Financial profiles of nurse-managed centers

Background and Purpose: Nurse-managed centers (NMCs) are a small, but growing component of community-based, primary health care options and safety nets. The purposes of this presentation are to: 1) report findings from a national survey of NMCs, focusing on their business and financial profiles; and 2) propose approaches to assess their financial sustainability.

Methods: A 184-item survey tool was developed by the Institute for Nursing Centers (INC). Items were formulated based on advice from consultants provided during a national consensus conference. All NMCs listed in a national directory were invited to participate in a survey about patients served, services provided, and financial arrangements. A total of 29 centers provided data from the 2004-05 fiscal year. The key financial data elements included expenses and revenues. From these data, cost per encounter, operating margins, and productivity ratios were calculated, and beginning benchmarks were computed based on percentiles. The survey is being repeated for 2005-06 data and two-year findings will also be presented if available.

Results: NMCs tend to be small, primary care services (median = 1,078 patients) serving diverse population groups; approximately 37% of patients are uninsured. Sources of revenue include self-pay, reimbursement through various governmental and commercial health plans, grants, contracts, and non-operating subsidies. Most commonly seen diagnoses are similar to those reported by community health centers with high numbers of visits for chronic disease management as well as health promotion. Financial data reflect substantial variability among NMCs.

Conclusions: Currently, many NMCs are struggling for sustainability because of their mission to serve underserved and uninsured groups, the low number of visits per provider FTE, and reliance on subsidies, commonly from schools of nursing. These data serve as the beginning national database to track the development of NMCs. Findings will be disseminated to health care policy and provider groups to document the need for options in primary care services and to support these important safety net providers as one of those strong options. The INC provided respondent centers with individualized analyses of their financial status and consultation regarding the meaning of financial indicators indicating strength as well as sustainability risk.