[NPInfo] New Orleans Primary Care Fix

Fri Mar 7 13:16:06 PST 2008

I don't know how NP practice is in Boston. However, Boston is where the mayor tried like heck, and is still trying, to stop Minute Clinic from opening. He says the clinics would not give safe care - no stats to back him up!

I would seem that this model is ideal for NP/PA practice, as there are many cities with NP clinics within the indigent areas.

Sue D in frigid, snowy MI

 --- On Fri 03/07, David Mittman < dmittman at comcast.net > wrote:
From: David Mittman [mailto: dmittman at comcast.net]
To: ACC-Circle at listserve.com, PAForum at mc.duke.edu, NPinfo at nurse.net
Date: Fri, 7 Mar 2008 12:20:30 -0500
Subject: [NPInfo] New Orleans Primary Care Fix

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. _______________________________________________ NPInfo mailing list NPInfo at nurse.net http://lists.nurse.net/mailman/listinfo/npinfo *****************************

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