August 17, 2011
Early last Friday morning I was joined by two of my Chippewa Valley legislative colleagues at a forum with area nurses. The forum gave us an opportunity to exchange ideas on how nurses can help bring health costs down.
My job was to listen and learn. The nurses educated us on how they can play an important role in reducing health costs.
Public health nurses shared the struggle to provide basic health screening to low income women. New budget rules stop money from flowing to nonprofit women’s health clinics. Instead the dollars must go to public health departments.
“Public Health Departments aren’t necessarily able to provide these services,” explained a public health nurse. “Unless you live in an impoverished area, you have no idea how needed these services are – all screenings, health education, prevention, mental health counseling – everything is done in these clinics.”
“We need to look upstream,” a nurse said. “We need to look at prevention. For every dollar spent on prevention we save five dollars. But public health is woefully under-funded. We can’t even keep nurses working in public health because they make so much more working in hospitals.”
“We have to look at the underlying determinants of health,” said another nurse. In other words, ‘what makes people healthy and stay healthy?’ She continued, “Education helps improve health. If we can educate and really change people’s health habits, we can lower costs – all of these things are related.”
One example of how nurses could lower costs relates to healthy babies: Pat (not her real name) was a public health nurse. She went to visit families who brought home a new baby. Other nurses worked at the public health clinic where families brought new infants for screenings. The nurses checked the babies and provided parents important information about well baby care. They made follow up visits to assure good health for mom and baby.
“But then I went to work at a doctor’s office,” said Pat. “I found out you need an MD [license] to do well child check-ups. I had been doing them for years but here [at the doctor’s office] I could not do well child check-ups.”
Sick babies and sick moms drive our state Medicaid budget. The most common reason a Wisconsin Family Medicaid patient is hospitalized relates to birthing. State data show almost one quarter of all hospital Medicaid costs are related to pregnancy, birth and neonate care. Contributing to high Medicaid costs are the pregnancy complications of Caesarian Sections, infant death and neonatal intensive care.
Troubled pregnancies are not only tragedies for individual families, but lead to additional costs for all of us down the road. Special education and special medical care are but a few of the costs incurred when a child is born too early or under circumstances due to poor prenatal care.
Nurses shared a recent Institute of Medicine report on the Future of Nursing. The report found nurses aren’t able to practice to the full extent of their education. If nurses were encouraged to expand their practice we would all save money.
For example, nurse midwives in Washington DC created a clinic for inner city pregnant women. Two separate evaluations found the clinic women had half the rate of Caesarian Sections, one third the rate of premature births and half the rate of low birth weight infants than traditional medical care. All these successes reduced costs. The clinic saved $1.2 million – more than enough to cover its operating costs for a year.
Every level of government is stretched thin. The single area where we spend the greatest amount of our state budget dollars is Medicaid. If we could tackle the rise in health costs, we could improve our bottom line. Think of the national debt, the state budget and the budget challenges facing local government and school districts. In every case health care is a driving force in rising costs.
Nurses have the right idea. Preventing disease and helping people choose healthy lifestyles could have a tremendous, positive effect on our state budget. Let’s put nurses to work keeping us all healthier and lowering costs for taxpayers.