primary
bies and their families. The study is in its
Lead Safe Babies
prevention approach that supports the mis-
final collection phase, and results are ex-
NNCC has been funded through the City
sion of eliminating health disparities.”
pected in early 2009. In October 2008, the
of Philadelphia and Washington, D.C. to
The major provisions of the new law
principal investigator presented preliminary
conduct the Lead Safe Babies, primary
include:
findings at the American Public Health As-
prevention home-visiting program through
zz All children beneath the age of 6 and
sociation conference. More dissemination
2011 through CDC grants. In 2008, NNCC
pregnant women are now due a unit-
staff and member centers in Philadelphia
wide lead clearance test before they
reached over 1,400 families directly with lead poisoning prevention education.
move into a rental unit. zz Families who add children to their home
is planned once results are finalized. North Philadelphia Breast Health Initiative
AFTER moving into a property can gain
The NNCC was funded by the GlaxoSmith-
testing at the request of the Mayor.
Kline’s Community Partnerships to ad-
In perhaps the most public health ground-
zz Any peeling, chipping or flaking paint
minister a breast health program in North
breaking program news this year, the
in a pre-1978 home is now a “presumed
Philadelphia. The NNCC has partnered with
NNCC was at the forefront of new man-
lead hazard” until the owner proves oth-
Temple Health Connection and 11th Street
datory lead testing for families at risk of
erwise and can be cited as a hazard vio-
Family Health Services of Drexel University
poisoning in Washington, DC. A new bill
lation under lead laws. The onus now
to increase the number of predominantly
was passed in City Council on December
lies on the landlords to prove the peel-
low-income, African American women over
16, 2008 that represents one of the most
ing paint is NOT a hazard. * The Mayor
40 years of age who receive mammograms.
far-reaching policy changes across the
can now initiate vast primary preven-
The program’s goals are to provide referrals
country in support of preventing lead poi-
tion policies, proactively conducting
for at least 140 women to receive a mam-
soning in children. The bill was conceived
lead inspections in dwellings in which
mogram from a mobile unit that will visit
by the DC Lead Elimination Task Force,
data shows risks are highest or popula-
the centers, and refer at least 180 women to
tions are most vulnerable.
receive a mammogram from the University
Lead Safe DC
a group of more than 30 medical professionals, academic researchers, housing
zz The law stipulates that the D.C. govern-
College of Medicine/Tenet Women’s Health
experts, healthcare providers and non-
ment is responsible for providing risk
Project and Temple University Hospital.
profits. For its 3 years in existence, the
assessments (specialized testing and
This initiative will serve as a pilot program,
Task Force has been led by Harrison
hazard remediation planning) in the
and an additional aim to expand the pro-
Newton, director of NNCC’s Lead Safe
homes of lead poisoned children.
gram in the future to other NNCC-member
DC program. The bill was sponsored by
Lead Safe D.C. continued building its
nurse-managed health centers in the Phila-
*The law creates the dust sampling technician position, which will allow for lower cost lead testing in the District. It’s a new legal discipline that has never existed in Washington D.C.
www.NNCC.us p 9
NNCC UPDATE delphia region that treat underserved wom-
improved their financial management skills;
marathon (13.1 miles), and twenty-one
en who are at high risk of developing breast
twenty have been placed in safer or more
students ran the 8K (5.1 miles). Thirty-six
cancer. The program is scheduled to start at
stable housing situations. This project is es-
leaders ran the full marathon, nine lead-
the beginning of 2009, so no outcomes have
sential as NFP nurses report that newly en-
ers ran the half, and four leaders ran the
been reported.
rolled clients are younger, poorer, and more
8K. Note that 100% of students and lead-
resource-challenged than ever before.
ers completed all three events! Students Run Philly Style in the past year also sig-
Philadelphia Nurse Family Partnership As the state of Pennsylvania grapples
Referral Management Initiative
nificantly developed the membership and
with budget challenges, we are pleased
The Referral Management Initiative, de-
participation of its Advisory Board and
to receive news that the Department of
signed to connect and support primary
increased the educational and professional
Welfare will continue to fund the Nurse-
care referrals with specialty care follow-
opportunities available to its students.
Family Partnership at level funding. The
up, received further commitment from
Students Run Philly Style had a great
Nurse-Family Partnership also received
GlaxoSmithKline via the Children’s Health
kickoff event on March 7th for its 5th sea-
a one-year, $16,000 grant from Women’s
Fund who granted the NNCC another one-
son, continuing with record growth. Over
Way. After opening up the proposal pro-
year, $50,000 grant.
six hundred youth came out to sign up for
cess for competitive bidding this year,
the program at the event at Franklin Field.
Pennsylvania’s Department of Public Wel-
Southwest Philadelphia
The event received coverage on 6ABC, in
fare again awarded the grant to the NNCC
Breast Health Initiative
The Bulletin and The Philadelphia Tri-
to continue providing the replication model
We are pleased that Susan G. Komen for
bune. More than eighty percent of the
of the Nurse Family Partnership (NFP) in
the Cure will fund our Southwest Breast
mentors will return to lead teams towards
Philadelphia. The Department of Public
Health Initiative for a second year, $40,000
November’s Philadelphia marathon. On
Welfare’s renewal commitment lasts until
grant. This program has made great prog-
the funding front, in addition to individual
2012. The grant will support existing ser-
ress partnering with the Fox Chase Can-
and corporate donations, Students Run
vices and support exploration for expansion
cer Center mobile mammography van and
received the following two grants over the
to serve more high risk, low-income first
the Health Annex nurse-managed health
last quarter:
time mothers who reside in Philadelphia.
center to ensure African-American women
zz Edna G. Kynett Memorial Foundation –
In fiscal year 2008, NFP served over 500
over forty years of age receive annual mam-
families. As of March 2009, there are 377
mograms, significantly exceeding first year
actively enrolled participants, and approxi-
expectations.
mately 180 babies. Seventy-five mothers/
a one-year, $15,000 grant. zz Independence Foundation – Students Run challenge grant – 2010-2011 $30,000. Additionally, NNCC is excited to announce
toddlers completed program in calendar
Students Run Philly Style
that Students Run Philly Style has been
year 2008. NFP is actively recruiting for
NNCC’s program Students Run Philly Style
selected as the named charity for the 2009
an open nurse home visiting position.
completed it’s fourth season this year, cul-
Philadelphia Marathon, a partnership direct-
Another milestone this year for the NFP
minating with the Philadelphia Marathon
ly resulting from four years of relationship
was creating and funding a social worker
Events on Sunday November 23rd. The
building on the part of Students Run staff.
position to focus on housing retention and
NNCC is pleased to report that Students
life skills training for the NFP clients. NFP
Run Philly Style served over 450 students
Tobacco Cessation
received a three-year grant from the Pew
this past year, 260 of whom participated in
For fiscal year 07-08, NNCC continued to
Fund for Health and Human Services for
the Blue Cross Broad Street Run in May
provide the community tobacco cessation
this important effort to increase client re-
and 100 of whom took part in the Philadel-
classes, “Be Free From Nicotine” in 6 lo-
tention in the program and stability in their
phia Half-Marathon September 21st. Stu-
cations with approximately 140 people
housing situations. The Philadelphia NFP is
dents Run had more than triple the number
participating. For fiscal year 08-09, NNCC
the only NFP in the country to experiment
of students run the Philadelphia marathon:
continues to provide “Be Free From Nico-
with this effort. Since the housing specialist
sixty-five students ran the full marathon
tine” in 5 locations and expects to serve
started in July 2008, over 60 clients have
(26.2 miles), thirty students ran the half
as many or more than the prior year. NNCC
www.NNCC.us p 10
NNCC UPDATE received a second (and final) year of fund-
nally, Women Go Red Philly Style encour-
its entirety and increase the scope of ser-
ing from the American Legacy Foundation
ages integrating policies that promote car-
vices it offers to consumers and mental
for the “Stay Quit, Get Fit” program, allow-
diovascular health into all aspects of daily
health professionals. To do this effectively,
ing staff to expand it to two centers: PHMC
life. Staff has held three advisory board
ACT contracted with the National Nursing
Health Connection and Abbottsford- Falls.
meetings with active participation from the
Centers Consortium for executive manage-
Stay Quit, Get Fit combines smoking ces-
City of Philadelphia Department of Health
ment support, including the employment of
sation with exercise and primary care for
and other key stakeholders, including
the Executive Director and the provision
a comprehensive approach focusing on
Temple University. Staff has finalized with
of administrative support services. With
decreasing chronic illness. In its first year
partners the kiosks with the educational
qualified, diverse and active members, a
the program completed five classes (seven
material for women. The program kickoff
widely utilized website (www.academyofct.
weeks each) and reached 67 participants
occurred in January 2009.
org), and sound organizational foundation,
with cessation counseling and exercise.
ACT is well-positioned to promote mental
The first year evaluation showed a statisti-
Women’s Health Week
health awareness and cognitive therapy as
cally significant reduction in the number of
NNCC has again been selected by the U.S.
an evidence-based treatment.
cigarettes that participants smoked at the
Department of Health and Human Ser-
The Academy of Cognitive Therapy
end of the class. Three months later 58%
vices, Region 3 (HHS) to coordinate a se-
(ACT) is a non-profit mental health or-
of participants had reduced their tobacco
ries of public events in collaboration with
ganization founded by leading experts in
use. Seventy-four percent of participants
member centers during National Women’s
the field of cognitive therapy to improve
reduced their body mass index and par-
Health Week (May 10-16, 2009). NNCC
mental health outcomes. Specifically, ACT
ticipants showed a statistically significant
will provide funding and administrative
works to (1) ensure that consumers in ev-
improvement in actual lung capacity. Many
and program support to 13 partner sites,
ery community have access to high-quality,
participants began or were re-engaged in
including member centers in Region 3.
effective cognitive therapists, (2) promote
managing their chronic diseases through
These events are planning to reach over
and integrate cognitive therapy at all levels
the primary care center. In its second year,
2,800 women with outreach, health educa-
of health care and social services, and (3)
the first class already attracted 38 partici-
tion and screening services.
strengthen cognitive therapy research to
pants. NNCC staff also significantly con-
continue to improve outcomes and respond
tributed to a study proposal (pending ap-
Bayer Partnership
to changing mental health issues. ACT has
proval) to the National Institutes of Health
In another exciting new venture, the NNCC
been governed and managed solely by its
to study exercise and other variables in the
is partnering with Bayer to improve the
Board of Directors since 2001. The organi-
Stay Quit, Get Fit program.
diabetes self management of African-
zation had focused primarily on educating
Americans in Philadelphia. A NNCC staff
consumers and professionals through its
Go Red for Women Philly
member will attend 15 events in the Afri-
website and certifying clinicians in cog-
NNCC has been implementing this new
can-American community (primarily con-
nitive therapy. ACT has over 700 highly
program from the Pennsylvania Depart-
nected to AME churches) over the next six
qualified, active members from a variety
ment of Health and partnership with the
months assessing those at risk for diabe-
of backgrounds including medicine, psy-
American Heart Association. The Go Red
tes and demonstrating how to use a glu-
chology, psychiatry and social work and a
for Women program works to improve the
cometer to monitor one’s diabetes before
well-respected and popular website (over 3
heart health of African-American women
and after meals.
million hits in 2007).
places where they work, live, and receive
HEALTH PROMOTION AND PREVENTION
been seeking grant funding to conduct con-
their health care. Additionally, the pro-
HIGHLIGHTS
sumer education, training of mental health
gram trains health care providers work-
In April 2008 the Board of Directors of
professionals, and research to promote the
ing in low-income communities on current
the Academy of Cognitive Therapy hired
cognitive therapy as a cost-effective, cul-
clinical guidelines for cardiovascular risk
its first Executive Director, Michelle
turally appropriate model of care.
assessment and treatment of women. Fi-
O’Connell, in order to fulfill its mission in
35 to 64 years of age by engaging them in
Since partnering with the NNCC, ACT has
www.NNCC.us p 11
NNCC UPDATE Hold the Date for our Southeastern regional workshop! The Health Center Empowerment Project (HCEP), a HRSA-funded program awarded to NNCC, is comprised of five regional workshops designed to provide training and technical assistance regarding three key areas: zz Program management and capacity building for participation in the HRSA health center program; zz Best practices for health outreach programs; and zz Maximizing non-HRSA funding sources to ensure long-term financial sustainability. The HCEP workshops provide training and technical assistance in these areas by helping health centers serving residents of public housing achieve sustainability, and increase the quality and availability of outreach programs designed to prevent disease and improve health outcomes. The next regional summit is being held in the Southeastern region - HHS Region 4, representing North Carolina, South Carolina, Kentucky, Tennessee, Georgia, Alabama, Mississippi, and Florida - in Nashville, TN on September 25, 2009. Our host is Bonnie Pilon, DSN, RN, BC, FAAN, Senior Associate Dean for Faculty Practice, School of Nursing of Vanderbilt University. At all regional summits, experts will provide trainings and workshops designed to increase the capacity of health centers to provide high-quality care to residents of public housing. Health center staff will also have access to an online resource center, an online course, peer mentoring opportunities, conference calls with experts and face-to-face training sessions.
For more information, please visit http://nncc.us/workshops/HCEP_SE.html
Institute for Nursing Centers Update by Joanne M. Pohl, PhD, APRN, BC, FAAN
T
he Institute for Nursing Centers, in
the summer. The partnership model used
the same process. The project is currently
partnership with Alliance of Chicago
in this project maximizes resources and
collecting initial data on contextual fac-
and Coker Group, continues to support
brings in expertise and support from vari-
tors, computer literacy, clinician (end-us-
EHR readiness evaluations and implemen-
ous technical experts in health information
er) satisfaction, clinician performance and
tation in Nurse Managed Health Centers
technology, nurse informatics, data analy-
medication safety and productivity. Some
around the country. Three different NMHCs
sis and statistics.
of the results will be available by the next
(Wayne State University, Glide Memorial
While implementing the programmatic
Health Center and Arizona State Univer-
and technical aspects of EHR, INC staff
The project received funding from the
sity) are in full swing implementation and
are collecting data and analyzing the fac-
W.K. Kellogg Foundation and the Agency
Wayne State University celebrated their
tors that lead to successful implemen-
for Healthcare Research and Quality and is
“Go-Live” in February 2008. INC continues
tation and compiling lessons learned.
fully in-line with INC’s goals of promoting
to help more NMHCs with site assessments
Concurrently, INC is researching patient
the contribution NMHCs make in deliver-
and implementation recommendations and
outcomes, provider performance and pro-
ing high quality health care to vulnerable
intends to bring approximately five more
vider satisfaction. This information will be
populations.
NMHCs into full partnership by the end of
vital to other NMHCs who begin to realize
NNCC newsletter.
www.NNCC.us p 12
NNCC UPDATE Spotlight on New NNCC and Member Programs by Naomi Starkey
Go Red for Women Philadelphia
of the general population in the US.
train healthcare providers in Philadelphia
Funded by the State of Pennsylvania in
zz 13% of women and 16% of African
Department of Public Health centers and
April 2008, Go Red for Women Philadelphia
Americans in Philadelphia have been
NNCC nurse-managed health centers in
is the NNCC’s newest health promotion pro-
diagnosed with diabetes – double the
current clinical guidelines around prevent-
gram. Go Red works to improve the heart
rate (7.5%) of the rest of the general
ing and treating heart disease in their pa-
population.
tients. These trainings will be conducted
health of Philadelphia’s African-American women in the places where they work,
There are also other factors that contribute
through a partnership with the American
live, and receive their health care. The
to disparities in cardiovascular and heart
Heart Association, and will include a day-
program trains health care providers work-
health among African American Women.
long event in celebration of Heart Disease
ing in low income communities on current
Some are lifestyle-related, such as busy
Awareness Month in February. Finally,
clinical guidelines for cardiovascular risk
working families and community stresses.
the program also contains a strong policy
assessment and treatment of women. It
Others are related to the quality of health-
development aspect. All partners will col-
also educates women in community, health
care, such as the use by providers of non-
laborate to work towards larger-scale sys-
care, and workplace settings about how to
standard care that ignores evidence-based
tems change that will improve the culture
reduce their risk of cardiovascular disease.
guidelines and patient education about car-
of knowledge and understanding of heart
Go Red for Women also encourages inte-
diovascular disease risk reduction. Larger
disease in Philadelphia’s African American
grating policies that promote cardiovascu-
systems and policy factors at the local and
Women.
lar health into all aspects of daily life.
employer levels, such as the unavailability
The Go Red for Women Program is cur-
The need in Philadelphia for a program
of healthy foods and supermarkets and
rently in its beginning phases, and will be-
like Go Red for Women is great. The rate
limited work-site promotion of health be-
gin reaching the community in fall 2008.
of heart disease among African American
haviors, also contribute to the occurrence
If you have questions about the program,
women is substantially greater than other
of heart disease in the African American
please contact Naomi Starkey, Go Red for
women. This is in large part due to risk fac-
population of women in Philadelphia.
