[NPInfo] New Orleans Primary Care Fix

[David Mittman]

2 questions
-I can't believe the Boston clinics do not have NPs and PAs?
-Does anyone know Dr. Sachs or how to reach him?
-I don't think docs will want to practice there in the numbers they  
expect to get.
Our 2 professions should set up a demonstration clinic and fund a  
study on it.
Dave


Boston clinics may be model for New Orleans
Tulane dean's plans still at talking stage
Tuesday, March 04, 2008
By John Pope
Staff writer
During his 28 years at Harvard Medical School, Dr. Benjamin Sachs  
helped launch a network of clinics to deliver a combination of  
primary and preventive health care to people in some of Boston's  
poorest neighborhoods.

As part of the preparation for establishing a similar system in New  
Orleans, Sachs, now dean of Tulane University's medical school, is  
leading a group of 14 health-care professionals and community leaders  
to Boston today to pick up pointers.

In Boston, about 200,000 people are treated each year at 25 community  
clinics, which are affiliated with Harvard and Boston University.  
While these neighborhood centers are designed to treat problems  
before they become major -- and more expensive -- participants are  
referred to doctors from one of those institutions if they need  
specialized care.

"I'm hoping to see how Boston did it so well so we won't have to  
reinvent the wheel," said City Councilwoman Jacquelyn Brechtel  
Clarkson, a member of the delegation.

Establishing such a network is an important part of rebuilding New  
Orleans, not only to provide readily accessible medical care but also  
to help persuade people to return to the city, Clarkson said.

"As we're rebuilding neighborhoods, we need this," said Dr. Karen  
DeSalvo, vice dean for community affairs and health policy at  
Tulane's medical school.

DeSalvo laid the groundwork for such a system shortly after Hurricane  
Katrina, when she and Tulane colleagues opened a clinic at Covenant  
House. This center, which treats about 1,000 patients a month, has  
become known beyond New Orleans. Among the grants it has received are  
$425,000 from Johnson & Johnson and $5 million from Qatar.



Community control

At this point, the New Orleans system is still in the talking stage.  
Although Sachs and DeSalvo said they have discussed the project with  
representatives of Central City, the Lower 9th Ward and the  
Vietnamese community, no sites have been picked for the two or three  
clinics Sachs envisions.

But everyone agrees on this point: Members of the communities where  
the centers go will play a dominant role in their management.

One possible clinic site would be in eastern New Orleans, where many  
of the patients would be members of the Vietnamese community.

Such a clinic "will be our facility. That is our demand," said the  
Rev. Vien The Nguyen, pastor of Mary Queen of Vietnam Church and a  
member of the Boston-bound group. "When we are the owners, we will  
determine when it will be open and when it will be closed," he said.

And that is fine with Tulane. "As the community goes, we go," Sachs  
said.

"The look and feel should come out of the neighborhood, like po-boy  
shops," DeSalvo said.

Sachs and DeSalvo have drawn support from Clayton Williams, the  
Louisiana Public Health Institute's director of health-systems  
management, who will be on the two-day trip.

"I think their vision is wonderful," he said. "We historically have  
not had enough neighborhood-based primary-care facilities to meet the  
needs of our population, and we think their vision is consistent with  
our vision of what should happen."

Although each clinic's plans will be community-driven, there will be  
close ties to Tulane, DeSalvo said. "This is not just sprinkling some  
primary-care doctors out there and saying, 'Good luck.' "



Quality, efficiency

The broad strokes of the Tulane plan are outlined in a 12-page  
brochure that Sachs and DeSalvo wrote with Leah Berger, director of  
the office of community affairs at Tulane's medical school, and Dr.  
Harvey Makadon, a clinical professor of medicine at Harvard.

Each clinic should provide high-quality primary and preventive care  
that will be cost-effective, the authors say. Each center should also  
manage chronic conditions such as diabetes and high blood pressure  
and reduce disparities in health care among population groups.

"People say we can't afford it," Clarkson said. "It's quite the  
opposite. These neighborhood clinics have preventive medicine and  
will make health care less expensive" for taxpayers who foot the bill  
for uninsured people.

This is the argument Sachs has used to build support for this concept.

"I didn't pitch the moral argument" for providing care, he said. "I  
pitched the business argument. The light went on, and they understood  
that they need to get involved."



Financing sources

Each clinic would have 10,000 to 20,000 square feet and have as many  
as eight primary-care doctors who could care for as many as 16,000  
patients a year, the authors say.

Each building could cost as much as $5 million, including equipment,  
and would have an annual budget of around $2.4 million, according to  
the brochure. Although each probably run a deficit of about $1.1  
million for the first two years, planners envision that would be  
eliminated as soon as the centers qualified for reimbursements by  
caring for uninsured people.

Money for the centers would come from federal and state governments,  
as well as private sources such as donations and philanthropic  
organizations, Sachs said.

Records would be kept electronically, with appropriate privacy  
safeguards, to prevent a recurrence of the widespread destruction of  
such paperwork by Katrina and floodwaters.

Although the centers would provide medical homes that would ensure  
better care, Sachs and DeSalvo envision them as community centers, too.

"What we're trying to do is rebuild communities, not just provide  
health care," said Sachs, who described such centers as "the glue  
that brings communities together."

Nguyen already has plans for putting a school next to such a clinic  
in his neighborhood, as well as a place for such activities as  
tutoring, job training and community-service projects.

In Boston, Sachs said, some patients found role models among clinic  
personnel who inspired them to embark on careers in health care.

"They found people who looked like them," he said.

. . . . . . .

John Pope can be reached at jpope at timespicayune.com or at (504)  
826-3317.