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University of Miami President Donna E. Shalala, Pennsylvania Gov. Edward G. Rendell: Nurse Practitioners Are Key to Obama Health Care Reform, Call for Increased Federal Funding for Innovative Nurse-Managed Health Care

Solution Already in Place: "Nurse-Managed Health Centers" Essential to Easing Health Care Crisis; Even as Doctor Shortage Worsens, Nurses Are Able to Triple Number of Patients Aided.

WASHINGTON, May 8 /PRNewswire-USNewswire/ -- Health care reform that focuses on fixing health insurance without dealing with the chronic and growing shortage of primary care physicians is likely to encounter "Massachusetts-style growing pains" unless nurse practitioners are fully involved in health care reform, according to University of Miami President and former Secretary of the U.S. Department of Health and Human Services (HHS) Secretary Donna E. Shalala, Pennsylvania Governor Edward G. Rendell, and other experts brought together today by the American Academy of Nursing (AAN) and its "Raise the Voice" (RTV) campaign.

Shalala, Rendell and the others agreed that "Nurse-Managed Health Centers" - an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations - will be a vital ingredient in any plan to increase the capacity of the nation's health care delivery system. The good news is that these nurse practitioner-led facilities are a "solution in plain sight" that already has been tested in Pennsylvania and 40 other states. Today, there already are over 250 Nurse-Managed Health Centers across the U.S. providing assistance to millions of Americans. It is estimated that these existing health centers could be expanded to reach over 20 million Americans, a significant number of the estimated 46 million Americans without health care insurance.

Experts have expressed great concern about the nation's supply of primary care physicians, and their ability to meet the needs of patients throughout the United States. The current downturn in the number of primary care physicians is likely to increase during the next 20 years, resulting in a shortage of as many as 44,000 physicians in the fields of general internal medicine and family medicine by the year 2025. Advocates of nurse-led care point out that while the current acute physician shortage is only projected to worsen in the coming years, the number of advanced practice nurses will rise significantly.

The implications for health care reform of the doctor shortage could be staggering. In Massachusetts, for example, passage of a universal insurance plan has overwhelmed the system's existing supply of primary care physicians. As of 2008, only 52 percent of internists in Massachusetts are accepting new patients. In the face of acute primary care physician shortages and steady reductions in the number of physicians who are willing to accept Medicaid and Medicare, it is unclear whether our existing primary care system will be able to meet the needs of a universally insured nation.

University of Miami President Donna E. Shalala, former Secretary of the U.S. Department of Health and Human Services (HHS) and Chair of the Advisory Committee of the Robert Wood Johnson Foundation funded "Raise the Voice" campaign of the American Academy of Nursing, said: "While increasing access to health insurance will help improve access to health care, our nation's health care crisis cannot be solved by insurance alone. Enhanced nurse practitioner involvement in primary care has the potential to dramatically increase access to health care, improve care for patients with chronic diseases, and improve the efficiency of the health care system, all by maximizing the use of our existing health care resources. One option - Nurse-Managed Heath Centers need additional federal funding. Just as important, nurses need a seat at the table when true reform is being debated."

Pennsylvania Governor Edward G. Rendell said: "The 'Prescription for Pennsylvania' experience, which two years ago focused on implementing innovative, non-physician models of heath care in the state has been nothing short of a major success. Our chronic care and patient centered medical home model, provides high quality health care to tens of thousands of patients that otherwise would find it difficult to access and pay for these services. By next month, we expect 400 primary care practitioners to be involved in four learning collaboratives, transforming chronic care for more than 750,000 patients. Greater nurse practitioner involvement in chronic care and rapid response is the inoculation we need to prevent rising heath care costs and ensure greater access to heath care."

National Nursing Centers Consortium Executive Director Tine Hansen-Turton said: "Our nation's 250 Nurse-Managed Health Centers are community-based, non-profit health centers that are staffed and run by advanced practice nurses (primarily nurse practitioners). They represent an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations. These health centers are positioned to significantly expand the capacity of our nation's overburdened health care delivery system in a cost-effective and affordable way, but their true potential remains untapped. These centers can provide the foundation for real health care reform that will work, serving tens of millions of additional families across the United States."