Women Program Coordinator, at nstar-
tors that disproportionally affect African
With the Go Red for Women Program,
American women, including low income,
the NNCC is partnering with the Health
poor diet and exercise behaviors, and lack
Promotion Council, the City of Philadel-
of knowledge and awareness. To illustrate
phia, the American Heart Association,
Southwest Philadelphia Breast Health Initiative
this point, here are a few facts about the
Temple University, Public Health Manage-
The NNCC was recently funded by the
health status of African American women
ment Corporation (PHMC), and St. Andrew
Susan G. Komen Breast Cancer Founda-
in Philadelphia:
Development, Inc. to bring opportuni-
tion to implement the Southwest Breast
zz 30% of women and 35% of African
ties for heart health education to women
Health Initiative, which is a new and ex-
Americans in Philadelphia are charac-
where they work, live, and receive their
citing initiative for the NNCC to address
terized as obese, compared to 25% of
healthcare. Women in workplace settings
breast health and cancer. The program
the general population in the US.
key@nncc.us or 215.731.7143.
at Temple University and PHMC’s behav-
is a partnership between the NNCC, the
zz 35% of women and 42% of African
ioral health centers will receive education
Health Annex and Drexel University Col-
Americans in Philadelphia have been
through interactive touch-screen kiosks
lege of Medicine/Tenet to provide free and
diagnosed with high blood pressure,
designed with St. Andrew Development,
low-cost breast cancer education, screen-
compared to 25% of the general popula-
Inc., and also in-person through on-sight
ings and treatment to underserved women
tion in the US.
Health Promotion Council staff. They will
in Southwest Philadelphia. The project
zz 25% of both women and African Ameri-
have the opportunity to participate in exer-
will reach 500 women in the targeted area
cans in Philadelphia have been diagnosed
cise groups, cooking demonstrations, and
through outreach and community connec-
with high cholesterol, compared to 17%
health fairs. Go Red for Women will also
tions, providing education on the manage-
www.NNCC.us p 13
NNCC UPDATE for at least 140 women to receive a mam-
coordinate care and provide referrals for
North Philadelphia Breast Health Initiative
women who need screenings, such as clin-
The NNCC was funded by the GlaxoSmith-
the centers, and refer at least 180 women
ical breast exams and/or mammograms,
Kline’s Community Partnerships to ad-
to receive a mammogram from the Univer-
and it will also coordinate any follow-up
minister a similar breast health program
sity College of Medicine/Tenet Women’s
care with Drexel and other convenient fa-
in North Philadelphia. The NNCC has
Health Project and Temple University
cilities for the participants. The goals of
partnered with the PHMC Health Con-
Hospital. This Initiative will serve as a
the program are to increase knowledge of
nection and 11th Street Family Health
pilot program, and an additional aim to
breast cancer among women in communi-
Services of Drexel University to increase
expand the program in the future to other
ties with exceptionally high rates of death
the number of predominantly low-income,
NNCC-member nurse-managed health cen-
from disease, and to increase their access
African American women over 40 years
ters in the Philadelphia region that treat
to early screening services, diagnoses,
of age who receive mammograms. The
underserved women who are at high risk
treatment and support.
program’s goals are to provide referrals
of developing breast cancer.
ment of breast health. The service will
mogram from a mobile unit that will visit
NNCC: Working to Eliminate Community Health Disparities by Sormeh Harounzadeh, Independence Blue Cross Nurse Intern
R
esolving community health issues
however, these alternatives are not perma-
The NNCC makes it possible for nurse-
challenges health care professionals
nent and they are often run by student vol-
managed health centers to provide care to
and policy makers alike. How is it pos-
unteers. Most clinics are only open once a
many people throughout the country. In
sible to provide efficient and cost-effective
week for several hours at a time and health
addition to their work for nurse-managed
primary care to large populations in cities
fairs are only held a few times a year. One
clinics, they have created various different
such as Philadelphia, where many are un-
solution that is promoted and supported by
outreach programs that seek to educate
insured and underinsured? There is poor
the NNCC is nurse-managed health centers.
members of the Philadelphia community.
access to health care and many people
These centers provide a permanent solution
These programs are truly changing people’s
are not educated about utilizing available
that increases access to health care both fi-
lives by providing them with education and
resources. Proper education and interven-
nancially and geographically.
support to make healthy decisions. During
tion can help eliminate many of the health
In order to meet the health care de-
my summer at the NNCC, I went on Lead
consequences from which people suffer.
mands of this country we must work to
Safe Homes visits with outreach workers,
As a nursing student at the University
lift the negative stigma that surrounds
Tameka Wall and Nina Howze. Lead Safe
of Pennsylvania, I have had two clinical
the nurse as a primary care provider. As
Homes is a program that educates new
courses in community health where I was
a nursing student, I have witnessed this
mothers about the threats of Lead Poison-
taught about primary care prevention and
pessimistic attitude first hand. Some peo-
ing and provides them with cleaning sup-
education. However, we never addressed
ple believe that nurses are not adequate
plies and a free home renovation if neces-
the topic of accessibility. This is the ques-
or educated enough to hold the position of
sary. One day, I even helped a coworker
tion that the National Nursing Centers
primary care provider. Although I have yet
stuff countless envelopes that would be
Consortium deals with everyday.
to work in a clinical setting, my observa-
sent out to thousands of new mothers in
There are different organizations and
tions in a hospital shadowing experience
the Philadelphia area and offer them the
groups that organize health fairs and open
led me to believe that the nurse practitio-
opportunity to have their homes screened
volunteer clinics to provide primary care for
ner runs the entire floor. During the four
for lead. The benefits from such a program
free. I have volunteered as a nursing stu-
hours on the OB floor I saw three post-
are clear, and it would be truly unfortunate
dent at a free clinic in South Philadelphia
partum bellies, eight nurses, two check in
if the program did not eventually develop
and I think they provide excellent services,
meetings, but not one doctor.
throughout the United States.
www.NNCC.us p 14
NNCC UPDATE Colleagues in the News: The NNCC also runs a Tobacco Cessation
tine addiction, but she offered suggestions
Member Awards and Recognitions
class that I attended. Elizabeth Byrne, the
on stress management and positive overall
PHILADELPHIA
counselor who runs the class, invited me
health choices. She emphasized the impor-
The 11th Street Family Health Services Center of Drexel
to one of her afternoon sessions. The class
tance of exercise and recommended forms
University was selected as a national model for care delivery
was held in a public library meeting room,
of massage therapy. It was a holistic health
by Innovative Care Models, announced Dr. Gloria Donnely,
which led me to believe it would be simi-
approach where both mental and physical
dean of Drexel’s College of Nursing and Health Professions.
larly to elementary D.A.R.E. classes where
aspects of health were addressed. Her ad-
The Center was among just 24 “acute care,” “bridge con-
people are lectured on the negative effects
vice was well received and appreciated by
tinuum” and “comprehensive care” organizations named
of drugs and alcohol. I never expected a To-
a crowd who desperately needed to escape
national models as part of a research project conducted by
bacco Cessation class to impress or move
a deadly habit. It is no surprise that in the
Health Workforce Solutions LLC and funded by the Robert
me, but as the seats filled and the crowd
past year, the program has reached 140
Wood Johnson Foundation.
started talking, the meeting was filled with
people, 69% of whom finished the class and
revelations and connections. People offered
of those finishers, 54% have quit smoking.
each other help and listened to experiences
The past success of NNCC’s programs
that could perhaps help them deal with
has led to their continued funding by the
what they were going through. People excit-
government and other sources. We can only
edly walked in the room with news that they
hope that nurse-managed primary care and
hadn’t smoked in three days or one week
wellness clinics as well as programs such
and were met with applause and genuine
as Lead Safe Homes and Tobacco Cessation
happiness from the rest of the crowd. What
will spread across the United States and be
may seem like a trivial accomplishment to
adopted by other organizations. Our coun-
a non-smoker is actually a world of success
try is in a health care crisis. NNCC’s primary
for someone who wakes up in the middle of
care prevention programs seek to rectify this
the night for a cigarette.
problem on a small scale, but it’s not enough.
Every couple of minutes there was
The problem now is awareness. People may
some coughing in the room that sent chills
still believe in the fatuous claim that nurse
down my spine. Many of the people in the
practitioners are not as qualified as primary
program had been smoking for the major-
care physicians, but there is no denying
ity of their lives and the negative effects
that in order to deter the growing health
were obvious. This was literally their last
disparity, nurses must be better utilized,
chance to overcome the addiction before it
and their scope of practice expanded.
became too late. Two people were already The Center, which is partnered with Family Practice and
suffering from COPD and many of them
Counseling Network, opened in 2002 through a partnership
said they had trouble breathing. Seemingly
between the North Philadelphia community and Drexel’s Col-
young women had visibly thinning hair and
lege of Nursing and Health Professions that began in 1996.
yellow-stained teeth. It is a morbid thought
It provides a comprehensive range of health services, in-
that some of these people will not be able
cluding physical examinations, diagnosis and treatment of
to quit smoking and will probably die from
illness, family planning, health maintenance and disease
the complications of tobacco use. But at
prevention services, dental, nutrition, physical fitness and
the same time I am optimistic because this
behavioral health.
program is giving them hope.
Its combination of behavioral-health services, which are
Elizabeth was an exceptional counselor.
integrated into daily care to improve the effectiveness and ef-
She was both knowledgeable and compassionate about the topic. Not only did she give examples of how to overcome a nico-
www.NNCC.us p 15
NNCC UPDATE Colleagues in the News:
Data Talks
ficiency of treatment, makes the Center unique in Greater Philadelphia. The Center’s transdisciplinary care team comprises a nurse practitioner and primary behavioral health consultant. Depending on patients’ needs, the teams may also include a health educator-nutritionist, physical therapist and dentist. Using a care team enables disciplines to learn from each other, as each provider learns from the other’s role.
NNCC Data Mart Research Network
T
he NNCC continues to manage a re-
nating research findings. Funded through
search network of nurse-managed
generous support from the Independence
health centers that are collecting data
Foundation and previously the Indepen-
electronically and pursuing research op-
dence Blue Cross Charitable Medical Care
The Center is a one-stop shop for health and wellness. It offers
portunities. Four participating nurse-man-
Program, the research network is con-
patients a centralized location to receive health and wellness
aged health centers went live with the Mi-
sidered a PBRN (practice-based research
services. Its holistic approach augments primary, behavioral
sys electronic medical record in July 2007.
network), registered with the Agency
and dental care with chronic-disease management, health pro-
The mission of the Data Mart Network is
for Health Care Research and Quality
motion and wellness services. In addition to its clinical services,
to build the capacity of nurse-managed
(AHRQ). NNCC staff received a grant in
the Center houses a fitness center, teaching kitchen and other
primary care health centers to collect
August from the Independence Blue Cross
common spaces for health-promotion activities such as yoga,
clinical data, thereby facilitating clinical
Charitable Medical Care Program for re-
cooking classes and family-fitness programs.
research aimed at adopting best practices,
newed funding for the PBRN.
The Center’s target population is medically underserved,
insuring quality patient care, and dissemi-
low-income patients and vulnerable adults with chronic illness in a section of Philadelphia known as the 11th Street Corridor. The corridor encompasses Spring Garden and Cecil B. Moore streets and Fifth and Broad streets. More than half
Member Services and Resources
its patients have Medicaid coverage, and an additional 33 percent are uninsured.
We have revised our mission!
zz Foster partnerships with people and groups who share common goals.
The Center’s director, Dr. Patricia Gerrity, was named an Edge Runner in 2007 by the American Academy of Nursing.
Vision
Through its “Raise the Voice” campaign, the academy is
Keep the nation healthy through nurse-
tium (NNCC) represents nurse-managed
mobilizing 1,500 fellows, partner organizations and health
managed health care.
health centers serving across the country.
The National Nursing Centers Consor-
Nurse-managed health centers seek to be
leaders to ensure that Americans learn about possibilities for transforming the healthcare system and that nurses are
Mission
recognized, and thus to be more effective,
helping lead the way.
To advance nurse-led health care
as an integral part of the nation’s health-
through policy, consultation, programs
care delivery system. To fulfill this ambi-
who are on the cutting edge of finding new ways to integrate the
and applied research to reduce health
tious goal, the NNCC Board of Directors
mental and physical health of patients. Gerrity, Ph.D., RN and
disparities and meet people’s primary
and staff are currently implementing a
FAAN, has served as associate dean of community programs in
care and wellness needs.
4-year strategic business plan to guide the
The Edge Runner award recognizes nursing professionals
Consortium’s future growth and foster the
Drexel’s College of Nursing and Health Professions since 1996. NNCC Named Edge Runner by American Academy of Nursing The National Nursing Centers Consortium was recently named
NNNC Goals
success of its members. The business plan
zz Provide national leadership in identi-
strategies include:
fying, tracking, and advising healthcare policy development.
Edge Runner by the American Academy of Nursing through
zz Position nurse-managed health cen-
its “Raise the Voice” campaign for nursing. Other NNCC mem-
ters as a recognized, cost-effective
bers have received a similar recognition.
mainstream health care model.
zz Enhancing our voice in shaping state and national policy; zz Fostering organizational growth; and zz Strengthening member center capacity and sustainability.
www.NNCC.us p 16
NNCC UPDATE Colleagues in the News: Other Honors
NNCC Committee Updates: by Lenore (Leni) Resick, Membership Committee Chair & Cari Goss, AmeriCorps VISTA
Deena Nardi, PhD, PMHCNS-BC, FAAN, nurse psychotherapist at the University of St. Francis Health and Wellness Center in
NNCC Education and
NNCC Membership Committee:
Joliet, was featured in the January 2008 issue of Newsline
Program Development Committee:
Dr. Leni Resick, Chair
Newsmagazine for Nurses, “Partnering with communities to
Dr. Sally Lundeen and
serve the un- and underserved”. Her guest editorial, “A time
Dr. Susan Beidler, Chair and Co-Chairs
The Membership Committee supports the growth and development of the NNCC
for redesigning healthcare: Everybody in, nobody out” ap-
The Education/Program Development
as a member organization. For more in-
pears in the May 2008, vol. 46 issue of the Journal of Psycho-
Committee has been busily planning for
formation on how to join, please email Dr.
social Nursing and Mental Health Services.
our annual conference in Philadelphia for
Resick at resick@duq.edu. Benefits of NNCC Membership:
Susan Gresko, MSN, CRNP, of VNA Community Services
2009. The committee has worked collab-
in Abington, PA was selected as a finalist in the Leader-
oratively with the NNCC staff to request
In these days of the shrinking dollar, de-
ship category of the Nursing Spectrum’s 2008 Nurse
abstracts, arrange the program to provide
ciding which professional organization to
Excellence Awards.
a variety of offerings related to best prac-
join is often a challenge. When comparing
Dr. Eileen M. Sullivan-Marx, PhD, FAAN, RN, CRNP was
tices to eliminate health disparities, data
member benefits and the cost of member-
awarded the 2008 Eastern Nursing Research Society’s John A.
management imperatives and funding and
ship dues, membership in the National
Hartford Geriatric Nursing Research Award.
sustainability issues.
Nursing Centers Consortium (NNCC) is a real bargain.
Tine Hansen-Turton, Andrea Mengel, and Elaine
The NNCC numerous membership ben-
Tagliareni were inducted into the Fellowship of the Philadel-
Quality Assurance and
phia College of Physicians.
Research Committee:
efits are useful to both the nursing center
Nancy L. Rothman, Chair
and the individual. Benefits to the nursing
Dr. Susan Beidler was appointed to the Agency for Health-
The Committee focuses on nurse-man-
center include access to funding informa-
Tine Hansen-Turton received the Nancy Sharp Leadership
aged quality assurance and research ac-
tion, education and advocacy for nursing
Award by the American College of Nurse Practitioners and was
tivities. As always, we welcome new mem-
centers, and legislative education that
named one of the 101 emerging Philadelphia connectors by
bers, please contact Nancy at rothman@
directly influence the sustainability of
Leadership, Inc.
temple.edu or 215.707.5436.
nursing centers. Benefits to the individual
Please send stories about your centers and the care you
NNCC Policy Committee:
attending NNCC conferences, continuing
provide to Anne Lynn at alynn@nncc.us
Dr. Jeri Dunkin, Chair and
education credits at annual conferences,
Dr. Susan Beidler, Co-Chair:
discounts on publications, and local, re-
care Quality Advisory Board.
include reduced rates for registering and
The NNCC policy committee continues to support the joint policy agenda to: secure
gional, national, and international networking opportunities.
funding for nurse-managed health centers
As a NNCC member you have to op-
thus enabling them to become financially
portunity to participate in Special Inter-
sustainable and continue to provide high
est Groups and serve on committees for
quality accessible health care; address ex-
advancing the work of nurse-managed
isting health care payer policies that deny
health centers. As a member, you have an
or limit reimbursement for care provided at
opportunity to take part in the local, re-
nurse-managed health centers; and obtain
gional, national and international work of
prospective (cost-based) payment status for
the organization by volunteering to serve
nurse-managed health centers. For more
on committees that work toward advanc-
information on how to join, please email
ing nurse-managed centers and developing
Tine Hansen-Turton at tine@nncc.us.
health care policy.
www.NNCC.us p 17
NNCC UPDATE It is simple to join and be a member.
If you are interested in joining the Well-
members. These services include, but are
Membership application forms can be
ness Center task force, please contact Phil
not limited to: business and strategic de-
found for all membership levels at www.
