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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


NNCC Newsletter 2009