Increasing the ratio of nurse practitioners to physicians

Many practices have realized that mid-level practitioners can competently provide a subset of the care traditionally provided by physicians.  However, a practice with four physicians and no mid-levels would have to grow significantly to add four nurse practitioners and reach just a 1:1 ratio.  Imagine a large organization with 50 or more physicians and you see one problem with delegating appropriate clinical tasks with any scale.  Of course that is the "Build" answer to the Build vs Buy question.  Allina Hospitals and Clinics have taken a different approach, kind of a rent to own path.  Other large organizations may follow suit if it works well and they are able to shift care from their Emergency Departments to the Minute Clinics while maintaining continuity with their primary care physicians.

The blurb below is from the ACPE Daily Digest.  Enjoy!

Allina, MinuteClinic partner to coordinate care for patients, share EMRs.

The Minneapolis Star Tribune (10/30, Yee) reports that Minnesota's "Allina Hospitals and Clinics is teaming up with MinuteClinic to coordinate care for patients and expand medical services down the road." Under the deal, "Allina doctors will offer medical oversight to MinuteClinic nurse practitioners...and the two organizations will share electronic medical records." Still, "neither organization will take a stake in the other, nor will they pay each other referral fees."

        Allina and MinuteClinic "will forward patients to each other and integrate their healthcare delivery systems," the Minneapolis/St. Paul Business Journal (10/29, Newmarker, subscription required) reported.

Closing The Triangle

Today I drove to Wellsboro, PA.  Wellsboro is in Tioga County, just below the NY border.  The meeting was to share the experiences of the Tioga Partnership For Health with representatives from Altoona, PA.  The folks in Tioga have taken an inclusive, collaborative approach to addressing health and wellness in their community.  The three original leaders of the partnership were the hospital system, the county social service leadership and the President of Mansfield University.  Over the past 12 years, they have developed trust by letting people work on the things that interested them.  Some people worked on smoking in pregnancy, others worked on obesity or school menu choices.  Their community health center participated in three Health Disparities Collaborative projects through the Federal Bureau of Primary Health Care.  They have grant funded staff as infrastructure, providing support to their volunteer work groups and handling day-day tasks.  Remarkably, they have decreased their hospital admissions rate in each of the last three years.

Each of the Tioga representatives reinforced the idea of helping people get past their own perceived limitations of what the partnership could accomplish.  When people said something couldn't be done, they asked "If it could be done, what would it look like?"  This helped people break out of learned helplessness.  They also used phrases like non-linearity, letting people with similar interests volunteer to work together and the trusting relationships formed within the work groups allowed the groups to take chances. 

The Altoona representatives noted that in the past, they had two competing hospitals that each started wellness programs, but rather than work together, they ended up being short-lived, ineffectual tools for driving market share.  Now their hospitals are in one system, so they may have better chances of hospital community collaboration. 


At the end of our meeting today, the Tioga folks agreed to drive to Altoona and share their stories with Altoona community leaders.  Then we get to see what emerges!

Cool Clinical Stuff

Cool Clinical Stuff is about sharing neat things that can improve clinical and operational performance in primary care, while also improving patient and provider satisfaction. Sometimes the examples will be from other clinical arenas or from outside healthcare all together. My hope is that the stuff you find here will enhance the lives of those who provide and those who receive primary care medicine.

Enjoy.