Greiner at PGreiner@mail.fairfield.edu or
velopment; health center development; pro-
nncc.us. Discover what level you, or your
Mary Ellen Miller at millerm@lasalle.edu.
gram development and support; marketing
organization fits, and send in your applica-
and public relations; information systems
tion. The following categories for member-
NNCC Mental Health Task Force
and data sharing; research; public policy;
ship include:
Roberta Waite and
staff and professional development train-
zz Nurse-Managed Health Center
Priscilla Killian, Chair and Co-Chair
ing; conferences; information list-serve;
zz Corporate
The Mental Health Task Force has been
funding support; newsletters and network-
zz Non-Profit Corporate
preparing a chapter on mental health well-
ing. Currently, there are NNCC-member
zz Associate
ness based on varied NNCC affiliate cen-
nurse-managed health centers, associate
zz Individual
ters. This chapter will be incorporated
and individual members throughout the
An additional advantage of being a NNCC
into the Wellness Book developed by Tine
U.S. If you would like membership infor-
member is having the opportunity to be a
Hansen-Turton. The Mental Health Task
mation, please call us at 215.731.7140 or
dual member of Nursing Centers Research
Force is also exploring issues that affect
visit our web site, www.nncc.us.
Network (www3.uwm.edu/Nursing/ncrn/
patient outcomes that are centered on cul-
DEV/index.cfm) and Institute for Nursing
tural knowledge, understanding and prac-
Centers (www.nursingcenters.org). Both
tice within the centers. We anticipate col-
If you, or someone at your centers, are
the Nursing Centers Research Network
lecting data on culture and mental health
doing something worth telling, let us know.
and the Institute for Nursing Centers offer
particularly as it relates to client engage-
We are looking for opportunities to increase
resources for the advancement of nursing
ment, client outcomes and nursing prac-
public awareness about nurse-managed
centers.
It’s News To Me
tice. As always, the Task Force welcomes
health centers. Spread the word and tell
If you have any questions about mem-
new members. If you are interested in par-
your story - contact any NNCC staff member.
bership please contact the Chair of the
ticipating and enhancing our efforts please
We encourage you to communicate to us
Membership Committee, Leni Resick at
contact Roberta Waite, rlw26@drexel.edu
what topics you would like to see included
resick@duq.edu for more information.
or 215.762.4975.
in our future newsletters. If you would
NNCC Wellness Task Force:
Section 330 Interest Group
like to submit articles for consideration Dr. Phil Greiner, Co-Chair and
for publication in future issues, please let
The Federally Qualified Health Center
us know. Should you have any questions,
(FQHC)/Section 330 Interest Group ex-
concerns or need additional information
NNCC is excited to announce that the
ists to support existing nurse-managed
about the NNCC, and how to become a
members of NNCC’s nurse-managed well-
health centers that are either 330 commu-
member, please feel free to contact us at
ness clinic taskforce are in the process of
nity health center grantees for FQHC look-
215.731.7140. You can also email your in-
writing a book that will help nurse prac-
alikes. The group also provides technical
quiry to tine@nncc.us.
titioners and nursing facility members
assistance to nurse and community lead-
around the country establish and better
ers to prepare them for obtaining FQHC
run nurse-managed wellness clinics and
status for their health centers. For more
faculty practices. Subjects covered by the
information about the conference calls or
book will include a brief history of the well-
to receive individual technical assistance,
ness center movement, building community
email Ann Ritter at aritter@nncc.us.
Maryellen Miller, Co-Chair
partnerships, funding sources for wellness centers, faculty practice models for well-
NNCC Services & Membership
ness centers and student involvement in
NNCC provides a wide array of services
wellness centers. Springer Publishing has
and technical assistance to its member
agreed to publish the book this spring.
health centers, associate and individual
www.NNCC.us p 18
On the Road With Nurse-Managed Health Centers Alabama
Capstone’s Rural Health Center in Parrish From Dream to Reality
J
une 2001, Capstone College of nursing opened
Bureau of primary health care. In October of last year
the only nurse-managed, federally qualified health
their first nurse-managed center in Parrish as a
the staff and practitioners moved into a much larger
center in Alabama. The nurse managed model is rec-
rural health center. The nurse-managed center was
new facility on highway 269 in Parrish. Their space
ognized as key to efficient, sensible, cost-effective
established by Dr. Jeri Dunkin, Saxon Endowed Chair
increased from 1100 square feet to over 4000 square
primary health care. Research shows that patient
for Rural Nursing, through grant funding from the
feet, giving them additional examining rooms and
satisfaction with care through a nurse-managed
Division of Nursing, Bureau of Health Profession,
more space. The vision of the new capstone rural
center is very high and management of patients
Health Resources and Services Administration of
health center is to be the premier primary health
with chronic illnesses (e.g., high blood pressure,
the U.S. Department of Health and Human Services
care provider in northwest Alabama. Their mission is
diabetes) is especially comprehensive and effective.
(1D11hp00115). The first center was located in a small,
to provide access to high quality, holistic, culturally
Dr. Dunkin, the CRHC staff and Board of Directors
cinder block, older building in downtown Parrish.
appropriate, family-centered primary health care
are proud they are successful in increasing access
CRHC operated as a certified rural health center un-
through a nurse-managed model in a teaching-
to health care for the rural residents of Walker and
til 2006 when it became a federally qualified health
learning environment. Students from Capstone Col-
surrounding counties. They welcome visits to their
center look-alike until July 1, 2007. A community
lege of Nursing, University of Alabama, and other
center and opportunities to share their experiences
health center, new access point grant was awarded
regional health professional schools receive clinical
and outcomes.
by the Department of Health and Human Services,
learning experiences through the center. CRHC is
Maryland
University of Maryland School of Nursing Governor’s Wellmobile Program Participates in the Maryland Statewide Pandemic Flu Drill by Rebecca Wiseman, PhD, RN
T
he Maryland Statewide Pandemic Flu Drill was
In Western Maryland, the Allegany County Health
held last June in multiple locations throughout
Department plan included a “live” test of the Well-
Dr. Rebecca Wiseman, Director of the Governor’s
the state. The UMSON Governor’s Wellmobile Pro-
mobile as an alternate care site with the goal to test
Wellmobile program stated that “Mobile health units
gram participated in the exercise in Western Mary-
for symptoms of the flu and to keep the local hospital
have a great capacity to assist communities dur-
land and on the Lower Eastern Shore.
from being overwhelmed during a pandemic. A press
ing times of crisis. They can be deployed to remote
expressed appreciation for the exercise.
On the Lower Eastern Shore, the staff of the Lower
release was distributed to local radio and news agen-
sites where people may be unable to travel to larger
Shore Wellmobile participated in a tabletop exercise
cies a week prior to the exercise to ask community
population areas, they can provide services to assist
with the health departments of Wicomico, Worcester
participants to come to the Wellmobile for free blood
in reducing the mass descent on an agency and thus
and Somerset. This was the first time the Wellmobile
pressure screenings. The residents of Cumberland
overwhelming that resource, and, they can provide
was incorporated into the regional emergency pre-
were advised that the nurses on the UMSON Governor’s
alternate care sites to provide primary care services
paredness planning and it offered an opportunity for
Wellmobile would be wearing protective equipment
to residents who need medications, minor first aid
each county to dialogue with each other on how to
such as gowns, gloves and masks which would likely
and reassurance. Mobile health units can assist resi-
best use the mobile health van. The planning group
be used during a real pandemic to protect against
dents as they “shelter in place” and travel from com-
developed a scenario where one county used the
the virus. Approximately 100 community residents
munity to community to bring needed services. We
mobile van to assist the projected well residents in
visited the Wellmobile and received free blood pres-
were very pleased to have this opportunity to dem-
receiving regular primary care services while other
sure screenings and information about emergency
onstrate the potential uses for mobile units.”
resources were designated to the residents who
preparedness and pandemic influenza. Interactions
were ill with the influenza.
with the community residents were positive and many
www.NNCC.us p 19
On the Road With Nurse-Managed Health Centers Michigan
The Challenges of Implementing a Nurse Practitioner Managed College Health Clinic by Mary White, MSN, ANP
N
ationally, thirty to forty percent of all college
assistant. The first semester of the pilot, 181 patients
Funding from this grant supported some of the clinic’s
students experience a time during their college
were seen in 259 encounters for mostly upper respi-
operational costs, including hiring an additional full-
careers when they are uninsured. Many are dropped
ratory and other simple illnesses. By the end of the
time nurse practitioner and front desk receptionist,
from parent’s insurance plans due to age and are not
pilot (August 2006), staff had cared for 625 students
as well as provided for evaluation and consulting
able to afford the costs of independent student insur-
in 1,068 separate patient encounters.
services to assist the NPC in developing financial sus-
ance plans. These students have significant problems
Within a few months of beginning the pilot clinic,
tainability of the fledgling clinic. The nurse practitio-
accessing the health care system due to lack of insur-
students were asking for more. Administration officials
ner providers were able to obtain provider status with
ance; they are unaware of public assistance programs
decided that having a more permanent space for the
Medicaid, Medicare, Traditional Blue Cross and Blue
they may be eligible for, and they avoid routine health
clinic was desirable. The university refitted two 2- bed-
Shield, and with WSU’s preferred student insurance
screenings due to cost of the evaluations. Wayne
room apartments in an on-campus apartment building
provider which was managed through PPOM. Insur-
State University is located near the center of Detroit,
into a clinic with four exam rooms, an office, reception
ance reimbursements are low, and point of service
and many of its students are from the city itself, which
area, waiting room, and medical assistant triage/lab
fees for non-resident hall students help with opera-
has a large proportion of uninsured and public assis-
room. Our main patient population remained those
tional costs not covered by the HRSA DON grant. We
tance (Medicaid) patients. Students at this university
students living in on-campus university-owned hous-
continue to apply to a variety of insurers for provider
can expect to be without insurance as they lose their
ing. Students residing in the residence halls paid an
status, but have found that as a student health center,
Medicaid coverage at 19 years of age.
access fee providing two office visits per semester at
some insurers will reimburse us as out of network for
Humble beginnings. For many years, Wayne
no cost. Other students paid a modest fee for service.
providing care to students living away from home and
State University (WSU) had been known as a com-
The Nursing Practice Corporation was responsible for
their primary care provider (PCP).
muter campus, as the vast majority of its 30,000 plus
all operating costs of the clinic and had a contract with
Services offered students include acute illness
students commuted from communities in the Metro
the university as an independent vendor. In this ex-
care, routine evaluations such as physical exams and
Detroit area. The only students residing on campus
panded space, we were able to provide health services
women’s wellness exams, management of chronic ill-
were largely international students in the university-
to 1077 students and ended the first “official” year with
nesses such as diabetes, asthma and hypertension,
owned apartment buildings. In early 2004 WSU be-
an average of 16-20 encounters per day, with half of all
travel health and vaccinations, routine immuniza-
gan building residence halls to increase the number
encounters being new patients.
tions, and health promotion services such as smok-
of students living on campus. The idea of opening a
Where’s the money? The Nursing Practice Corpo-
ing cessation, weight management, and stress man-
health care clinic on Wayne State University campus
ration (NPC) is a not for profit corporation composed
agement. Health promotion activities are frequently
began about the same time, but the university was
of faculty from the College of Nursing and the Univer-
provided in the residence halls in the evenings, when
not willing to finance this service.
sity’s Provost. Members of this corporation submitted
a larger proportion of students are available and will-
After several proposals from both the College
a proposal for grant funding to Health Resources and
ing to participate. Health education sessions address
of Nursing’s Nursing Practice Corporation and the
Services Administration Division of Nursing (HRSA
sexual health issues such as contraception, sexually
School of Medicine’s faculty practice group, univer-
DON) to provide training for nurse practitioner and
transmitted infections, and safe sex practices, sleep
sity administration agreed to a pilot clinic developed,
baccalaureate nursing students at the Campus Health
disorders, nutrition, safety issues on campus, and al-
implemented, and staffed by the Nursing Practice
Center. The College of Nursing was awarded this three
cohol and substance abuse.
Corporation. The pilot clinic was located in a small
year training grant in July 2006 and the first nurse
After successfully serving students for two se-
student lounge in one of the new residence halls,
practitioner students began clinical rotations that fall
mesters in the “new” space, adjacent space became
and serviced only students living in the residence
semester. Baccalaureate students were offered op-
available and was offered to the Nursing Practice
halls or university-owned apartments, providing ill-
portunities to interact with the campus community
Corporation for further expansion of the clinic. Al-
ness care only for 20 hours per week. Staffing this pi-
through health assessment and health education pro-
though patient volume did not fully utilize current
lot was a nurse practitioner, and a part-time medical
gramming for student s living in the residence halls.
space and staff, the NPC voted to expand into this
www.NNCC.us p 20
On the Road With Nurse-Managed Health Centers newly available space as the likelihood of any other
streamlined with the ability to have the patient’s
Still hoops to jump through. Our HRSA funding
space being available when patient volume maxi-
insurance provider, demographic data, and reason
ends in June 2009, and our challenge during this
mized current clinic capabilities was not likely. The
for the encounter readily available with the pass of
last year of the grant is to maximize insurance reim-
university was willing to cover the cost of renovation
the computer’s cursor over the patient’s name. The
bursements and to negotiate for a universal health
of the space. And so the plans began.
health record was fully implemented in February
access fee to be assessed all students registered
Entering the Electronic Age. As we continued to
2008, and has made accessing data for quality con-
at WSU. With a large percentage of our students
grow, we were provided an opportunity to implement
trol evaluations much simpler. No more looking for
uninsured, we are challenged to develop creative
a combined practice management/electronic health
charts hidden on someone’s desk! And we are able
ways to cover the costs for routine health concerns
record system in August 2007. Acquired through the
to document in a patient’s record, contact our col-
for those students without insurance and an in-
Institute of Nursing Centers and Alliance of Chicago,
laborating physician by phone to review the record
ability to pay. We are confident we will be able to
this system has provided both challenges and de-
and he is able to directly add his comments and or-
cross this hurdle with some hard work and creative
lights. After almost a year since the practice man-
ders into the active document. We are planning on
negotiation. After all, it was just 3 years ago we be-
agement service was implemented, the clinic is able
adding nursing diagnoses and interventions into the
gan in a small lounge, and baby, look at us now!
to track insurance filings and reimbursements accu-
EHRS this next year so we can monitor which nursing
rately. Scheduling patient appointments has become
diagnoses and interventions are commonly used.
Missouri
BEAR Care: A Nursing Center for Health Continues to Grow by Caroline Helton, MS, MN, RN, Susan Sims-Giddens, Ed.D., RN & Carol Daniel, MSN, RN
B
EAR Care: A Nursing Center for Health is com-
Community students conduct: health education
are meeting a variety of clients’ needs. Those sites
pleting its second year of working with the
fairs, health screenings; educational classes targeting
include: a low income housing development for at
Kitchen, Inc., nonprofit corporation that provides
chronic illness, smoking cessation, parenting con-
risk populations; a homeless or at-risk drop in cen-
services, including living accommodations and
cerns, an open-door wellness clinic two days/week
ter for youth; a hotel housing unit for single women
health care, to homeless and uninsured individuals.
which allows individuals to meet with the student
and families for up to two years while assisting the
An expansion to the center this year is Victory Mis-
nurses one-on-one. During one-on-one meetings,
resident to gain financial stability through educa-
sion, supported by private grants and donations to
clients voice concerns they have never had the op-
tion and job training; a transient drop-in center; a
provide housing and food to homeless men. Utiliz-
portunity to express to other health care providers.
children’s care center (for those living at the hotel);
ing the concept of “nursing wellness center without
It is at these times, that students educate on a num-
and a boarding/trade school for men. Although not
walls”; senior nursing students participate in a col-
ber of issues and clarify client concerns. Frequently,
a traditional nursing wellness clinic, the students
laborative movement with several agencies without
clients will bring in their medications that have been
are developing an “Ask a Nurse” clinic at the Kitchen
a nursing presence. Currently, Missouri State senior
prescribed just to have someone talk with them about
Inc. medical clinic. This clinic is available for educa-
nursing majors (both the generic and BSN comple-
the effects and side effects of those medications.
tion, assessment, and referral. In the event that an
tion students) conduct wellness clinics at seven sites
During the Leadership/Management clinical, not
emergent condition is noted during the assessment,
within the Kitchen, Inc. and Victory Mission. At the
only are students learning the methods and manage-
the nursing student can triage the individual into a
wellness clinics nursing students assess, educate,
ment skills needed to facilitate healthy community
provider at the medical clinic.
and refer clients. Students are assigned to a site
outreach, but students are developing skills in writing
The Nursing Center has been a great success and
for 64 – 96 hours of clinical each semester for two-
proceduresandprotocolsforafunctioningnursingwell-
the number of clients served has grown dramatically.
service learning nursing courses. Community Health
ness clinic. This ever-changing Policy and Procedure
During the 2008 academic year, nursing students
and Leadership/Management Nursing students are
book is well researched and serves as a guide to direct
assessed 1,872 individuals; educated 1,454 individu-
supervised by nursing faculty and have availability
the work of all of the students at the wellness center.
als, families or groups; and referred 313 individuals
to them at all times.
