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More Insured Patients Leading To New Kind Of Care

A major strategy of the new federal healthcare law is to provide insurance for low income people. The uninsured tend to delay getting care and when they do, they use the emergency room. But the strategy has a problem, adding more people to the insurance roles means we need more primary care providers. Much of that burden is now falling to nurse practitioners and a new type of health clinic. Margaret Graham assesses 40 year old Michelle Mingle who has come to Ohio State’s Total Health and Wellness center with a racing heartbeat. “Based on the fact that you’ve had these heart palpitations over the past month and that has occurred several times, we’re going to go ahead and do an EKG," says Graham. Graham is not a doctor – she’s a nurse practitioner. That’s a nurse trained to diagnose patients who can prescribe certain drugs. In fact there is no doctor at the clinic which is run by OSU’s college of nursing. It opened last month at University Hospital East. “I think that as we get more and more people in the health care system, on the health care rolls we have to use the best provider for the situation and make sure that all providers are able to practice to their full scope," says Graham. In addition to primary care nurse practitioners, the clinic includes a pharmacist, dietician, and a social worker, and soon a psychiatric mental health nurse practitioner. A physician is available by phone or e-mail if necessary. Mingle’s visit helps put her mind at ease. “Kind of maybe a little worried about heart disease, but she’s made me feel more comfortable that maybe it’s not," says Mingle. Without this clinic, Mingle might have gone to the emergency room – which is much more expensive. Keeping patients like Mingle out of the ER is one of the goals of the nurse practitioner run facility. Director Kristie Flamm says the east side location is convenient to bus transportation and close to low-income patients who will soon be covered under the Affordable Care Act. “In the long-run this should really save health care dollars if we can prevent heart attacks, if we can prevent strokes, if we can identify diabetes early in patients and get them treated for their diabetes and prevent the long-term complications," says Flamm. The clinic recently received a $1.5 million federal grant. A recent study indicated that Ohioans are 29% more likely to visit the ER than the national average. It’s estimated misuse of the E.R. amounts to nearly a billion dollars of wasted health care dollars in Ohio every year. A billion dollars for visits that could be avoided and handled in a primary care setting. In addition to the cost savings, more nurse practitioner-run clinics could help the healthcare system overcome a shortage of primary care doctors. Miami University last fall set up a Nurse Practitioner clinic on the Oxford campus for its more than 3,000 employees. Miami economics professor Melissa Thomasson says before the clinic opened employees frequently went to the E.R., if they had the flu or an ear infection because there are not enough primary care providers in the area. “We did have a pretty high number of people who went to the E.R. for such things and again the copay to the employee is $100 but when that hits our health plan it’s billed out to like $1200," says Thomasson. Doctors seem to welcome the shift to nurse practitioners. Tim Maglione speaks for the Ohio State Medical Association which represents 20,000 physicians. “It’s something that the physician communities support and embrace as a kind of a team-based approach to care. A multi-disciplinary team based approach to care is where we’re moving today in health care," says Maglione. Maglione adds that having a physician to consult with will be important in complex cases though to maintain quality of care. Ohio Hospital Association’s Jonathan Archey says the group supports parts of the federal health care law. “When you can allocate resources more effectively you can provide the care more efficiently and the idea is to make it better for the patients and also better for the cost curve as well," says Archey. We could see more of these clinics Under the Affordable Care Act. The federal government will spend nearly $2 billion to add more than 12,000 primary care physicians, nurse practitioners and physician assistants in the next 3 years.