Originally published in MedPage Today
by Kristina Fiore, MedPage Today Staff Writer
Encouraging “medical homes” to deliver care outside the emergency room should be a key aspect of healthcare reform, according to researchers, policymakers, and business leaders.
“It’s not rocket science to put a nurse practitioner near a public housing project,” said Jeffrey Brenner, MD, a physician in private practice in Camden, N.J., who analyzed hospital claims data there and is in a pilot program with the Camden Coalition to improve healthcare delivery.
Brenner found that the “leading” patient among area hospitals was seen 324 times, and that 90% of costs were attributable to just 15% of the patients.
There were also 12,000 emergency department visits for upper respiratory infections over that time period.
He suggested that establishing a nurse practitioner in these communities would improve care while reducing costs and burdens on emergency departments.
“The fix to this whole mess is primary care, or the medical home,” Brenner said at a healthcare symposium organized by the New Jersey Chamber of Commerce here.
The organization’s goal invited representatives from hospitals, pharmaceutical companies, academia, and business to discuss solutions to healthcare reform issues.
The so-called medical home could reduce costs by streamlining care, improving patient education and understanding, and reducing medical errors, researchers said.
Nurses and pharmacists would have significant roles in the medical home, participants said.
Susan Hassmiller, PhD, RN, of the Robert Wood Johnson Foundation, one of the sponsors of the event, said inadequate nursing can lead to reduced quality of care and an overburdened nurse staff.
For that reason, addressing an impending nursing shortage is critical, Hassmiller said. In New Jersey, the average age of nurses is 50 years, and the vast majority are expecting to retire within five years.
The same is true of nursing educators, a shortage that may leave insufficient faculty to teach new nursing students.
“Improving health and healthcare for all Americans can’t be possible without an adequate nursing force,” said Susan Blackwell-Sachs, PhD, RN, dean of the College of New Jersey’s school of nursing and director of the New Jersey Nursing Initiative, a project of the Robert Wood Johnson Foundation.
“Shortages directly affect the quality of care.”
Brenner said change won’t come easily. Healthcare currently accounts for 18% of the gross domestic product, and some forecasters say it could rise to 25% in 10 years.
“When something becomes a quarter of the economy, getting control of it is going to be incredibly difficult,” he said. “The healthcare reform bill does not begin to chip way at this.”
He equated fixing healthcare to a “whack-a-mole” game: “You fix it in one spot, it pops up somewhere else.”
He said an essential question is whether to first cover everyone, then try to control costs, or do both at the same time.
Brennar said he preferred “an incremental approach,” and noted that “if you cover everyone, then we can really talk about the cost issue.”
He added that the take-home message is that state chambers of commerce have a large role in healthcare reform.
“We really need to fix this state by state,” he said.
Dana Egreczky, a senior vice president with the New Jersey Chamber of Commerce, said business owners should make their voices heard on reform, at both a national and state level.
“I’m not sure we can do anything about federal decisions on reform from here in New Jersey,” she said. “What we can do in this state is to fix this system.”
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