The seven wellness sites currently being utilized
to other agencies or resources.
www.NNCC.us p 21
On the Road With Nurse-Managed Health Centers New Jersey
New Jersey Children’s Health Project: A Program of the UMDNJ School of Nursing Mobile Healthcare Project by Gloria J. McNeal, PhD, ACNS-BC, APN, C, FAAN, Professor and Associate Dean UMDNJ School of Nursing & Project Director Overview
and provide health promotion/disease management
Following a year of planning, the Project initiated the
The University of Medicine and Dentistry of New Jersey
services for at-risk populations, 2) to foster community
delivery of primary care services in early March, 2007,
School of Nursing (UMDNJ-SN), in a collaborative, joint
involvement in the health assessment and referral
at five clinical sites located in the greater Newark
partnership initiative with the Children’s Health Fund,
process; and, 3) to provide culturally and linguistically
area, which to date now total 10 sites. Analysis of the
has implemented a nurse-faculty managed Mobile
sensitive health promotion/disease management
Project’s preliminary data findings indicates a current
Healthcare Project, designed to reduce the morbid-
health education. The project staff provides primary
caseload consisting of 786 patients, with encounters
ity and mortality of medically underserved residents
care and screening services utilizing a mobile health-
ranging from 5 to 22 visits daily. The Project serves a
of the greater Newark area. This grant-funded Project
care facility on wheels designed to reduce the tradi-
predominantly minority population of 67% , Black;
utilizes an interdisciplinary collaborative approach
tional barriers to health care access.
31% Hispanic; and 2% White. Fifty-seven percent of
and outcomes oriented focus for a nurse-faculty man-
the patients seen are female. While the Project servic-
aged, university-based mobile healthcare project,
Preliminary Outcomes
es patients in all age groups, the largest percentage of
in collaboration with the UMDNJ University Hospital.
A $250,000 grant from the Healthcare Foundation of
patients are those in the 0-25 age category (53%). To
The Project cost effectively utilizes faculty-supervised
New Jersey, with matching funds provided by UMDNJ-
date, the majority of visits (37%) are made to perform
student nurses and an interdisciplinary mobile health
SN, covered the cost of start-up operations in April
physical examinations for health clearance to permit
team staff, in association with the clinical affiliates of
2006. A HRSA grant for $1.7 million over five years was
attendance at work or at elementary and pre-school.
UMDNJ, community-based organizations (CBOs) and
awarded to the Project at the start of FY ‘08. In part-
Dental screening and referral comprise the second
faith-based healthcare initiatives. Situated within the
nership with the Children’s Health Fund, the Project
most frequent reason (8.9%) for patient encounters.
UMDNJ School of Nursing, this initiative uniquely cre-
has joined with a national network of mobile health-
Table 1 below provides a summary of the clinical out-
ates public-private partnerships, in the mutual goal to
care programs to leverage support for addressing
comes for the project. Project sustainability will be
improve access to care for urban at-risk populations.
the healthcare needs of the underserved. Additional
achieved through third-party reimbursement mecha-
The broad objectives of this nurse-faculty managed
funding of $50,000 was provided by CHF to support
nisms, capitated rates for managed care organization
mobile healthcare project are: 1) to screen, identify
the part time services of the Project’s pediatrician.
fee structures, and continued extra mural funding.
Table 1 – Summary of Mobile Project Clinical Outcomes Day of the Week
Site Location
Time
Monday
Office Day
9-5
Tuesday, 1st and 3rd
Newark Preschool
10 - 3
Wednesday, 2nd and 4th
El Club de Barrio / Integrity House
10 - 3
Wednesday, 1st and 3rd
Ironbound Corp
10 - 3
Tuesday, 2nd and 4th
Covenant House
10 - 3
Thursday, 1st and 3rd
The Leaguers / Clinton Hill Academy
10 - 3
Thursday, 2nd and 4th
Vision of Hope / Newark NOW
10 - 3
Friday, 3rd
Precious Littles, Early Childhood Development Center
10 - 3
Saturday
Prescheduled Health Fairs
10 - 2
www.NNCC.us p 22
On the Road With Nurse-Managed Health Centers Table 2 – Mobile Project Clinical Site Rotations Number of Days Clinic is Open
3 days with weekeends and after-hours on call
Number of Clinic Sites
10
Number of Patient Encounters, YTD
1,009
Chief Reason for Clinic Visit • Physical Examinations
37%
• Dental Screening and Referral
8.9%
• Genitourinary Conditions
4.4%
• Respiratory Conditions
8.5%
• Infectious Processes
5.5%
• Skin Conditions
5.2%
• Psychiatric Conditions
2.8%
• Musculoskeletal Conditions
3.4%
• Neurological Conditions
6.3%
• Tumor/Palpable Mass
1.2%
• Positive Pregnancy Test
2.1%
• Gastrointestinal
4.4%
• Endocrine
1.6%
Number of Follow-Up Visits
1 - 3 per month
Number of Physician Referrals
1 - 3 per month
www.NNCC.us p 23
On the Road With Nurse-Managed Health Centers New York
NYU College of Nursing Faculty Practice: Addressing the Healthcare challenges of the 21st Century by Madeleine Lloyd MS,FNP-BC, MHNP-BC
I
n 2005, a landmark partnership between the New
practice located within the NYU College of Dentistry.
Medicare, some commercial insurance and offers an
York University Colleges of Nursing and Dentistry
A ribbon-cutting celebration was held February 26,
income based service fee system for those with no
inspired a vision to create innovative, collaborative
2007 at the NYCCN Faculty Practice (NYUCNFP) and the
insurance. To date, over 1000 patients aged 18 years
clinical practice models in which nurse practitioners
funders, Barbara and Donald Jonas of the Barbara &
and up have been served by the NYUCNFP providers,
(NP) and dentists partner to achieve high quality and
Donald Jonas Family Fund at the Jewish Communal Fund
undergraduate nursing and graduate NP students
cost-effective health outcomes. With the synergies
and The Fan Fox and Leslie R. Samuels Foundation,
with 61% of visits being returned patients. After a
that this partnership creates new opportunities exist
Inc., were honored for being healthcare visionaries.
recent patient satisfaction survey 97% (n=101: 11%
to address barriers to linking oral and systemic health
The practice is integrated with the teaching and
response rate) of patients either agree or strongly
and patient access to primary healthcare services.
research missions of the College of Nursing which
agree that they would recommend the practice to
Together the Colleges are examining new paradigms
addresses the increase need for primary care among
friends/family searching for a primary care provider.
in interdisciplinary practice in which NPs and Dentists
New Yorkers, particularly older adults, who have a
We envision this project as an important step in link-
partner to provide primary health care and dental care
higher prevalence of chronic illness and the 15 mil-
ing dentistry and nursing to improve the quality of life
under one roof. On this premise, the New York Uni-
lion Americans who visit their dentist each year but
for all patients, by offering a “one stop shopping” ap-
versity College of Nursing (NYUCN) launched a nurse
do not access medical care. NYUCNFP is an article
proach that increases access to comprehensive, high
practitioner faculty managed primary health care
28 Medicaid approved practice but also accepts
quality and cost effective health care.
Pennsylvania
Using Students to Foster Independence of Older Adults The 19130 Zip Code Project: Community College of Philadelphia, Department of Nursing by Jean Byrd RN, MSN, CNE, and M. Elaine Taglaireni RN, EdD
F
or the past six years the Community College of
ability was assessed and monitored in several NNCC
students focused on teaching in these areas and
Philadelphia (CCP), Department of Nursing,
Wellness Center sites. During academic year 2007-
directed their interventions toward education re-
through funding from the Independence Founda-
2008 faculty in the Department of Nursing, who are
lated to disease management, such as signs and
tion, Philadelphia, PA has provided leadership for
responsible for supervision of students participating
symptoms management education and manage-
the development and modification of a web-based
in service-learning activities in north Philadelphia,
ment of medication and/or its side effects.
tool to describe types and patterns of health promo-
as part of our community based 19130 Zip Code Proj-
zz The health and life management advocacy catego-
tion/disease prevention services and constituencies
ect, identified key findings from this project. These
ry represented a significant intervention approach
served across the life span in selected NNCC Well-
findings formed the basis for service learning activi-
for older adults. Therefore at senior housing sites,
ness Centers. Dr. Eunice King, Senior Program Officer
ties directed toward older adults. Findings from the
the students and faculty, with agency partners,
and Evaluation….at the Independence Foundation
previous project are presented with a description of
created mechanisms to foster client’s self-help
and Dr. Elaine Tagliareni, Professor of Nursing and
how learning activities were developed:
abilities including: 1) assistance with appointment
Independence Foundation Chair at CCP chronicled
zz Older adults participated in health promotion/dis-
scheduling; 2) help with preparing forms and ap-
the development of the tool and described findings
ease prevention activities that focused primarily
plications; and 3) support with maintenance of
for both individual and group encounters in seven
on cardiovascular education and wellness educa-
daily activities of living.
centers (Tagliareni & King, 2006).
tion related to issues associated with aging, i.e.,
zz Hypertension screening and monitoring is a signif-
In another project funded by the Independence
changes in sensory perception, dietary modifica-
icant way for students to initiate health promotion
Foundation, Effective Interventions Project, the ca-
tions and exercise for wellness. During the fall se-
activities with older adults. Therefore, teaching
pability of older adults to maintain optimal functional
mester, in three separate senior community sites,
was directed to promote clients’ ability to manage
www.NNCC.us p 24
On the Road With Nurse-Managed Health Centers their hypertension (such as education on medica-
how the quantity of common health problems is
a companion. The participants record this informa-
tion, and signs and symptoms) and hypertension
not necessarily the determinant of older adult’s
tion on a worksheet that they carry with them while
screening clinics were initiated at two other senior
self-perception of health.
walking. The participants hand in these worksheets
Presently, as our Wellness center has grown and pro-
each week, when they check in with the students
zz Older adults who did experience falls (less than
grams to enhance functional mobility of older adults
and interns who inquire about their health, their
10%) had higher self-rated potential depression
have been developed, we now recognize a need to
progress with walking, and other related health con-
scores. Therefore, two initiatives were started by
systematically collect data related to program out-
cerns voiced by the participant. An individual en-
students, in collaboration with the Independence
comes and program effectiveness. Therefore, with
counter form is filled out and recorded on the web-
Foundation Community Nursing Interns. Faculty
funding from the Independence Foundation, we con-
based health promotion disease prevention tool by
and students initiated the Time to Walk Program
tinue to work on modification of the web-based tool
students or faculty. At the conclusion of the walking
and actively utilized the Geriatric Depression Scale
to collect and describe types of health promotion/dis-
program and one month after the program ends,
(GDS) to screen older adults who participated in
ease prevention services and constituencies served,
each participant is asked a set of follow up questions
the program. In this way, residents who self-select-
but we have also developed a software program to
that explore changes in the participant’s satisfaction
ed to join the walking program, some related to a
collect and analyze outcome data related to a walking
with life, risk for depression, and the continuance of
history of impaired walking ability, are adequately
program for older adults.
walking with a companion. In the Fall 2008 the sites
citizen sites in north Philadelphia.
CCP nursing students and Independence Founda-
began to utilize a web-based tool to collect data. It
zz Older adults with a greater number of self-reported
tion Community Interns, Karen Harrigan RN, BSN and
is our hope that future modifications of the tool will
health problems described themselves as in poor
Sylome Fox RN, recruited members from the com-
generate ways to collect and analyze aggregate data
to fair health. Yet these same older adults consid-
munity to participate in a walking program, entitled
about NNCC developed health promotion programs
ered their ability to care for themselves to be above
Time to Walk. A protocol for collection of outcome
from a wide variety of NNCC Wellness Centers.
average. Therefore, students now ask community
data for the Time to Walk Program, which includes
residents with multiple common health problems
both pre and post intervention data, was developed.
References
to describe their ability to care for themselves. In
At present four NNCC Wellness Center sites are col-
Tagliareni, M. E. & King, E. S. (2006). Documenting
this way students deal with their own biases about
lecting data. Participants record the amount of time
Health Promotion Services in Community-Based Nurs-
how older adults perceive functional ability and
spent walking, and whether or not they walked with
ing Centers. Holistic Nursing Practice, 20(1), 20-26.
screened for potential depressive symptoms.
News From York College of Pennsylvania Department of Nursing & Nurse-Managed Wellness Center News
T
he York College of Pennsylvania Department of
Thanks to a $25,000 Wellspan Community Part-
position of Wellness Center Director. Approval of
Nursing now operates three Nurse Managed
nership grant, each of the Nurse Managed Wellness
this position reflects the support for the Nurse Man-
Wellness Centers in York City. Their first center, lo-
Centers are open when the college is not in ses-
aged Wellness Centers from both the College and the
cated at Broad Park Manor in York city, has now been
sion, with student interns providing services under
community. The long-term plan is to integrate other
in operation for seven years. In this center, as well
the supervision of and Advanced Practice Nurse. In
nursing clinical courses into the Centers, develop
as the other two, senior level community health
addition, and Asthma Safe Kids program, funded by
primary care service provision, and integrate stu-
nursing students provide health assessment and
Weyer Community Foundation grant, is also in op-
dents from other majors.
teaching to low income medically underserved York
eration year round.
This year, the Centers were features in the public
city residents. Throughout the 2007-2008 academic
Cheryl Thompson, RN, DNP, Associate Professor
relations program at the college with both radio and
year over 2000 client contacts occurred through the
has served as Wellness Center Director for the past
television advertising. A link to the radio advertise-
Centers. A description of each of the Centers can be
several years. Beginning next fall, Audra Johns will
ment can be found on the web page.
found at http://www.ycp.edu/nursing/2527.htm
assume those responsibilities in a newly approved
www.NNCC.us p 25
On the Road With Nurse-Managed Health Centers News from Project Salud and La Comunidad Hispana, Kennett Square, PA: Work Healthy Youth Program by Marguerite P. Harris, M.S., CRNP, Director Project Salud
I
n September 2007, Project Salud received a grant
as the backbone of the health education workshops
tino youth, there are no such restrictions on who
from the PA Department of Health to provide pri-
held in the community
may take advantage of the program at the school. In
mary and preventive health care to Latino Youth. Key
Although all FNPs see adolescents for physical ex-
terms of preventive health care at Avon Grove High
to the project was the hiring of the Healthy Youth Co-
aminations and vaccines, our adolescents are more
School, the PNP and HYC are not able to address re-
ordinator (HYC) whose job description includes out-
likely to be scheduled with our PNP (all of our provid-
productive health issues- referrals must be made to
reach to youth and education regarding the need for
ers are bilingual). All adolescent clients are routinely
the main site for this information giving.
physical examination and vaccines and other crucial
screened for depression (Beck Depression Index)
Some of the challenges in meeting the grant
preventative health services. In addition the HYC
and for alcohol and substance abuse (Screening,
objectives are related to finding adequate, bilin-
works with the agency’s Latina youth group, GUAPAS
Brief Intervention and Referral Tool or SBIRT). The
gual and bicultural resources in behavioral health.
(Girls United Achieving Professional Aspirations and
HYC also coordinates follow up for needed behav-
There is a lack of adequate and accessible bilingual
Successes), whose activities include volunteering at
ioral health services. Since most youth are referred
mental/behavioral health services in Chester County.
Project Salud and developing and presenting health
to primary care by the HYC, there is an established
This lack of services is compounded by the fact that
education for clients waiting for their medical visit.
rapport and trust with her, which is crucial for suc-
youth who do not have U.S. citizenship are ineligible
Lifestyles education has been crucial to support the
cessful follow-up of behavioral health issues.
for health insurance making more difficult to locate
growth and development of the Latina girls.
Within 4 months into the program, Avon Grove
accessible services for this group. Furthermore, lack
The HYC utilizes two health education curricula:
High School asked Project Salud to open a satellite
of parental understanding of mental health issues
Life Planning Education, developed by Advocates for
office on site 6 hours per week, in order to provide
often results in a delay in acquiring services until
Youth, and Toward No Drug Abuse, developed by the
physical examinations and vaccines to all students,
crisis occurs. Finally, financial stresses result in de-
Institute for Health Promotion and Disease Preven-
and especially sport school physical examinations.
lays to seeking physical examinations and vaccines
tion Research at the University of Southern California
Although the program is geared to serving the La-
for youth who are basically healthy.
Daily Miracles Happen at Work Healthy Work Wellness Centers in Kennett Square, PA by Natalia Molina McKendry, MPH
I
t is a foggy summer morning in Kennett Square,
because it is a successful work wellness program
years, La Comunidad Hispana has helped thousands
PA. The smell of compost wafts in the air. It is the
driven by the nurse-managed model of care. What
of families and individuals on their journey to this,
smell of an industry that provides millions of dollars
also makes Work Healthy unique is that the approach
their new county, and towards self-sufficiency.
in revenue to this quaint town in Chester County, PA.
is twofold. Workers receive clinical services from
In July 2006, La Comunidad Hispana and three
It is 3 am and the mushroom pickers are reporting to
a CRNP and a medical assistant and receive health
of Chester County’s mushroom farms began work on
work with their hip waiters on and their headlamps in
education and health promotion from fellow mush-
an innovative program, known as the Work Healthy
place. The work that these men and some women do
room workers who have been trained as lay health
program. Work Healthy is a holistic program that
in the dark and dank mushroom houses is back break-
educators by a Health and Wellness Coordinator.
combines both clinical services and health educa-
ing and challenging, but it must be done well, and it
To really understand Work Healthy, there needs
tion and health promotion on site at the mushroom
must be done quickly. The need for income is so great
to be an understanding of La Comunidad Hispana
farm. Employees at Kaolin Mushroom Farms, Phillips
that many of the workers work not five or six days a
and the work and relationships that staff have built
Mushroom Farms and To-Jo Mushroom Farms all have
week, but some actually work all seven days of the
throughout the years. Founded in 1973, La Comuni-
access to this unique endeavor that is the result of the
week to sustain their livelihood here and send money
dad Hispana (LCH) is non-profit organization dedicat-
support of mushroom farm owners and the commit-
home to relatives. What time does this leave for an-
ed to improve the quality of life, health and well be-
ment of LCH to eliminate and address health dispari-
nual check ups or any type of medical attention?
ing of low-income Hispanics and other under-served
ties that affect the Hispanic mushroom worker.
