Transcript Painting a portrait of utilization: Medicare and nurse managed health centers American Public Health Association 140th Annual Meeting San Francisco, CA 30 October 2012 Jennifer Bellot,

Painting a portrait of utilization:
Medicare and nurse managed
health centers
American Public Health Association 140th Annual Meeting
San Francisco, CA
30 October 2012
Jennifer Bellot, PhD, RN, MHSA, CNE
[email protected]
Presented by Sarah J. Powell, MA
Presenter Disclosures
Jennifer Bellot
The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
No relationships to disclose
Background
• Access to primary care for older adults
• Safety net
• Patient centered medical home
• Medicare utilization
Nurse managed health centers
“Nurse-managed health centers, often referred to as nurse-managed
health clinics or NMHCs, are (outpatient centers) run by nurses. Many
have advanced practice degrees and are nurse practitioners, clinical
nurse specialists, nurse midwives, and public health nurses. (NMHCs)…
have the expertise to diagnose illness and prescribe medication, to make
referrals to specialists, to provide pre-and post-natal care, and to offer a
wide variety of other primary health care services. (NMHCs) are
focused on the needs of communities.”
-Definition taken from the National Nursing Centers Consortium www.nncc.us
Sample
• 15 total NMHCs, 10 met criteria for participation
– 5 others were wellness clinics (did not bill for services) or
pediatric NMHCs (did not have Medicare beneficiaries)
• 9 in urban areas, 1 suburban-rural
• Total of 1,077 discrete Medicare beneficiaries seen across SEPA
NHMCs in 2011, ranging from 31 to 332 at each site.
Findings: Demographics
• Mean age 53.6 years (Range 0-96 years)
Findings: Dual eligibility
Source: Kaiser Family Foundation
www.kff.org
Findings: Dual eligibility
• Almost 80% under age 65
• Concentrated under age 42
• Indicates young disability, rather
than poor elderly
Implications and Limitations
• Medicare
older adults in NMHCs
• Need to expand sample to determine if this is a geographic
phenomenon
• Further exploration of ICD-9, CPT codes and RVUs
• Does not address wellness care, free care or undocumented care
Future directions
• Expansion of sample to regional, possibly wider
• Urban, suburban, rural comparisons
• Service level intensity
• Focus groups of older adults
• Comparisons with standard FQHCs
Acknowledgements
• This project is funded by the Robert Wood Johnson Foundation Nurse
Faculty Scholars Program, a national program of the Robert Wood
Johnson Foundation administered by the Johns Hopkins University
School of Nursing.
• Thanks to Marie Dennis, PhD, for her assistance with data organization
and analysis.
October 12, 2009