Expansion of Community Health Centers Increases Demand For Nurse Practitioners

The Health Care Reform bill contained a provision to double the number of Federally Qualified Health Centers, which provide affordable primary care, dental care, mental-health counseling and low-cost prescription drugs.

Nationwide, about 7,500 new health center sites will be opened or expanded.

Research indicates that patients who receive care at community health centers have lower medical costs because providing quality primary care services can reduce the need for other ambulatory and hospital-based medical care, thereby lowering overall medical costs.

George Washington University researchers released a report recently that projects billions of dollars in savings from this major new investment in community health centers.

The analysis by the George Washington University School of Public Health, "Strengthening Primary Care to Bend the Cost Curve: The Expansion of Community Health Centers Through Health Reform", found the $11 billion in additional federal grants for community health centers will:

• Reduce total national medical costs by more than $180 billion over the next 10 years, including savings of more than $50 billion in federal Medicaid spending and more than $30 billion in reduced state Medicaid expenditures.
• Increase the number of patients receiving primary care at health centers by at least 18 million by the end of the decade, effectively doubling the number of people served.

Professor Leighton Ku, the lead author of the report, said the new law both expands health insurance coverage and strengthens the role of community health centers. "These changes create an economic engine to extend the primary health care home model to many more rural, urban and suburban communities across the nation."

In 2008, 1,080 community health centers — independent nonprofit clinics with locations in more than 7,000 medically underserved urban and rural communities — provided comprehensive primary health care to 17 million patients, mostly low-income. At the same time, health centers' current capacity falls substantially short of need. Because of this concern, Congress made a considerable investment in the expansion of community health centers, increasing funding by at least $11 billion over the next five years in order to increase the number of patients and communities served by health centers and widen the range of services offered.

"The Congressional Budget Office has estimated that 32 million fewer people will be uninsured by 2019. These analyses indicate that community health centers will be able to provide primary care to a significant share of the newly insured, as well as continuing to serve a large number of those who remain without coverage. As a result, the efficient and effective primary care that will be received by millions more patients at community health centers should help bend the curve of rising health care costs."

THe report goes on to state that "The expansion of community health centers should also help lessen concerns about a potential provider shortage," because rather than rely on physicians to provide primary care services, Federally funded Community Health Centers usually rely on a team-based approach to care and make fuller use of nurse practitioners, physician's assistants, regular nurses and other allied health staff to provide patient care.

"For example, almost 90 percent of health centers employ nurse practitioners or physician's assistants, compared to less than half of regular private physicians' offices, and almost a third of health center patients receive care from such clinicians. By diversifying staffing, health centers are better able to cope with shortages of any specific type of clinician."

The report also stated that "In the long run, however, the supply of primary care clinicians, whether they are to serve patients in community health centers or in private practices, will need to be expanded and the nation and states will need to consider how to address this problem."

To read the full report from the Geiger Gibson/ RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services, click here.

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