Enter La Comunidad Hispana and its innovative
people through advocacy and bilingual programs in
“Given Kaolin’s sense of responsibility toward the
Work Healthy Program. The program is innovative
health care, education, and social services. Over the
well being of our employees, this Work Healthy initia-
www.NNCC.us p 26
On the Road With Nurse-Managed Health Centers tive will address the challenging and ever changing
screenings for diabetes and high blood pressure.
promote healthy lifestyles; have access to a walking
health needs of our dynamic, immigrant work force,
This past year, well over 400 workers were vaccinat-
group which meets three times a week; and receive
and will allow us to promote healthy habits, as well as
ed against influenza by the staff of the Work Healthy
incentives for positive progress.
provide much needed health services, all at the work
staff. The mushroom owners covered the cost.
The Work Healthy program is already having an im-
site,” said Mike Pia, owner of Kaolin Mushroom Farms.
Another key component to this program is health
pact on farms employees like, Gael Bernal. Bernal, 45
Funded through a 4-year matching grant from the
education. A monthly newsletter is distributed reach-
years old, recently spoke with the nurse practitioner at
Robert Wood Johnson Foundation’s Local Initiatives
ing approximately 1,300 workers. Health messages are
his worksite clinic about how tired he had been feel-
Funding Partners (LIFP) program, Work Healthy was
shared with employees on strategically placed bulle-
ing. The nurse practitioner suggested Gael be tested
one of 12 initiatives selected to be funded from a pool
tin boards located in lunchrooms and locker rooms.
for diabetes. Upon testing, he was diagnosed with dia-
of 219 applicants. As a part of the LIFP program, a cad-
Lunch talks are also offered echoing the themes in
betes. Gael was started on medication and almost im-
re of local funders matched the Robert Wood Johnson
the newsletter, especially important in reaching those
mediately gained back his strength. Gael came back to
Foundation grant. These local partners include: The
that are illiterate or have low literacy.
the clinic every week for a month to learn more about
Philadelphia Foundation; Brandywine Health Foun-
The core of the Work Healthy’s health education
checking his blood sugar and changing his diet to suit
dation; Chester County Hospital Foundation; Health
and health promotion efforts are the “promotores”
his work routine. Now he feels that if he has a question
and Welfare Foundation of Southern Chester County;
who are peer health educators. The “promotores”
or a problem with his blood sugar, he can stop by the
Independence Blue Cross; Independence Founda-
are a group of persons, who are mushroom workers
clinic on his lunch break for a short visit.
tion; Kaolin Mushroom Farms; Phillips Mushroom
themselves, trained to provide a health education on
This program was recently featured in the Philadel-
Farms; Robert McNeil; and To-Jo Mushroom Farms.
cardiovascular disease, diabetes, nutrition, fitness,
phia Inquirer and in that piece employee, Estella Zavala
and mental health issues. They also serve as impor-
Luna described the convenience of the Work Healthy
tant liaisons to the Work Healthy clinic.
health center at her workplace, “Before, I never had
Each of the Work Healthy participating mushroom farms is home to a satellite health center. Project Salud is LCH’s nurse-managed health center, which
“Work Healthy is a success because of the layers
physical exams,” she said. “But here they have every-
provides bilingual primary health care services. With
of support that envelop the program. From all of the
thing I need, so I can make sure I’m healthy and get
a health center at each farm, employees can sched-
funders, to the staff of the mushroom farms, and the
checked more frequently.” Additionally, Luna describes
ule appointments with a bilingual nurse practitioner
work that the promotores do everyday, Work Healthy is
the importance of the health education component of
for acute or episodic care. Employees can also have
a testament that businesses do care about the health
the program, “I read the literature a lot,” said Luna. “It
“walk-in” appointments during health center hours.
of their workers and that leadership can be cultivated
teaches me so much. Before, I was really unhealthy. The
The on site health centers reduces many access to
from within the community to address disparities of
literature explains how to be healthier, what to eat, and
health care barriers for the Hispanic mushroom
health” said Natalia Molina McKendry, LCH’s coor-
why it’s good for you. And I make my kids eat healthier,
worker including but not limited to: language and
dinator of health and wellness services. In her role,
too,” she added. “I’m really grateful for all of it.”
culturally competent care, transportation, time off
McKendry works very closely with the staff of LCH and
LCH is very pleased with the success of the program
from work for a medical appointment, and a source
liaisons at each farm to ensure the program is running
thus far, due in part to the commitment of the lead-
of referral for specialty care. All of the workers insur-
smoothly. In addition, McKendry has worked with liai-
ership and staff at Kaolin Mushroom Farms, Phillips
ance carriers are accepted as form of payment and
sons at the mushroom farms to develop specific health
Mushroom Farms and To-Jo Mushroom Farms. “With-
for the uninsured, payment is based on a sliding fee
initiatives. One example of this is at To-Jo Mushroom
out their support, this project would have never made
scale. The health centers offer: physicals, women’s
Farm, where an initiative called “Healthy Lifestyles”
it off the ground. We are very grateful to be working
health exams, men’s health exams, vaccinations,
is underway. A cross between a weight management
with such a supportive team,” stated Michele Tucker,
assistance with chronic disease management such
group, a walking group, and a support group, through
President of LCH’s Board of Directors.
as diabetes and high blood pressure, mental health
this program, employees consult with the nurse prac-
If you are interested in learning more about
screenings, referrals to specialists, and much, much
titioner regarding his/her weight; use a fitness journal
the Work Healthy progr m, please contact Nata-
more. Approximately three times a year, the clinical
to track BMI, weight loss/weight gain, activity and nu-
lia Molina McKendry at 610.444.4545, ext. 20 or
staff goes to the lunchrooms and offer free health
tritious recipes; participate in monthly workshops that
nmckendry@lchps.org.
www.NNCC.us p 27
On the Road With Nurse-Managed Health Centers Recent News and Updates from Mount Morris by Mona M. Counts, PhD, CRNP, FNAP, FAANP
W
hen the Primary Care Center of Mt. Morris,
agreement for management with Cornerstone Care,
Plan operates public-sector health care plans in
Inc. (PCC) opened its doors in 1994, it became
a regional Community Health Center. The goals of
Delaware, Ohio, Pennsylvania, South Carolina and
one of the first nurse practitioner run practices in
the two organizations are the same – to serve un-
Tennessee and serves consumers enrolled in gov-
the United States. The services provided to the un-
derserved residents of the county – and each brings
ernment-sponsored managed care programs. The
derserved community were comprehensive, coordi-
something special to the partnership. Cornerstone
Gold Star Pay for Performance Program recognizes
nated and cost-effective.
contributes its professional business knowledge,
primary care providers for:
while the PCC brings to the table a nurse practitioner
zz Being available and accessible to members
approach to the delivery of health care.
zz Preventing illness via immunization and education
The emergence of managed care and the lack of recognition of NPs as PCPs prompted the need to reevaluate the practice’s business model to address
Plans are for the PCC to continue as a nurse prac-
zz Screening for signs of potential or impending illness
rising costs and decreased revenue. New funding
titioner run practice. Intraprofessional relations will
zz Minimizing the impact of non-preventable illness
streams were sought and successfully attained, in-
capitalize on the strengths of each group and should
PCC Clinical Director, Mona M. Counts, Ph.D., CRNP,
cluding the PCC designation in 2003 as a Federally-
lead to an increased focus on health promotion and
FNAP, FAANP, is currently serving in her second year
Qualified Health Center Look-Alike.
risk reduction in the rural population served.
As the business of health care continued to become more complicated, it became apparent that a
as President of the American Academy of Nurse Practitioners (AANP). During her tenure, she has had the
Awards and Recognition
opportunity to witness nurse practitioners across the
greater degree of business acumen was required for
PCC recently received a Gold Star Award from
county employing creative and innovative approach-
the PCC to continue providing services while remain-
Unison Health Plan of Pennsylvania for meeting the
es in health care, and assisted in the development
ing competitive in a shrinking market.
organization’s goals for quality, efficiency and the
and implementation of nurse-managed centers.
In 2008, the PCC entered into a collaborative
provision of effective medical care. Unison Health
Building Leadership and Management Skills in Penn’s Nursing Center by Eileen M. Sullivan-Marx, PhD, FAAN, RN, CRNP
C
linicians, educators and researchers associated
colleagues partnered with the Penn’s Geriatric Edu-
with nursing administration experts in acute care,
with the Living Independent For Elders (LIFE)
cation Center to build on work done to promote clini-
Drs. Kathleen Burke and Linda Carrick, Sullivan-Marx
Program at the University of Pennsylvania School
cal skills for nurses in long term care that included
brought together a team of nurse experts in team
of Nursing have been partnering for six years on a
among other areas, fall prevention, medication
building, power and negotiation, change theory,
Department of Health and Human Services Division
management, and team communication. Working
directing and delegating, conflict resolution, adult
of Nursing grant entitled “Building RN Training Skills for Geriatric Nursing Excellence” directed by Eileen M. Sullivan-Marx, PhD, FAAN, CRNP, Associate Dean for Practice & Community Affairs. The purpose of this grant which was funded through the Nurse Reinvestment Act was to develop learning modules for registered nurses (RNs) in geriatric long term care settings through a training program for RNs that will provide them with the requisite skills to educate licensed practical nurses (LPNs) and certified nursing assistants (CNAs) in competencies for comprehensive geriatric care excellence. Sullivan-Marx and her
www.NNCC.us p 28
On the Road With Nurse-Managed Health Centers education, and cultural competence to develop and
geriatric care team, enhance team morale, improve
given learning need variation by setting and diver-
test learning modules for nursing and professional
care, and increase retention of all nursing staff.
sity within groups; participants need opportunities
staff in several long term care settings including the
Despite enthusiastic support by administrators in
(freedom of disclosure) to share personal stories/is-
School of Nursing’s LIFE Program.
the long term care settings and the School of Nurs-
sues resulting in critical thinking; and follow up is
The University of Pennsylvania School of Nurs-
ing’s LIFE Center, the training team was challenged
needed to debrief on issues that may only skim the
ing’s Center for Professional Development had ini-
by scheduling difficulties and availability of staff to
surface, e.g., conflict resolution. Nurse participants
tially developed 4 of the leadership training modules
be trained either on or off site. Shortages of nurs-
were especially interested in case based information
for acute care settings that were revised and used for
ing staff and the lack of dedicated time in clinicians’
and training in management/conflict resolution; im-
this project. Pilot participants stated the there was
schedules for training by a center hampered initial
plementing training and dealing with system issues.
a need for RN educational programs on leadership
start of training. Valuing training of clinical staff in
Full or half day courses were preferred over two hour
and management since the majority of participants
issues of leadership and management is a gap in
blocks of time. As program developers, we gained a
(80%) had received none or insufficient content in
both long term care and primary care, the research-
heightened appreciation of the extent and nature of
their basic nursing education programs. Many stated
ers found. With persistence and administrative sup-
management needs and the difficulties associated
they needed to “learn on the job” with no skills in
port, and as training began, the flow of training
with having those needs met.
leadership or management and were unprepared for
improved as participants were engaged and excited
After the first three years of funding, Sullivan-Marx
the role as staff nurses and nurse managers work-
about skills that they were learning. A strong take
and co editor, Deanna Gray-Miceli published the learn-
ing with many diverse health care providers. Center
away message of this project is the need for nursing
ing modules in a book “Leadership and Management
for Professional Development conducts ongoing
and administration to place value on management
Skills for Long Term Care” published by Springer Pub-
needs assessment with each continuing educa-
and other training and to build this in to schedules
lishing Company, LLC, with an accompanying website
tion program. Content for registered nurses to learn
and expectations in the work site.
for training materials. Current funding is focused on
leadership and management are requested by 30%
All modules were highly rated and nurse partici-
development of half-day workshops in team building,
of the 1000 annual participants in survey needs as-
pants indicated that their confidence in knowledge
negotiation, change process, adult education, and
sessments in the last three years.
of clinical topics was greater than their confidence
cultural competence for leadership. Promoting health
The project also focused on centers and agen-
in managing educating others even though their
for older adults and emergency preparedness in nurs-
cies that had a diverse workforce and served minor-
jobs called for them to be doing so. Lessons learned
ing long-term care centers are now being tested in
ity aged individuals to improve interaction with the
in the process are that teacher adaptability is key
several centers including the LIFE Program.
www.NNCC.us p 29
On the Road With Nurse-Managed Health Centers Texas
News from the University of Texas Health Services (UTHS), Houston
W
ith the promotions of Thomas Mackey, PhD, RN,
Julie Lindenberg, DNP, RN, FNP-BC is the former
filling a much-needed gap after the passing of pro-
FNP-BC, FAAN, FAANP to the Associate Dean for
Director of the Family Nurse Practitioner program at
lific nurse researcher Frank Cole, PhD, RN, CEN, FNP,
Practice at the University of Texas School of Nursing
the University of Texas School of Nursing at Houston
FAAN, FAANP, in 2006.
at Houston and Elizabeth Fuselier, DNP, RN, FNP-BC
and a 2007 graduate of the Doctor of Nursing Prac-
Recently, the clinic has also added Kristi Edmon-
to the acute care setting in the position of Chief of
tice program at Columbia University. Lindenberg has
sond, RN, Executive Assistant, Sherry Snook, medical
Advanced Practice Nursing at the University affiliated
been practicing at the clinic since 1992.
assistant, and Lori Ibarra, receptionist, to its already
Hospital, Memorial Hermann, a new Director was appointed to the Nurse-Managed Health Center.
Cathy Rozmus, PhD, RN is also a welcome addi-
strong team.
tion as a part-time nurse researcher for the Center,
Building the Case for a Nursing-managed Clinic: The St. Vincent’s Nurse-Managed Health Clinic by Kathryn Fiandt, DNS, FAANP, Associate Dean for Graduate Programs and Clinical Affairs, University of Texas Medical Branch School of Nursing
U
niversity of Texas Medical Branch (UTMB)
uninsured users were identified as the pool of ap-
fairs, the School of Nursing was invited to develop
School of Nursing will be opening a new com-
proximately 500 uninsured patients with chronic
a proposal for a new primary care practice for these
prehensive primary care clinic this September. The
health problems who were “frequent flyers” in the
patients. A critical component of the proposal was a
St. Vincent’s Nurse-managed Health Center will pro-
emergency room and in the hospital. Here at UTMB
cost analysis or plans for demonstrating a return on
vide care to an ethnically diverse population of un-
analysis of the 2006 utilization patterns of these pa-
investment analysis.
insured adults with chronic health problems and will
tients determined that the patients with a diagnosis
The data regarding hospitalizes was available to
be funded 100% by monies from the UTMB hospitals
of type 2 diabetes and/or hypertension in this pool
us. A current recommendation for analysis of cost
and clinics budget. This amounts to $225,000/year
of patients averaged 1.75 hospital stays per year at
effectiveness for disease management programs is
in fiscal support of the operations of this center. The
a rate of about $13,000 of uncompensated care per
to look at “number needed to avoid”, i.e. number
only In Kind expenses will be the overhead which
hospitalization. This groups of patients, although not
of avoidable health care events (e.g. ER visits or
will be absorbed by the building owner, a community
the major factor in uncompensated care (e.g. oncol-
hospitalizations) needed to avoid to cover the cost
center, the St. Vincent’s House and an estimated 0.2
ogy costs are much higher) were seen as a target for
of the intervention (Linden, 2006). We were able to
FTE in faculty practice. The costs of a full time family
a low cost intervention for which there might be a
determine that given the $225,000 cost of operat-
nurse practitioner, medical assistant, some time for
sizable return on the investment.
ing the clinic and given that each uncompensated
a clinical laboratory science faculty to develop and
As a result of these data two programs were pro-
hospitalization resulted in average $13,000 loss for
maintain the lab, and for practice management and
posed. A year ago, a nurse case management pro-
the hospital, the hospital will breakeven on their in-
evaluation by the office of the SON Assistant Dean for
gram was initiated targeting the identified pool of
vestment in the clinic when we have resulted in 17
Clinic Affairs, are all covered in the budget. In this
chronically ill “frequent flyers”. This program has
avoided hospitalization. Since the actual operating
article I would like to discuss how the SON was able
been going well but hit a “snag” when the nurses
costs of the clinic are probably closer to $300,000
to successfully build the fiscal argument for this in-
discovered that the safety net clinics in the commu-
if overhead and faculty In Kind are factored in, a
vestment in a nursing center.
nity (the local federally qualified community health
more realistic breakeven will be 23 hospitalizations
UTMB, like many academic health centers, has a
center and the internal medicine residents clinic)
avoided, still a realistic goal.
commitment to serving the uninsured and vulner-
were over subscribed and additional primary care
Before we even open our doors it is clear that the
able residents of the community. The fiscal drain of
spaces was needed to provide health care homes
argument for on-going sustainability of the clinic will
these patients on the system is, however, a signifi-
for the patients. As a result of on-going interactions
be based in the data that we collect as a part of the
cant challenge to the need to “balance the books”
regarding the value of nursing centers between the
care we provide. As a result, a comprehensive pro-
every year. There are many reasons for these uncom-
physician director of the UTMB Office of Community
gram evaluation plan has been developed includ-
pensated costs but one subset of the population of
Outreach and the SON Associate Dean for Clinical Af-
ing obtaining IRB approval for the data collection
www.NNCC.us p 30
On the Road With Nurse-Managed Health Centers process. In addition to traditional outcomes such
be feasible because the costs of the clinic are not
clinic was built solely on the needs of the patients.
as clinical status and patient satisfaction, outcomes
justified based on numbers seen per se, but on hos-
The problem with that argument is that the patients’
that track access to care, health disparities and costs
pitalization avoided, so fewer patients can be seen
needs were in direct contradiction to the need of the
will be carefully monitored. Although the care pro-
and more time given to each patient. Nursing inter-
system to cover the costs of doing business. Finally,
vided will be at no cost, we will capture charge data,
vention data will be collected with each encounter
building on the success of our relationships within
i.e. determine the billable worth of each visit. In ad-
to describe the complex interventions provided that
the academic health center and our sound fiscal
dition, each patient’s history of hospitalization in
will, we believe, result in improved outcomes.
argument, we must follow-through on our commit-
the last year will be determined at intake per patient
There are several critical lessons to be learned
ment by providing quality care and documenting
report and then verified through a review of records
from what we have accomplished and regarding
the value of the services we offer, not just in clinical
for all UTMB patients. It is anticipated that over 90%
what we hope to accomplish. The first lesson is
outcomes or in patient satisfaction, but in demon-
of patients will be established users of the UTMB
the importance of building a relationship with like
strating a cost savings that outweighs the cost of the
health system. At each subsequent visit patients will
minded leaders in the hospital and/or academic
clinic, i.e. the “return on investment”. When we do
be queried about recent hospitalizations and emer-
health system. Our relationships were built on our
that we can be reasonably confident that the system
gency room visits.
shared commitment to providing care to the most
will continue to provide the fiscal support we need for continuity of our nursing center.
