Bacon's Rebellion

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Everybody Wins – Nurse Practitioners for Underserved Communities

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sherlockj
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by James C. Sherlock

The University of Pennsylvania School of Nursing has instituted a terrific program thanks to a wealthy alum who gave $125 million to recruit and train nurse practitioners to practice in underserved communities.

The Leonard A. Louder Community Care Nurse Practitioner Fellows program will be tuition-free and students who still need help will be granted stipends. The program will start with 10 enrollees next year, eventually reach an annual target enrollment of 40 Fellows, and will be sustained by income from the grant. (See the link above for additional details.)

What attracted me to this is the need in Virginia.

The program fits like a glove with a parallel program, Health Enterprise Zones, which in Maryland has saved enough Medicaid money to fund a Virginia Nurse Practitioner Fellows Program here.

I  wrote a bill that was introduced in 2020 by then-Delegate Jason Miyares, R-Virginia Beach, to establish a Heath Enterprise Zones (HEZ) initiative modeled after Maryland’s hugely successful program. I wrote about it here. The Virginia Hospital and Healthcare Association (VHHA) reportedly supported the bill. It passed overwhelmingly in the Health Committees.

It failed in Appropriations — because, I assume, the Fiscal Impact Statement did not project the Medicaid savings that were proven in Maryland.

Maryland’s HEZ program, a collaboration between local communities, federal programs and the state, has:

  • reduced health disparities among racial and ethnic minority populations and among geographic areas;
  • improved health care access and health outcomes in underserved communities; and
  • reduced health care costs and hospital admissions and re-admissions

The Maryland HEZ program has saved enough money from lower hospital ER visits and admissions that, if it were modeled in Virginia, the savings would easily fund a nurse practitioner program here to staff it.

Virginia has at least eight schools of nursing that offer nurse practitioner programs:

  • George Mason
  • Hampton
  • Marymount
  • Old Dominion
  • Radford
  • Shenandoah
  • University of Virginia; and
  • VCU

We also have a Virginia Nurses Association. And a Department of Health. And urban politicians. And rural politicians. And Diversity, Equity & Inclusion practitioners everywhere you look.

I hope they will take these twin initiatives from other states, combine them, and get them into law here with leadership from the Governor.

I cannot find any losers in such a program, and can identify a heck of a lot of people in underserved communities who would benefit greatly.

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Comments

7 responses to “Everybody Wins – Nurse Practitioners for Underserved Communities”

  1. WayneS Avatar
    WayneS

    Whoops. The first time I read the headline I read “Underserved” as “Undeserved”.

    Seriously, though, it looks like a wonderful program.

  2. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    The expanded use of both nurse practitioners and physician associates would go a long way to helping underserved communities. As I remember from your earlier posts, the HEZ proposal deserved more serious consideration by the GA. It is too bad that it could not have gotten into the mix this year; there is plenty of money around to fund it. I encourage you to keep trying. You may want to lobby the Virginia Joint Health Care Commission to take it up. That is a well-established and well-respected legislative commission, with fairly extensive staff support. Here is the link. http://jchc.virginia.gov/staff.asp The membership will likely change after the session is over and the House appoints its new members.

    1. Matt Adams Avatar
      Matt Adams

      Pedantic post: It’s physician assistant, not physician associate.

    2. James C. Sherlock Avatar
      James C. Sherlock

      Thank you. I presented the HEZ concept to the JCHC a couple of years ago with no result. I am just some guy from Virginia Beach.

      Jason Miyares carried the bill with the results described in the article.

      My current strategy is to get the new administration to take it out of my hands and pursue it through the Department of Health.

      The goal is to have both a study and a bill ready for the next session that would guide the FIS.

      VDH has the responsibility for public health in Virginia.
      Though I offered it to the previous Health Commissioner, he was never going to move on it more because of inertia than because he opposed it. VDH was leaderless.

    3. James C. Sherlock Avatar
      James C. Sherlock

      Thank you. I presented the HEZ concept to the JCHC a couple of years ago with no result. I am just some guy from Virginia Beach.

      Jason Miyares carried the bill with the results described in the article.

      My current strategy is to get the new administration to take it out of my hands and pursue it through the Department of Health.

      The goal is to have both a study and a bill ready for the next session that would guide the FIS.

      VDH has the responsibility for public health in Virginia.
      Though I offered it to the previous Health Commissioner, he was never going to move on it more because of inertia than because he opposed it. VDH was leaderless.

  3. NCDCcc Avatar
    NCDCcc

    The patient doesn’t win! NPs have far less training than physicians (<5% of training of physicians). They are put in situations without physician oversight to the danger of patients. In addition the NPs don’t even go in rural areas which was the purpose in the first place. It seems like “WIN-WIN” but it is a huge patient safety issue and it is the corporations employing unqualified “health care providers” for the profit.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Wow. So let me unpack that.
      – When an RN goes to two years of graduate training to be a NP, she emerges with “< 5% of the training of an M.D." Who knew? - "They are put in situations without physician oversight to the danger of patients”. First, nothing in this post says an NP would be a sole provider in an HEZ office. That would be determined by the board of the HEZ. Second, if an NP were opening a freestanding ER all by herself, you might have a point. But of course an NP is not licensed to do that. In fact, HEZ providers are designed to keep people out of the ER by treating them before their conditions get that bad.
      – “the NPs don’t even go in rural areas which was the purpose in the first place”. They would if they wanted one of the scholarships, which would be designated for the most underserved areas in the state.
      – “Huge patient safety issue”. Not if the NP honors the limits of her license.
      – “it is the corporations employing unqualified “health care providers” for the profit.” In this context, neither you nor I have any idea what that means.

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