Advocacy Platforms

SCHOOL-BASED HEALTH CENTERS ARE GOOD FOR PENNSYLVANIA

Education Plus Health Works for Health Equity in PA

School-Based Health Center (SBHCs) are considered nationally to be one of the most effective strategies for delivering preventive care to under-served youth, particularly adolescents. In-school medical providers are able to provide acute and preventive care, render diagnoses and write prescriptions. The services range from health screenings, delivering sick and injury care, preventive well-child care and sports physicals, administering flu shots and vaccines, conducting mental health and substance screenings and also mental health treatment, and providing confidential reproductive health care for teens. For many children and teens who live in poverty, the collaborative work of the SBHC provider makes the goals of the medical home for continuity of care achievable.

Students who have access to SBHCs have better grade point averages, get more physical activity and eat better than their counterparts. Schools that house SBHCs have seen reduced absenteeism rates and Medicaid costs, particularly for children with chronic health conditions like asthma. In Pennsylvania, many cities are ranked as some of the worst cities to live nationally if you suffer from asthma. Philadelphia is ranked 4th, Scranton ranked 21st, Allentown ranked 27th, Pittsburgh is ranked 42nd and Harrisburg is ranked the 52nd worst place to live if you have asthma. Asthma is the leading cause of absenteeism. Scranton’s chronic absenteeism rate is 28%, Pittsburgh’s is 30%, Philadelphia’s is 38%. However, school-based health centers (SBHCs), many supported further by community workers, consistently show decreased absenteeism and hospitalizations as a result of their work with asthmatic students.

In Pennsylvania, some Education Plus Health schools have seen a 10% decrease in absenteeism annually since 2016.

Currently SBHCs in Title one schools are funded by Medicaid reimbursement, but Medicaid rates are insufficient and the model is not sustainable on Medicaid reimbursement alone. While there are more than 2,500 SBHC providers across the country, in Pennsylvania, they exist in only seven cities or counties serving less than 10,000 low-income students and they are not sustainable in the long-run. In order for SBHCs to thrive and survive in Pennsylvania, we need state support with dedicated funding and supportive policies.

Proposal:
State support of $45,000 per school clinic would help to meet the true cost for a 20-hour per week-or more SBHC model in each school to increase capacity and services to the students and their families. A pilot of State support serving the pediatric population most likely to lack routine health care, adolescents, would educate and engage the most vulnerable segment of children at the crucial time when they are about to become responsible for their own health care and lay the groundwork for more SBHCs in PA. Specifically, these dollars would enable increased services and capacity through three core areas of need:

  • Increased supplies and equipment
  • More competitive salaries to recruit and retain high quality medical providers and community health workers
  • Critical infrastructure expansion – to proactively manage for student health outcomes, expand for more comprehensive services including behavioral health and oral health care, and ultimately serve more high-need schools and students

Dedicated support high schools to launch or expand upon existing SBHCs with more provider hours serving the most high-need students in Pennsylvania would reduce absenteeism, teen pregnancy and STD rates, hospitalizations due to asthma and other chronic conditions, and enable better health outcomes overall among youth. Dedicated support would also enable data reporting and analysis back to the State to quantify and coordinate the return on investment to Pennsylvanians.

If you are interested in getting involved with the advocacy campaign, please contact Sheila Ballen at sheila@educationplushealth.com.

Read more

Education Plus Health Supports Full Practice Authority (FPA) SB 25/ HB 100:
Full Practice Authority and licensure laws allow all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribing medications and controlled substances. 22 states and DC have full practice authority. Pennsylvania is one of only 16 states that requires career long physician supervision or collaboration but does not restrict the functions of nurse practitioner (NP) practice.

Full Practice Authority Allows Nurse Practitioners to:

  • Ensures that a nurse practitioner (NP) can utilize their full license.
  • Continues full collaboration among NPs, health care providers and specialists as needed to care for their patients without the burden of additional regulation or cost.
  • Improves access to NPs as providers of health care and brings health care costs down due to improved access.
  • Brings Pennsylvania in line with the model of practice recommended by the Institute of Medicine, the Federal Trade Commission, National Council of State Boards of Nursing and the National Governor’s Association.

How Does Full Practice Authority Support School-Based Health Centers?

Many school-based health centers (SBHCs) employ nurse practitioners to deliver primary care in schools for low-income students, working in collaboration with each student’s primary care provider. For nurse practitioners (NPs) that practice in collaboration with a physician for at for at least three years and more than 3,600 hours, removing the requirement that NPs enter into a paid business agreement with a physician every time they start a new position at a different organization would yield significant results. Currently, every time a NP starts a position with a new organization, they must start a new collaboration with a physician resulting in significant delays and unnecessary costs. Those added resources could be used directly towards improving outcomes for low-income children. Removing the requirement that NPs always need to be collaborating with a physician would:

  • Allow NPs to start work, evaluating and diagnosing patients, initiating and managing treatments and prescribing medications, etc., on their first day working at a new organization. By allowing NPs to work to their full capacity on day one of new employment, they will avoid the current 3-6 month delay for the prescriptive authority license to be approved.
  • Allow the NP and their new organization to submit for Medicaid and payer credentialing and reimbursement on the very first day the NP begins work, thus avoiding the 3-6 month wait for the prescriptive authority license.
  • Decrease burdensome administrative costs and streamline the State Board of Nursing process by reducing the number of nurse practitioner prescriptive authority licenses that must be processed each year with each provider’s new employer arrangement, thereby saving precious tax dollars.
  • Create more accountability for NPs for their own work and potential errors in their own name as the sole provider responsible for their care.

The Full Practice Act does NOT:

  • Change scope of practice for NPs.
  • Change the quality or safety standards for day to day practice.
  • Remove, or override, professional agreements already in place with a practice site.
  • Remove the NP’s responsibility to consult with, or refer to, other healthcare providers when appropriate.

In June 2019, the Pennsylvania Senate passed SB25 and sent the bill to the House of Representatives. It is currently in the Professional Licensures committee awaiting action.

If you are interested in getting involved with the advocacy campaign, please contact Sheila Ballen at sheila@educationplushealth.com.

Read more

PRIMARY CARE ACCESS & UTILIZATION
Academic success increases with improved health and emotional wellbeing. Conversely, educational achievement is impaired by health disparities, particularly for urban minority youth. Asthma, diabetes, unhealthy weight, vision problems, teen pregnancy, and problems with inattention and hyperactivity have tremendous effect on students’ ability and motivation to learn. School-based health centers mitigate many barriers to academic success in underserved youth populations. Dozens of empirical studies demonstrate the effectiveness of school-based health centers in reducing absenteeism, emergency room utilization, hospitalization, and Medicaid costs overall, particularly for children with chronic health conditions like asthma.

  • A study by Johns Hopkins University found that school-based health centers reduced inappropriate emergency room use among regular users of school-based health centers.
  • A study of school-based health center costs by Emory University School of Public Health attributed a reduction in Medicaid expenditures related to inpatient, drug and emergency department use to the use of school-based health centers.
  • A study of elementary school-based health centers conducted by Montefiore Medical Center found a reduction in hospitalization and an increase in school attendance among inner-city schoolchildren for asthma.
  • A number of studies on school-based health care’s effects on asthma management found decreases in hospitalization rates of 75-85% and improvements in the use peak flow meters and inhalers.

If you are interested in getting involved with the advocacy campaign, please contact Sheila Ballen at sheila@educationplushealth.com.

Read more