It is well documented that health systems with a robust primary care base provide better access to health services and have improved health outcomes, lower mortality, and more equitable care. Strong primary care can also result in significant cost savings. Yet, it’s estimated that more than 83 million people in the U.S. live in areas without sufficient access to a primary care physician.
According to a recent survey, the average time to secure a new-patient appointment is approaching one month in 15 of the largest cities in the U.S., and another survey found more than a third of Medicare patients are waiting more than a month to see a doctor.
As the fastest-growing U.S. profession, nurse practitioners are well positioned to fill these gaps. There are more than 385,000 licensed NPs in the U.S., 70 percent of whom deliver primary care, and nurse practitioners are the healthcare provider for more than 1 billion health visits annually.
The rise of the nurse-led clinic
A growing trend is the nurse practitioner-led clinic. Wendy L. Wright, DNP, is chief clinical officer of Duet, a growing network of locally owned NP practices, and estimates there are 4,000 such clinics in the U.S. Twenty-seven states have full practice authority for NPs, though nurse practitioners can open clinics in other states too, though rules vary.
Studies show that nurse-led clinics provide care in line with standard physician-delivered care, and generally provide more time with patients, leading to greater satisfaction.
Yet, running a healthcare clinic can be challenging, not only from a clinical perspective, but from a business standpoint, too. Healthcare is often a game of scale – insurers tend to negotiate rates with organizations that treat large volumes of patients. Smaller clinics are often at a disadvantage.
Wright learned this firsthand as the owner of two clinics in New Hampshire.
“I recognized that unless I changed some things, I was not going to be able to sustain,” she said. “The reimbursements to nurse practitioners through places like Medicare are 85 percent of a physician, but our costs are the same. It still costs me the same for rent. It costs me the same for staff. My supplies are the same.”
Scaling to support NPs
Around this time, Wright was approached by Jonathan Goldberg, the founder and CEO of Duet, to join the organization as chief clinical officer.
Recognizing that nurse practitioners can reach vulnerable populations and transform outcomes; the organization seeks to help manage the administrative and financial aspects of running a clinic.
“We are the first network for NP-owned clinics,” Wright said. “From startup to scaling, to hiring, to billing and coding, to negotiating with insurers, we help sustain their practices.”
In New Hampshire, for example, a pool of 11 NP clinics recently benefited from Duet’s negotiations with regional insurers, which increased their revenue anywhere from 25 percent to 40 percent by rewarding their care quality.
Investing in primary care reduces healthcare costs in the future. Every $1 increase in primary care spending produces $13 in savings, according to reports.
“Primary care is a low-cost option,” Wright said.
There is a tech component to Duet’s services, too. Healthcare reimbursements are increasingly tied to quality outcomes, which requires the data infrastructure to manage patients in and outside of the clinic walls.
“We’ve developed our software to provide a dashboard to every NP that shows patients with care gap opportunities,” she said. “It helps NPs support their patients in getting their physicals, important screenings, and transition care visits following hospitalizations.”
Expanding NP-led care nationwide
Today, Duet has partnered with 100 NP-led clinics, but the team has their sights on the full 4,000.
“We want to do what we’re doing here in the Northeast for every NP business owner in the country,” she said. “We want to be the voice of nurse practitioner-led clinics. We’ve got the technology, we’ve got smart people at the helm who do this work, and if we bring people together, we stand the best chance of providing the care that we all want to provide.”