We know that providing access to care alone is
vulnerable of patients and that emphasis overcame
not sufficient to avoid hospitalization, so the clinic is
traditional physician and nurse practitioner bar-
designed to provide “intensive primary care” using
riers in the system. The second lesson is the value
References:
a partnership between the nurse case management
of speaking the shared language of finances. Prior
Linden, A. (2006). What will it take for disease man-
practice and the clinic nurse practitioners with an
to providing a comprehensive analysis of where
agement to demonstrate a return on investment? New
emphasis on self-management support strategies
the system was “bleeding” money and determining
perspectives on an old theme. The American Journal of
as well as traditional medical interventions. This will
the “low hanging fruit”, the argument for a nursing
Managed Care, 12 (4), 217-222.
To learn how to start and sustain Nurse-Managed Health Centers, don’t miss: Community & Nurse-Managed Health Centers: Getting Them Started and Keeping Them Going, a National Nursing Centers Consortium Guide, a Springer Publication
For More Information
go to www.NNCC.us
www.NNCC.us p 31
On the Road With Nurse-Managed Health Centers Washington
After nine successful years of treating patients in the Spokane community, the People’s Clinic closes its doors by Margaret Auld Bruya, DNSc, ARNP, FAAN, Professor and Assistant Dean, Academic Health Services, Washington State University Intercollegiate College of Nursing
F
ollowing the recommendations of a blue-ribbon
them with information about other clinics so that
utilized to develop a community partnership model
panel comprised of academic and commu-
they could pursue the care options that were most
of primary health care.
nity experts, the People’s Clinic, a nurse-managed
comfortable to them.”
When the clinic first opened, Bruya anticipated
clinic operated by the Washington State University
The possible closure of the clinic was first an-
serving 120 patients per month; however, the
Intercollegiate College of Nursing, closed its doors
nounced in June, 2007, after the College of Nursing
need was exceptional. Within months of opening,
on May 15. Nurse practitioners at Washington State
was informed that federal funding for the program,
the clinic exceeded capacity and grew from being
University, who worked at the clinic, are accepting
which totaled approximately $400,000 each year,
open two days per week in 1998 to five days per week in 2004. And, it expanded to three locations in Spokane and one in Yakima, Wash. In addition, the clinic provided satellite efforts to provide health services at Havermale High School, an alternative high school located in one of Spokane’s poorest communities. The People’s Clinic has cared for more than 27,500 unduplicated clients from the Spokane County area and has provided accessible and affordable healthcare services to the county’s homeless, marginalized, vulnerable, and low-income families. The faculty-directed care of these vulnerable populations not only supported the mission of the college, but also helped serve an important educational purpose for its students.
clinical practice contracts with existing clinics in
would not be renewed effective June 30. Washing-
“The People’s Clinic has performed an important
Spokane. This action will allow the nurse practitio-
ton State University President Elson S. Floyd later
service for many people in Spokane who need ac-
ners to continue to offer services within the commu-
announced that the university would provide bridge
cess to health care,” said Bruya. “It was important for
nity, but without the administrative responsibilities
funding to ensure continued health care for People’s
us to do everything possible to see that the patients’
of operating a clinic.
Clinic patients as they made the transition to other
interests were protected and that transition plans
health care providers.
were put into place this past year.”
“Both care continuity and patient choice were important to us when we decided to close the clinic,”
The original People’s Clinic, located in downtown
The WSU Intercollegiate College of Nursing con-
noted Margaret Bruya, director of the People’s Clinic
Spokane, opened in 1998 and was designed to im-
tinues to provide and promote partnerships with
and professor at the WSU Intercollegiate College of
prove access to health care and mental health ser-
the health care community in Spokane. Its students
Nursing. “We have been providing care for over nine
vices in the Spokane community for underinsured
work, study at, and contribute to resources at several
years and wanted to give our existing patients the
and low-income families. In addition, the Clinic
health-related outreach programs in Spokane.
option of continuing to work with our nurse prac-
provided primary healthcare education to WSU In-
titioners if they chose. We also wanted to provide
tercollegiate College of Nursing students, and was
www.NNCC.us p 32
NNCC UPDATE The Coding Corner by Margaret M. Foley, Ph.D., RHIA, CCS, Temple University, Department of Health Information Management, College of Health Professions ICD-9-CM Codes Updates
Secondary Diabetes
Hematuria
Effective October 1, 2008
Secondary diabetes mellitus is diabetes
Hematuria coding has been expanded. The
It’s that time of year again. There are sev-
caused by another condition or medical
new code are: 599.70, Hematuria unspeci-
eral new and revised ICD-9-CM diagnosis
treatment, such as: cystic fibrosis, infec-
fied, 599.71, Gross hematuria and 599.72,
codes that will become effective in October.
tion or use of corticosteroids. A new cate-
Microscopic hematuria. Code 599.7, used
Practice encounter forms and computer files
gory of codes, 249.00 though 249.91 have
to report hematuria previously is no longer
need to reviewed and updated accordingly.
been added to capture secondary diabetes
a valid code.
This article focuses on changes that are
mellitus and its related manifestations.
likely to impact a nursing center. The entire
All of the codes within category 249 use
Pressure Ulcers
list of new codes needs to be compared to
the fifth digit of 0 to represent diabetes
Two codes should now be assigned for
encounter forms and computer files. The list
that is “not states as uncontrolled, or
pressure ulcers. In the past, a code from
is available at: http://www.cdc.gov/nchs/
unspecified”, and 1 for diabetes that is
the 707.0x range only was assigned to
datawh/ftpserv/ftpicd9/icdtab09add.pdf.
described as uncontrolled. Similar to the
identify the location of the ulcer. Now a
coding for Type I and Type II diabetes,
code from the 707.0x range for the site and
Genital Wart and Plantar Wart
many of the secondary diabetic complica-
a code from the new subcategory, 707.2x
The Centers for Disease Control and Pre-
tions require a code from the diabetes cat-
to identify the stage of the ulcer should be
vention (CDC), Division of STD Prevention
egory and an additional code for the mani-
assigned. For example, a stage III pres-
– Epidemiology and Surveillance Branch,
festation. For example, diabetic nephrosis
sure ulcer of the heel is coded as: 707.07,
is currently developing several monitor-
due to secondary diabetes would be coded
Pressure ulcer, heel and 707.23, Pressure
ing programs to evaluate the impact of the
as 249.40, Secondary diabetes with renal
ulcer, stage III.
quadrivalent human papillomavirus (HPV)
manifestation and 581.81, Diabetic neph-
vaccine upon HPV-related conditions. Some
rosis. (Previously, secondary diabetes
Fevers
monitoring activities related to anogenital
was coded to 251.8.)
The code used previously to report fever,
warts will use ICD-9-CM diagnosis codes
780.6, has been expanded (780.60 through
captured in managed care organization da-
Headache Syndromes and Migraines
780.65) to include specific types of fever-
tabases. An analysis of anogenital wart di-
Several new codes (339.00 through 339.89)
related conditions such as: post procedur-
agnoses in these administrative databases
have been added for various types of head-
al fever (780.62), post-vaccination fever
indicates that several ICD-9-CM codes are
ache syndromes, for example, 339.00,
(780.63) and chills without fever (780.64).
currently being used to report such condi-
Cluster headache syndrome and 339.10,
In the new coding series, fever, not further
tions. Therefore, the following changes
Tension type headache, unspecified. The
specified, is now coded as 780.60.
have been made to make wart-related code
code for ‘headache’, not further specified,
assignments more consistent.
has not changed (784.0).
Abnormal Vaginal and
Effective October 1, code 078.11, Condy-
The migraine category, 346.xx, has
loma acuminatum, is to be assigned for con-
had some terms re-indexed to other
Similar to the codes already available to re-
ditions such as: condyloma, genital warts
codes within the migraine category or
port cervical PAP smears results, new codes
and anogenital warts. (These conditions
to the new headache syndrome section,
have been added for abnormal vaginal and
were previously coded to 078.10 or 078.19.)
339.xx. The fifth digits for the migraine
anal cytological smears and intraepithelial
Additionally, in response to a request
codes have been revised to capture
neoplasia. In creating this new set of codes
from the American Academy of Pediatrics,
whether there is any mention of status
it was also necessary to make some modi-
code 078.12, Plantar warts, was created to
migrainosus, a severe form of migraine
fications to the existing abnormal cervical
specifically identify plantar warts. (Plantar
in which the headache attack lasts for
cytology codes. The cervix and the anus
wart was previously coded as 078.19.)
over 72 hours.
both have transformation zones where the
Anal Cytological Smears
www.NNCC.us p 33
NNCC UPDATE mucosa becomes squamous. Preferably, a
References
cytologic sample will contain cells from this
1. ICD-9-CM Tabular Addenda, October 1, 2008 (FY09),
mellitus, ICD-9-CM Coordination and Maintenance
transitional zone. A sample may be consid-
available at: http://www.cdc.gov/nchs/datawh/
Committee Meeting, March 22-23, 2007 Diagnosis
ered satisfactory, (for example, a postmeno-
ftpserv/ftpicd9/icdtab09add.pdf
Agenda, available at: http://www.cdc.gov/nchs/
pausal woman may lack endocervical cells
3. Attachment 2 to minutes - Secondary diabetes
ppt/icd9/att2_2DM_mar07.ppt#257,2,Overview
present in the transformation zone because
2. ICD-9-CM Coordination and Maintenance Commit-
of normal physiologic changes), but a code
tee Meeting, March 22-23, 2007 Diagnosis Agenda,
is needed to indicate that a sample is lacking
available at: http://www.cdc.gov/nchs/data/icd9/
the transitional zone. The cervical, vaginal
agendamar07.pdf
of C&M Proposals 4. ICD-9-CM Coordination and Maintenance Committee Meeting, March 19-20, 2008 Diagnosis Agenda,
and anal codes are located in subcategories
available at: http://www.cdc.gov/nchs/about/
795.0x, 795.1x and 796.7x, respectively.
otheract/icd9/maint/agendaMa08.pdf
NNCC Technical Assistance
A
s a member benefit, NNCC provides
cal and surgical topics, and their breadth
and topic index enable you to easily search
direct member services and techni-
and depth are unrivaled in on-line profes-
for and locate specific information. These
sional medical education.
programs are extremely useful for health-
cal assistance at no additional cost to its members. Examples of technical as-
These Grand Rounds Online programs
care professionals in the primary care
sistance include assisting health centers
offer more than 110 hours of Category 1
specialties, but also serve as an effective
with applications to become community
CEU and additional lectures will be added
tool for those who wish to broaden their
health centers, conducting site-visits and
sequentially. Each program is
knowledge in areas outside their chosen
meeting with university leadership to dis-
zz Original, evidenced-based, and presented
specialty.
cuss challenges and opportunities, assisting with the development of business and strategic plans, providing grant writing assistance and visiting legislators with or on behalf of member centers.
in the traditional Grand Rounds format zz Lively and informative, and enabling you to remain clinically current zz Accessible 24/7 and available on an unlimited basis
Over 110 fully accredited online Con-
zz Designed to provide up to 1.5 hours of
tinuing Educations Units (CEUs) available
ACCME, AAPA, AOA and ASNA credits
to NNCC members.
if you take the self-administered test at
National Nursing Centers Consortium
the end of each program
Unlike many other CEU programs, the GEF series accepts no commercial support from pharmaceutical companies or medical device manufacturers. This important policy preserves the integrity of the content and the objectivity of the distinguished faculty. An annual and quarterly subscription is now available through NNCC at an attrac-
(NNCC) and the non-profit Graduate Ed-
Grand Rounds Online also serves as a rap-
tive professional discount. Before enroll-
ucation Foundation (GEF) have agreed
idly accessible clinical information library.
ing, you may access Grand Rounds Online
to enable our members to benefit from
By going to www.ceulectures.org/nncc
and review any three lectures at no cost.
a series of web-based clinical seminars
and clicking on Grand Rounds Online, you
Please check out this new opportunity
presented by many of our nation’s leading
will be able to access the site in real-time
by visiting www.ceulectures.org/nncc
healthcare educators. These interactive
as clinical issues arise in your day-to-day
and click on Grand Rounds Online. I think
CEU lectures, known as Grand Rounds
practice. The Web site and lectures are
you will agree this is an excellent way to
Online, cover a broad spectrum of medi-
structured so that the table of contents
earn CEUs.
www.NNCC.us p 34
NNCC UPDATE Policy News 111th Congress - Report Language: introduced a draft version of the Affordable Health Choices Act. This sweeping 600 page health care reform bill proposes bold changes that will transform the nation’s health care delivery system. NNCC is pleased and excited to announce that the bill includes language that would create a $50 million grant program within the Bureau of Primary Health Care for nurse-managed health clinics offering primary care and wellness services to vulnerable populations around the country. The following NNCC Policy Requests were
The inclusion of this language in
included in U.S. Senate Report 109-287:
Kennedy’s initiative is a tremendous
zz The Committee recognizes the service to
opportunity for nurse-managed health
the uninsured by Integrated Health Cen-
clinics representing the culmination of
ters [IHCs] and Nurse-Managed Health
advocacy activities which began almost
Centers [NMHCs]. These nonprofit
two years ago. In September of 2007,
hospital-affiliated or university-based
Senator Inouye (D-HI) and Senator Al-
health centers provide much needed
exander (R-TN) introduced the Nurse-
primary care to a diverse and disadvan-
Managed Health Clinic Investment Act
taged population. These health centers
of 2007 (S. 2112) calling for the creation
are frequently the only source of prima-
of a federal grant of a grant program for
ry care to their patients. The Committee
NMHCs. On October 9th 2007, NMHCs
encourages HRSA to explore options to
leaders from across the country held a
include IHCs and NMHCs in new public-
legislative briefing in support of this leg-
private safety net partnerships thereby
islation, speaking passionately about the
increasing access for the medically un-
growing role of NMHCs and the need for
derserved. Specifically, the Committee
funding. The briefing was attended by
encourages HRSA to explore granting
approximately 60 people including staff-
these health centers the ability to ap-
ers from the both the House and Senate.
ply for FQHC Look-Alike status. Senate
Although, S. 2112 did not advance
Rept. 109-287 p.38
out of committee, Senator’s Inouye and Alexander used the momentum gener-
Federal Issues
ated by our 2007 efforts to introduce an
zz On June 16 2009, NNCC experienced a
updated version of the legislation in this
true breakthrough on federal level as
year’s congress. The new legislation en-
Chairman, Kennedy and the members
titled the Nurse-Managed Health Clinic
of the Senate Committee on Health
Investment Act of 2009 (S. 1104) also as
TOP: Dr. Jan Towers and Tine Hansen-Turton; CENTER:
Education Labor and Pensions (HELP)
has a companion bill in the House (HR
Dr.Sally Lundeen; BOTTOM: Ann Ritter and Brian Valdez.
www.NNCC.us p 35
NNCC UPDATE 2754) introduced by Representatives
zz NNCC staff advocated that the Stimulus
expansion of non-physician providers
Lois Capps (D-CA 23) and Lee Terry (R-
Bill include advanced practice nurses un-
to be included in Massachusetts man-
NE 02) on June 8th 2009. Ultimately, out-
der the Health Information Technology
aged care plans.
standing work by Jacqueline Rychnovsky
(HIT) proposed Medicaid and Medicare
in Senator Inouye’s office persuaded the
demonstrations. Ultimately, advanced
Managed Care/Center Reimbursement
Senate’s HELP committee to build lan-
practice nurses were included in the
zz NNCC policy staff worked to develop
guage from S. 1104 into the Affordable
Medicaid HIT component of the bill.