Independence Foundation President Susan E. Sherman noted: "Philadelphia may be the future vision of health care reform in the United States. Because we believe in the model's potential, the Independence Foundation has invested millions of dollars in 12 Nurse-Managed Health Centers that provide primary care, health promotion, and disease prevention services. These Nurse-Managed Health Centers help clients manage current health problems, detect potential health problems, and reduce the risk of future health problems. We are proud of our support of this innovative model of care, but our support is not enough to sustain these centers. We need federal funding to bolster private sector support."


The National Nursing Centers Consortium, a non-profit organization comprised of Nurse-Managed Health Centers throughout the country, has a five-point plan with new ideas to increase access to health care, improve care for patients with chronic diseases, and improve the efficiency of the health care system:

  • Ensure Access to Care for the Underserved by Protecting the Government's Investment in Nurse-Managed Health Centers. Many Nurse-Managed Health Centers are affiliated with academic schools of nursing, and received federal start-up funding through the HRSA Division of Nursing. Although these centers serve a high percentage of uninsured patients, they often cannot qualify for the enhanced resources that the government offers Federally Qualified Health Centers (FQHCs). By increasing funding and reimbursement for this innovative model of care, the government can encourage the sustainability of existing primary care access points and help health centers offset the high costs of providing care to uninsured, low-income and vulnerable families.
  • Improve Geriatric and Chronic Care by Adopting an Inclusive Definition of the "Medical Home." Nurse practitioners are currently excluded from participating in a number of "medical home" initiatives - including the Medicare Medical Homes demonstration project administered by CMS - despite the fact that Nurse-Managed Health Centers serve as full-fledged primary care homes for hundreds of thousands of individuals. To ensure that America's increasing population of seniors has access to high-quality, comprehensive primary care models, it is essential that the concept of the "medical home" be expanded to include nurse-led practices.
  • Create More Efficient Infrastructure for Health Care Administration. Even though the process of provider credentialing is essentially the same for every insurer, providers must submit multiple credentialing applications to all insurers in his or her market. A unified credentialing clearinghouse for all health care providers could reduce or eliminate unnecessary delays and redundancies in the credentialing process. This could reduce administrative costs in health centers by 25 percent.
  • Increase Opportunities for Health IT Implementation. Nurse practitioners and Nurse-Managed Health Centers must have the same opportunities as other providers to take part in initiatives designed to improve primary care outcomes. To achieve this, the government must fund Health IT initiatives outside of its existing funding frameworks, which tend to focus on physician-led practices and existing FQHCs. Given the nation's growing shortage of primary care physicians, it is critical that the government ensures that Nurse-Managed Health Centers have access to incentives that would allow them to implement new Health IT initiatives and improve quality of care for their patients.
  • Invite New Players to Join the Health Reform Discussion. Nurse practitioners are the fastest growing group of primary care professionals in the country. Although nurse-managed care models are a relatively new movement in health care, they reach large numbers of patients throughout the country. These providers have new ideas that promise to increase the accessibility and affordability of health care in the United States. Without their voices at the health reform table, we may lose the opportunity to implement a more interdisciplinary, team-based model of health care.

To learn more about Nurse Managed Health Centers, please review the PowerPoint presentations of National Nursing Centers Consortium Executive Director Tine Hansen-Turton and Independence Foundation President Susan E. Sherman by visiting


The American Academy of Nursing ( serves the public and the nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge. Every day across America, the Academy and its members create and execute knowledge-driven and policy-related initiatives to drive reform of America's health care system.

The American Academy of Nursing "Raise the Voice" campaign receives support from the Robert Wood Johnson Foundation; today's briefing was supported in part by the Independence Foundation.

EDITOR'S NOTE: A streaming audio recording of the news event will be available on the Web as of 3 p.m. EDT on May 8, 2009 at

SOURCE American Academy of Nursing, Washington, D.C.
Copyright©2009 PR Newswire.
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