Health Choices Act.
a series of comments in response to the Pennsylvania Department of In-
NNCC staff are closely monitoring
State Issues
surance’s call for comments regarding
the progress of this month’s hearings
zz NNCC policy staff members worked on
the proposed merger between Inde-
on the Affordable Health Choices Act to
emerging policy issues in Pennsylvania
pendence Blue Cross (IBC) and High-
ensure our language remains a part of
in order to advocate for nurse-managed
mark. While IBC has been a strong
the legislation. The advances made on
health care at the state level. Three
supporter of nurse-managed health
the federal level would not have been
separate bills (HB 1824, SB 5, and
centers in Southeastern Pennsylva-
possible without the tireless efforts of
HB 2625) were introduced that would
nia, Highmark has repeatedly refused
NNCC members around the country.
create funding mechanisms for com-
to credential nurse practitioners as
Now as major heath care reform seems
munity-based health care providers.
primary care providers in the western
a real possibility for the first time in de-
All three of the bills include language
part of the state. NNCC expressed its
cades, we must keep up the pressure
explicitly
nurse-managed
concerns about whether Highmark’s
to take full advantage of this unprec-
health centers as a category of health
discriminatory policies towards nurse
edented opportunity.
providers who will be eligible for fund-
practitioners would expand statewide
ing under the new legislation. In con-
following the proposed merger in of-
nection with these activities, the NNCC
ficial written comments to the Depart-
Policy & Program Strategist traveled
ment of Insurance and letters to key
to Harrisburg to attend meetings with
lawmakers (both Democrat and Re-
legislative staff and testify in front
publican). Subsequently the merger is
including
of the Senate Public Health and Wel-
not moving forward.
fare Committee about nurse-managed
zz NNCC staff and a consultant continue
health centers. Although these efforts
to work with members to get them
were ultimately unsuccessful (none of
credentialed with managed care com-
the three bills were passed), NNCC suc-
panies. Recently, NNCC staff has been
cessfully raised its members’ profile at
working with Sandra Berkowitz, NNCC’s
the state level in Pennsylvania.
nurse-attorney consultant who spe-
zz NNCC developed and submitted writ-
cializes in insurance issues, to help
ten comments to state policymakers
Independence Blue Cross implement
in Massachusetts and Pennsylvania
a plan-wide policy recognizing NPs as
about regulatory changes that would
primary care providers.
ABOVE: Tine Hansen-Turton and Congresswoman Lois Capps;
impact NP primary care providers. The
NNCC presented Capps a 2008 Champion Award.
outcome was a bill, which include the
www.NNCC.us p 36
NNCC UPDATE Insurers’ Policies on Nurse Practitioners as Primary Care Providers: Two Years Later Results of NNCC’s Managed Care Credentialing Survey Indicate That the Healthcare Landscape is Changing, But Many Insurers Still Do Not Recognize Nurse Practitioners as Primary Care Providers by Anne Ritter The following is an abridged summary of the
Nurse-Managed Health Centers:
Nurse-Managed Health Centers’ capacity
results of NNCC’s 2007 Managed Care Creden-
zz Provide health care to the uninsured
for growth and, in turn, threaten the long-
tialing Survey. We encourage you to read the
and underinsured (nearly half of all
term sustainability of a key component of
full article, authored by Tine Hansen-Turton,
patients seen in nurse-managed health
this country’s health care safety net.
Ann Ritter, and Rebecca Torgan, published in
centers are uninsured).
the November 2008 issue of Policy, Politics & Nursing Practice.
zz Provide cost-effective care that reduces
A National Study of Managed Care Cre-
expensive emergency room use and
dentialing and Reimbursement Policies
hospitalization among patients.
The National Nursing Centers Consortium
Nurse-Managed Health Centers: A Valu-
zz Provide health care in rural and urban
(NNCC) conducted a nationwide survey of
able Part of the Health Care Safety Net
communities where health care dispari-
managed care organizations in Summer
ties are most acute.
2007. Results indicate that credentialing
Nurse-Managed Health Centers represent a promising model for the health care
Despite the fact that Nurse-Managed
and reimbursement policies regarding pri-
safety net in the United States. Staffed
Health Centers address some of the most
mary care NPs have improved somewhat
and managed by advanced-practice nurs-
widely-pursued goals in health care policy
since NNCC conducted a similar survey in
es (including Nurse Practitioners, or
today, their work is commonly misunder-
2005 (see Table 1).
NPs), these health centers provide pri-
stood and undervalued by managed care
Of the 232 insurers included in the 2007
mary health care, disease prevention and
companies. Nearly half of all managed care
NNCC survey of NP credentialing policies,
health promotion services to people in ru-
organizations in the United States refuse
53% credential NPs as primary care pro-
ral and urban areas with limited access
to credential Nurse-Managed Health Cen-
viders. In 2005, only 33% of managed care
to health care and record over 2.5 million
ter staff and directors as primary care pro-
plans surveyed credentialed NP primary
annual client encounters.
viders. These prohibitive policies reduce
care providers. However, the overall pattern of managed care treatment of NPs demonstrates that NPs are still not consid-
Table 1 Comparison of Managed Care Credentialing Policied: 2005 - 2007 80
% of plans in survey sample credentialing NPs as primary care providers
60
ered to be the equal of physicians in their role as primary care provider, and are not treated equitably by many insurers. Among plans that credential NPs as primary care providers: zz Only 56% reimburse NPs at the same rate as physicians, even though NP primary care providers offer essentially the same
40
services as primary care physicians zz 38% reimburse NP primary care providers at a lower rate than primary care
20
0
physicians
2005
2007
zz 6% reimburse NPs at lower rates than physicians, except in underserved areas
www.NNCC.us p 37
NNCC UPDATE State Laws Do Not Protect NPs from
However, data demonstrate that the impact
the credentialing policies of Medicaid and
Discriminatory Credentialing Practices
of these state laws is minimal, and the pro-
Medicare managed care plans regarding
Currently, 23 states currently have some
tection that they provide to NPs is weak.
NP primary care providers.
form of “any willing provider” (AWP)
zz Of 21 plans in states with AWP laws
zz Insurers with significant Medicaid prod-
law in effect. AWP laws ostensibly re-
that arguably apply to NPs, only 52% of
uct lines were much more likely than any
quire managed care companies to admit
these plans credential NPs as primary
other category of insurer in the entire
care providers.
survey to credential NPs as primary care
into their provider networks any willing provider able to meet the terms of the
zz In states with AWCP laws that arguably
providers (73% of managed care organi-
company’s provider agreement. Another
apply to NPs, only 51% credential NPs
zations surveyed in this category creden-
related type of law meant to eliminate
as primary care providers.
tial NPs as primary care providers).
unfair discrimination against provid-
zz These figures are essentially identical
zz Only 43% of insurers with significant
ers are “any willing class of provider”
to those in states with neither AWP nor
commercial product lines credentialed
(AWCP) laws. These laws prohibit in-
AWCP laws impacting NPs, suggesting
NP primary care providers.
surers from refusing to contract with a
that these laws have little or no impact
zz Only 33% of insurers with significant
particular provider solely because of the
on managed care credentialing policies.
Medicare product lines credentialed NP
provider’s licensure. Non-physician providers, such as NPs,
primary care providers. Federal Laws Do Not Protect NPs from
It is worth noting that the plans that have
have fought hard for laws like these, on the
Discriminatory Credentialing Practices
made the biggest strides in NP credential-
assumption that they would lead to more
Similar laws at the federal level (applicable
ing practices since 2005 are those in the
equitable managed care policies. However,
to Medicaid and Medicare managed care
commercial category (see Table 2). Since
credentialing practices are inconsistent
plans) also seem to have no positive im-
2005, pro-NP credentialing policies have
even in states with Any Willing Provider
pact on credentialing and reimbursement
experienced a 19% jump among commercial
(AWP) or Any Willing Class of Provider
policies. The results of this survey suggest
plans. This strongly suggests that any in-
(AWCP) laws. These types of laws ostensi-
that federal regulations intended to elimi-
creases in NP credentialing among Medicaid
bly prohibit discrimination by managed care
nate unfair discrimination against non-phy-
and Medicare plans over the past two years
companies against certain provider types.
sician providers have no positive impact on
are not the result of increased enforcement of federal regulations, but are instead the result of larger economic trends that have
Table 2 Correlation of HMO Product Lines with Credentialing Policies: 2007
impacted insurers in all categories. Increased Clinical Independence Correlates with Improved Credentialing Policies
80 70
HMOs with significant
Most nurse practitioners in the United
Medicaid Product Lines
States have a collaborative relationship with a physician to ensure quality care. In
60
some states, nurse practitioners must be
50 HMOs with significant
40
Medicare Product Lines
scribe medication; in others, nurse practitioners may provide care and prescribe
30
medication with no physician involvement.
20 HMOs with significant
10
Commercial Product Lines
0
supervised by physicians in order to pre-
% of HMOs Credentialing NPs as PCPs
While regulations regarding prescriptive authority vary somewhat from state to state, NPs may prescribe medication in all 50 states and the District of Columbia.
www.NNCC.us p 38
NNCC UPDATE State laws allowing NP prescriptive in-
limited, nurse practitioners must be placed
Managed Health Centers and the care
dependence were one of the single stron-
on equal financial footing with primary care
that primary care nurse practitioners
gest indicators (across the entire survey)
physicians. To achieve this goal, nurse prac-
provide. In our market-driven health
of pro-NP credentialing policies (see Table
titioners and others who support innovative
care system, convincing employers to le-
3). As states require more physician in-
community health initiatives must band to-
verage their purchasing power in support
volvement for NP prescriptive power, few-
gether to remove financial barriers to Nurse-
of Nurse-Managed Health Centers may
er managed care companies are willing to
Managed Health Center practice.
have as much of an impact on managed
credential NPs as primary care providers.
In particular, the study suggests that:
care policies as any lobbying efforts.
zz In states that require no physician in-
zz Efforts to increase governmental regula-
Despite increases in the number of NPs
volvement in order for NPs to prescribe,
tion of managed care provider networks
who have been able to secure better cre-
71% of insurers surveyed credential
may not result in tangible benefits to
dentialing status and reimbursement, the
NP primary care providers.
goal of obtaining equitable credentialing
NPs as primary care providers. zz In states that require physician collabo-
zz Supporters of Nurse-Managed Health
and reimbursement for NP primary care
ration (or a similar intermediate level of
Centers must educate legislators about
providers will remain elusive as long as
physician involvement) for NPs to pre-
the role that Nurse-Managed Health
laws forbidding provider discrimination
scribe, 50% of insurers surveyed cre-
Centers play in the nation’s health care
are not enforced, and as long as managed
dential NPs as primary care providers.
safety net and the unique barriers to
care companies view NPs as primary care
sustainability that they face.
providers of last resort.
zz In states that require physician supervision or delegation for NPs to prescribe,
zz Supporters of Nurse-Managed Health
Discrimination against NPs who pro-
only 46% of insurers surveyed creden-
Centers must educate managed care
vide care to underserved communities is,
tial NPs as primary care providers.
company staff about the quality, scope
in effect, a form of hidden discrimination
and cost-effectiveness of nurse practi-
against the poor. If Nurse-Managed Health
tioner primary care.
Centers receive fair compensation for the
Recommendations and Next Steps In order for Nurse-Managed Health Centers
zz Supporters of Nurse-Managed Health
care that they already provide every day to
to continue to provide primary health care
Centers must educate employer groups
managed care enrollees, we can ensure the
services in areas where physician access is
who purchase insurance about Nurse-
long-term sustainability of these important safety net providers.
Table 3 Correlation between State Requirements for NP Prescriptive Authority and HMO Credentialing Policies: 2007 80
States requiring no physician involvement
60
States requiring intermediate
40
level of physician involvement
20 States requiring physician supervision or delegation
0
% of HMOs Credentialing NPs as PCPs
www.NNCC.us p 39
NNCC UPDATE NNCC’s Managed Care Contracting Project Promoting Fair Reimbursement for Nurse Practitioners Who Provide Primary Care by Ann Ritter
N
NCC’s members operate a broad and
Researching the issues
vider, and are not treated equitably by many
diverse network of Nurse-Managed
In order to advocate most effectively, it is
insurers. While there remains much work
Health Centers that provide crucial prima-
necessary to have reliable, comprehensive
to be done to ensure fair treatment of NP
ry care, health promotion and disease pre-
information about how insurers treat nurse
primary care providers, it has been tremen-
vention services to low-income, uninsured,
practitioners (NPs) who act as primary
dously useful in NNCC’s advocacy efforts to
and under-insured patients throughout the
care providers. Thanks to NNCC’s research
be able to point to published, peer-reviewed
country. A major barrier to the sustainabil-
about managed care policies, it has be-
research that describes some of the unique
ity of these centers is the refusal of many
come possible to understand and analyze
fiscal challenges that our members face.
insurers to 1) recognize nurse practitioners
national trends in insurer policies, and de-
(NPs) as independent primary care provid-
scribe how policies within a certain region
Advocating with insurers
ers; and 2) reimburse NPs who provide pri-
compare to those of the nation as a whole.
Since 2006, NNCC staff and consultants
mary care at the same rate as primary care physicians.
In summer 2004, NNCC conducted its
have worked with NNCC members in Penn-
first managed care survey. The results
sylvania, Maryland, and Michigan to facili-
The lack of adequate reimbursement
were unpublished, but helped NNCC begin
tate the contracting process and advocate
from managed care organizations contrib-
to understand the insurance landscape and
with provider network managers at several
utes to the financial instability of Nurse-
the stated reasons why insurers refused to
large insurance companies. NNCC negotiat-
Managed Health Centers. Because Nurse-
recognize NPs as primary care providers.
ed with credentialing staff at Aetna, which
Managed Health Centers serve such a high
The following year, NNCC conducted a
led to 12 Nurse-Managed Health Centers
percentage of uninsured and underinsured
more comprehensive nationwide survey of
in Pennsylvania being credentialed as pri-
patients, barriers to sustainable funding
managed care organizations to learn more
mary care provider sites. NNCC staff also
sources represent an immense challenge
about how insurers treat NPs who act as
worked with Aetna representatives to de-
to health center directors. To address
primary care providers. The results of the
velop credentialing agreements with NNCC
these issues, NNCC created the Managed
survey were published in a 2006 issue of
members in Maryland. NNCC’s consultant
Care Contracting Project to serve NNCC
Nursing Economics, and a related article
on managed care issues also worked with
members. In recent years, NNCC staff and
was published in a 2006 issue of Policy,
credentialing staff from United Healthcare
consultants have worked with primary care
Politics, and Nursing Practice. In summer
to explore a similar contract for Nurse-
member centers in multiple states to help
2007, NNCC updated its national managed
Managed Health Centers in Eastern Penn-
centers receive credentialing that desig-
care survey (read the full article this issue
sylvania. As a result, a number of NNCC
nates them as primary care providers.
of NNCC Update). The 2007 study has been
members entered into new provider con-
accepted for publication in the journal
tracts with United Healthcare.
Our Strategy
Policy, Politics, and Nursing Practice, and
In 2008, NNCC staff and consultants
NNCC takes a multi-pronged approach to
will appear in a forthcoming issue in 2008.
have continued to work with NNCC mem-
advocacy regarding managed care con-
The next comprehensive survey update is
bers to facilitate the contracting process.
tracting issues, including:
slated for summer 2009.
In spring 2008, NNCC worked with NNCC
zz Researching the issues
Over the years, NNCC-managed care sur-
members in Michigan to set up a series of
zz Advocating with insurers
vey results have indicated that, while creden-
conference calls with a representative from
zz Educating policymakers
tialing and reimbursement policies regarding
Cofinity, a large provider network that is
z z P roviding technical assistance to
primary care NPs have improved somewhat,
a subsidiary of Aetna. In addition to help-
NPs are still not considered to be the equal of
ing to compile information requested by
physicians in their role as primary care pro-
Cofinity representatives (about patient de-
members
www.NNCC.us p 40
NNCC UPDATE mographics, most-frequently billed codes,
the merger. In addition to submitting writ-
pendence Blue Cross Headquarters in Phil-
etc.), NNCC was also able to advocate for
ten comments to the Department of Insur-
adelphia, PA, was a great success. Approxi-
members in Michigan by placing the discus-
ance about the proposed merger, NNCC also
mately 60 people from states throughout
sion in a national context and describing
brought up the issue in testimony in front of
the Northeast participated in the event, and
Aetna’s policies in southeastern Pennsyl-
the Pennsylvania Senate Public Health and
we received uniformly excellent feedback
vania. While each health center director
Welfare Committee, and again in multiple
from both participants and HRSA staff.
will ultimately make an individual decision
letters to state Senators, consultants hired
The Health Center Empowerment Proj-
whether to enter into a provider agreement
to evaluate the merger, and members of the
ect’s next live regional event will take place
with Cofinity, NNCC was able to help ensure
Governor’s health care reform cabinet. Cop-
in Atlanta, GA (serving HHS Region 4) in
that all NNCC members would be creden-
ies of all of these documents are available
late September or early October 2009. It
tialed as primary care providers and listed
to NNCC members who wish to draft similar
will be followed by another regional event
as such in the Cofinity provider directory.
letters and comments to lawmakers. If you
in March 2010 in San Francisco, CA (serv-
are interested in receiving copies of these
ing HHS Regions 9 and 10).
Educating policymakers
materials, please contact Ann Ritter at
In addition to working with insurer staff
aritter@nncc.us or 215.731.7142.
and representatives, NNCC also educates
In addition, NNCC will begin to coordinate a series of free and low-cost webinars for health centers, the first of which will
policymakers so that they are aware of the
Providing technical assistance to members
feature NNCC’s Nurse-Attorney Consultant
challenges that restrictive insurer policies
In addition to individualized technical as-
Sandra Berkowitz sharing her expertise
can pose to our members and the vulner-
sistance to our members, NNCC will also
about insurer contracting and credential-
able communities that they serve. In 2007
offer webinars and live workshops about
ing issues. It is slated to take place in June
and 2008, NNCC worked with members in
managed care contracting and reimburse-
2009. All NNCC members will receive addi-
Pennsylvania to educate state lawmakers
ment issues (as well as a wide variety of
tional information about these training op-
about restrictive insurer policies, especially
other topics) to a broader audience through
portunities in the near future. Please keep
in light of a significant proposed merger
the Health Center Empowerment Project,
your eyes open for more information about
between Highmark, Inc. and Independence
a multi-year project funded by the HRSA
event and webinar registration!
Blue Cross. In Pennsylvania, Highmark has
Bureau of Primary Health Care.
If you have any questions about the
been resolutely opposed to credentialing
The Health Center Empowerment Project
Health Center Empowerment Project or any
NPs as primary care providers, and this posi-
officially kicked off on February 24, 2009,
other issues regarding insurer credentialing
tion would be potentially devastating to our
with the Northeastern Regional Workshop
and reimbursement, please contact Ann Rit-
members if it were adopted statewide after
Project. The event, which was held at Inde-
ter at aritter@nncc.us or 215.731.7142.
NNCC-Member Peer Review Articles: zz A White Paper was published by Disease
zz Sullivan-Marx, E. M., & Gray-Miceli,
Management, a peer-reviewed academic
D. (Eds.) (2008). Leadership and Man-
Sigma Theta Tau International published
journal, edited by Dr. David Nash of Jef-
agement Skills for Long Term Care. New
a book entitled: “Conversations with Lead-
ferson University Medical School, pub-
York: Springer.
ers,” co-authored by PHMC Board member,
Books
lished by Mary Ann Liebert, Inc. NNCC
zz Mackey, T. (2008). Practice management
Susan Sherman, Vernice Ferguson and Tine
co-authors include: Ken Miller, Mona
challenges for advanced practice nursing.
Hansen-Turton. Book signings took place at
Counts and Tine Hansen-Turton.
Clinical Scholars Review, 1(1), 11.
the NNCC annual conference and in Balti-
zz Sullivan-Marx, E.M., Cuesta, C. L., &
zz Mackey, T. (2008). Marketing your nurse-
Ratcliffe, S. J. (2008). Exercise among
managedpractice:becomea“marketpreneur”.
urban dwelling older adults at risk for
Clinical Scholars Review, 1(1), 13-17.
more on November 3, 2007.
health disparities. Research in Gerontological Nursing, 1, 1-10
www.NNCC.us p 41
NNCC UPDATE Capstone Rural Health Center: A Leader in Technology by Ann Ritter Capstone rural health center began using Encite Electronic Medical Records around May of 2004. Some of the adversities faced were keeping communication flowing between client and vendor, having realistic expectations and allowing for a learning curve. The hiring of Matthew Mauldin as Manager of area computing services has been an asset because he has invested the required time needed to configure the EMR to the clinic’s practice. Matt expects to see areas of improvement in instant access to patient charts, legible charts, decrease in clinical errors, improved staff communication, reduced overhead in charting expenses, increased reimbursement and improved statistical tracking of all areas of the clinic. Despite hesitation because of the possibility of information being left on screen and the possibility of patients attempting to damage the systems, a wall-mounted workstation for charting purposes only was installed in all seven patient rooms. The reservations once present have now been pushed aside after seeing the nursing staff charting in the rooms and building more of a bond with the patients. David Jones, nurse practitioner, states, “Being able to chart electronically in the room gives us more access to the point of care, in other words we do everything right with the patient. The patients feel a better sense of involvement in their care when we can work through the documentation with them.” Read Matthew Mauldin’s article below for a staff perspective of what it takes to implement electronic health records…
Capstone Rural Health Center Implements an EMR by Matthew Mauldin, Manager, Area Computing Services
I
n January of 2008 I began my first job
stant errors. Peggy McGraw, LPN, shared
and I became the Trainer and Support for
in the health care world. I had no idea
with me, “Many times the system would
M & M Computer Services in July 2004.
what EMR, HIPAA, PHI, or any other acro-
lock-up or have errors pop up and block any
Here we are today in April 2008 with many
nym stood for. I do now! The main reason I
progress being made, if the system lost con-
hurdles behind us. My first task was to
was hired was to help bring Capstone Ru-
nectivity, which by the way happened count-
evaluate Capstone’s use of the software.
ral Health Center (CRHC) to the next level
less number of times daily, we would have
From there I created an implementation
of patient care by using the technology we
to start our charting from step one. “ There
plan, picked a team leader and began the
already had in place. After the first “hon-
was a constant struggle the first few months
process of working with Capstone staff.
eymoon” month I started taking a needs
working in the clinic. After two months of
Some of the adversities Capstone faced
assessment of the clinic. I found the server
hearing the complaints with the system, I
were keeping communication flowing be-
to be obsolete. Nurse practitioners wanted
met with Dr. Dunkin and asked her if I could
tween client and vendor, having realistic
a better way of charting instead of leaving
attend training in San Antonio with our soft-
expectations and allowing for a learning
each patient room to chart, but feltthat
ware support team. She supported the idea
curve. Capstone’s hiring of Matt has been
the EMR program we are using, ENCITE,
and the weeks following Bobbie Robertson,
an asset because he has invested the re-
wasn’t being used to its fullest potential.
Nurse Practitioner, and I flew to San Anto-
quired time needed to configure the EHR
There was reservation towards using this
nio to meet with Pat Blair.
to the clinic’s practice. Matt has set goals
program. For years the clinic ran on paper
I spent the week with Pat and she
keeping in mind that the clinic can’t expect
charts and that’s the way most of the staff
showed me many things I had no idea our
to go paperless all at once. Matt realizes
wanted it to stay. Change is sometimes met
EMR software did. I was unaware that our
that modifications, enhancements and up-
with great hesitation but with the staff’s
software we had been fighting with was
grades of the software are ongoing. In the
help, we hope to be completely paperless
actually a powerful piece of software that
next six months, Matt and I expect to see
within six months.
had the potential to make our clinic run
areas of improvement in instant access to
with great efficiency.
patient charts, legible charts, decrease in
I spent my first few months hearing nothing but bad things about ENCITE. I heard
“Capstone Rural Health Center began
clinical errors, improved staff communica-
that the program was filled with bugs. The
using Encite Electronic Medical Records
tion, reduce overhead in charting expens-
program was useless because of the con-
around May of 2004. My name is Pat Blair
es, increased reimbursement and improved
www.NNCC.us p 42
NNCC UPDATE statistical tracking of all areas of the clinic.
der the thermal printer and tamper resis-
will sign off on all lab work preformed. This
Both Matt and I are planning great things
tant rolls. This product has become a hit
will not only ensure the accuracy of labs,
for Capstone.”
among staff and patients alike. They are
but make it more efficient and time will be
all excited to see that their little clinic in
spent on other needs than manually enter-
rural Alabama is a step above the rest.
ing in data for each lab.
After arriving back in Alabama, I came in with a passion to get this clinic where it needed to be. I knew one person wouldn’t
The new workstations are in place, we
Our biggest and final project, I hope, is
be able to change the clinic but it would
are now compliant with the state with our
about to take place. We have purchased a
be a group effort. After speaking with our
prescriptions, and just when I think I have
new server to bring us up to date. We will
two full time nurse practitioners, we imple-
a chance to breathe, I am approached by
be installing all software from scratch and
mented a workstation mounted to the wall
Peggy asking if we purchased Electronic Vi-
configuring the data to meet our needs spe-
in each patient room for charting purposes
tal monitors, could they input data directly
cifically. Our software will be secured from
only. I was very hesitant to do this because
into our EMR system. I told Peggy I would
the server end to ensure no PHI is removed
of the possibility of Patient Information
do some investigating. I contacted Pat, she
from our network. We will have this new
being left on screen and the possibility of
contacted Encite, and found that yes we can
server in place by June 9, 2008. Having this
patients attempting to damage the sys-
input data directly from our Spot Vital Ma-
in place will allow our ultimate goal to hap-
tems. After I provided my coworkers with
chines to our EMR software. The Vital Mon-
pen, being completely paperless in 2009.
strict instructions with the systems, we
itors are machines that monitor not only
This job has been the very rewarding,
went ahead with the install. All seven of
your blood pressure but your Pulse Oxemit-
and I have only been working with CRHC
our patient rooms are now equipped with
ry, heart rate, and temperature. This allows
for five months now. I cannot wait to see
workstations. The reservations I had have
for more accurate readings and reduces the
where we are as a staff but as a clinic in
now been pushed aside after seeing the
possibility of incorrect data inputted into
the years to come. I have always been in
nurses and nurse practitioners charting
the EMR software. The picture to the right
the Educational field so working within
in the rooms and building more of a bond
shows Rhonda Black with a patient getting
the healthcare field has really opened up
with the patients. David Jones states, “Be-
her vitals checked with our new system.
my eyes to how important technology is in
ing able to chart electronically in the room
While the Vital Machine is checking the pa-
this field. Working with this group is the
gives us more access to the point of care, in
tient’s vitals, Rhonda is inputting Past, So-
most rewarding of all. We are a family here
other words we do everything right with the
cial, Family history at the same time. Hav-
and we take care of our own like families
patient. The patients feel a better sense of
ing everything in the room at the same time
are supposed to. I may put a kink in their
involvement in their care when we can work
brings us back to the statement David made
workflow when I implement new technol-
through the documentation with them.”
earlier, “The patients feel a better sense of
ogy, but everyone here shows a great re-
involvement in their care when we can work
spect of each other and their job duties. We
through the documentation with them.”
all know that we have a job to do, but at the
After the task of implementing workstations in each room, next on my priority list was becoming compliant with the state
We are in the process of bringing in a
end of the day working with this group is
guidelines concerning the tamper proof
new internet service provider for more data
more rewarding than successfully install-
prescriptions. After doing some investi-
transfer ability. We are implementing a tele-
ing a workstation in a room, or a new vital
gating, I found a very inexpensive way to
health project, providing LabCorp ability to
machine. Peggy said one day, “With many
ensure all tamper rules were met and in a
securely download data to our system. Lab-
software updates, relocation of building
way we all come in contact each day of our
Corp handles all patient labs needing to be
site, new computers, and new hardware
lives. Micro Format is a company specializ-
preformed. When the Nurse Practitioner re-
CRHC has come a long way in improving
ing only in Tamper Resistant Prescription
quests lab work to be done, he or she clicks
the age of the paperless provider client
Products. After researching this company
one button and the information is securely
care.” With this excellent staff and the
and their method of Rx Compliance, I in-
transmitted directly to LabCorp. Once the
technology we have in place, CRHC will be
formed Peggy, Bobbie, and David of my
data is received, run, and report is ready,
the leader of Nurse Managed Facilities in
find. They were all interested in getting
Lab Corp securely transmits the data back
the state of Alabama!
this implemented. I recommended we or-
to our office and the Nurse Practitioners
www.NNCC.us p 43
NNCC UPDATE International News The 2008 NNCC and Auckland University of Technology-sponsored Global Healthcare Solutions for Vulnerable Populations Conference a Great Success
O
n January 16-17, 2008, over 200 health
Health, Stephen McKernan, along with
zz Introducing the nurse-managed health
professionals, representing 16 coun-
Colin Tukuitonga, Chief Executive of Min-
center and nurse-led movement along
tries gathered at the Spencer on Byron
istry of Pacific Island Affairs discussed
with new entrepreneurial and consum-
Hotel at Takapuna Beach, Auckland, New
New Zealand’s health issues. Tom Fraw-
Zealand at the first Global Healthcare Solu-
ley, Irish Ombudsman and Jenny Hogan,
zz Discussing nurse practitioner and ad-
tions to Vulnerable Populations Conference.
National Council for the Professional De-
vance practice nursing movement in the
The conference was sponsored by Auck-
velopment of Nursing and Midwifery, dis-
land University of Technology, the National
cussed the Irish perspective and Dr. Ken
zz Advancing learning and research oppor-
Nursing Centers Consortium, Fulbright New
Miller, Nursing Dean in Delaware, along
tunities across different healthcare en-
Zealand and Eisenhower Fellowships.
with Dr. Thomas Mackey, University of
vironments and different countries; and
The Conference, which was a direct
Texas, Dr. Joanne Pohl, University of
zz Discussing solutions global policy and
outcome of Executive Director, Tine Han-
Michigan and Dr. Mary Jo Baisch, Univer-
sen-Turton’s Eisenhower Fellowship in
sity of Wisconsin, among others, covered
Conference participants concluded that
2005, provided an exciting opportunity
the U.S. perspective. Specific topics that
Nurse Practitioners serve an important
for health-care professionals from around
was shared, included:
role in expanding care to vulnerable popu-
the world to share innovative health care
zz Sharing best practice healthcare pro-
lations. However, in order to maximize
models and services and to discuss best
grams and initiatives between the
their potential in New Zealand, important
practices for treating vulnerable popula-
community and healthcare profession-
next steps will be to get the process of be-
tions. The Global Healthcare Solutions
als which address key issues, such as
coming a nurse practitioner more stream-
to Vulnerable Populations Conference’s
accessing primary healthcare, public
lined. In the upcoming months, AUT and
emphasis was on population-based and
health, mental healthcare, health litera-
University of Auckland will be partnering
community-based healthcare along with
cy, housing, poverty, social isolation, ed-
to explore new ways to support Nurse
health promotion and preventive care
ucation and overall population health;
Practitioner practices.
through primary care through nurse-led
zz Providing strategies to growing and
For more information about the con-
primary care and public health programs.
sustaining healthcare practices and
ference papers and presentations, visit:
Keynote speaker, Director of General
programs;
www.nncc.us.
er-driven best practices;
U.S., Ireland, and globally;
legal challenges & opportunities.
Above: NNCC Board and colleagues having fun in New Zealand; RIGHT: Dr. Christina R. Esperat in New Zealand.
www.NNCC.us p 44
NNCC UPDATE NNCC Staff/Consultants: Tine Hansen-Turton, Executive Director tine@nncc.us Laura Line, Deputy Executive Director lline@nncc.us Alex Lehr O’Connell, Grants Development Manager alehr@nncc.us
NNCC Newsletter Staff: John Paul Curtin, Americorps VISTA member, Lead Safe Babies jpcurtin@nncc.us Julia Battochi, Lead Safe D.C. Intern jbattochi@nncc.us Kate Taylor Operations & Programs Coordinator ktaylor@nncc.us
Amalia Petherbridge, Assistant Director, Students Run Philly Style amalia@nncc.us
Kay Kinsey, P.I. and Administrator / NFP kkinsey@nncc.us
Anatolia Rodriguez, Outreach Worker, Lead Safe Babies arodriguez@nncc.us
Mary Anderson, Heart & Soul Program Health Educator manderson@nncc.us
Angela Wyan, Assistant Director, Lead Safe D.C. awyan@nncc.us
Lisa Whitfield-Harris Operations Manager, NFP lharris@nncc.us
Ann Ritter, Director, Health Center Policy & Development aritter@nncc.us
Michelle O’Connell, Executive Director, Academy of Cognitive Therapy moconnell@academyofct.org
Anne Lynn, Member Relations Manager, alynn@nncc.us
Nancy DeLeon Link, Regional Public Health, Emergency Preparedness Coordinator, ndlink@phmc.org
Brian Valdez, Health Policy Manager, brianv@nncc.us Caroline Ridgeway Policy Associate for CCA cridgway@nncc.us caroline@ccaclinic.org Elizabeth Byrne, Smoking Cessation Program Manager ebyrne@nncc.us Eudora Burton, Housing Specialist Social Worker, Nurse-Family Partnership, eudora@nncc.us Grace Lee, Administrator, Health Information Systems glee@nncc.us
Harrison Newton, Director, Environmental Health harrison@nncc.us Heather McDanel, Program Director, Students Run Philly Style mcdanel@nncc.us
Co-Editors: Tine Hansen-Turton Sormeh Harounzadeh Contributing Writers: NNCC Members Ann Ritter Ken Miller Christina Esperat Laura Line Grace Lee Alex Lehr Robin Squellanti Joanne Pohl
Naomi Starkey Program Coordinator, Go Red for Women nstarkey@nncc.us Shawana Mitchell, Coordinator of Environmental Safety Programs shawana@nncc.us Shawn Alston, Network Administrator salston@nncc.us Sheneka Frasier-Kyer Lead Hazard Control Manager sheneka.frasier-kyer@phila.gov Tameka Wall Program Coordinator, Asthma Safe Kids twall@nncc.us Todd Ziegler Lead Outreach Referral Manager, tziegler@nncc.us William Longo, Americorps VISTA Member, Students Run Philly Style wlongo@nncc.us
Jamie Ware, Law Intern jware@nncc.us
www.NNCC.us p 45