The Reporter: December 1997, Vol.8, No.5
School of Nursing Makes History with New Practice

 With yet another first on its list of accomplishments, the Columbia University School of Nursing has opened a primary care practice, Columbia Advanced Practice Nurse Associates (CAPNA), at the Columbia-Presbyterian/Eastside facility. CAPNA is the first practice in the United States in which major insurance companies reimburse advanced practice nurses at the same rate as physicians. Beginning in January, Medicare also will cover CAPNA visits.

 CAPNA officially opened Sept. 29 with a ribbon-cutting ceremony at the Eastside facility on East 60th Street. Dr. Mary Mundinger, dean of SON, and Donna Hanover, broadcast journalist and first lady of New York City, expressed enthusiasm for the benefits CAPNA will offer New York residents."This practice is putting New York at the forefront and will be a vanguard of what's happening across the country," said Ms. Hanover, who also lauded CAPNA for its efforts to ensure health care for all New Yorkers.

 Among the services CAPNA offers are flexible office hours including evenings and weekends, in-home or office follow-up care, primary care delivered by an advanced-practice nurse, and preventive health care. Advanced practice nurses (APNs) have master's degrees in a primary care specialty, such as family practice, and are credentialed by the state to diagnose and treat illness and prescribe medications. They also have hospital admitting privileges. APNs do not replace physicians, but srather work in collaboration with physicians.

CAPNA's office opened in September at the Columbia-Presbyterian/Eastside clinic with a ribbon-cutting ceremony. Pictured, from left, are Dorothy Dorion, SON class of 19957; Dr. Mary Mundinger; Donna Hanover; and Mary D. Lindsay, SON class of 1945.

 "CAPNA's advanced practice nurses have always worked very well with physicians, and for patients this is clearly a win-win situation. We want to stress that this is a partnership with CPMC physicians," says Dr. Mundinger. "Our nurses are forming a collaboration with the physicians and will bring new patients into the Columbia practice, expanding our marketshare and offering additional choices to our patients."

 Dr. Mundinger says CAPNA was many years in development, much of that time being spent convincing insurers that it was a good idea. "Managed care companies have suffered because of the public perception that they decrease choice and reduce care and time with patients. We capitalized on that by arguing that APNs are a new choice in health care one that has been well-researched and proven safe and effective. "Dr. Mundinger also emphasizes that nurses are known to give more attention to patients by listening and engaging in health education, counseling, and general wellness advancement. "We argued that each of our visits would last substantially longer and therefore we required the same reimbursement per visit as physicians in order to cover our costs. " Dr. Mundinger says that if the APNs were reimbursed at a lesser rate, they would be accused of engaging in price competition with physicians.

 Those arguments worked, resulting in CAPNA becoming a reality. The next step, following the practice launch, is to evaluate the program so that a model can be established for the rest of the nation. Corporate and foundation sponsors for that evaluation include the Kellogg Foundation, the Robert Wood Johnson Foundation, the Kaiser Family Foundation, and the Commonwealth Fund. In addition, the insurance company Oxford has agreed to participate by giving a matched cohort of patients to make comparisons regarding patient satisfaction, cost, and quality.

 "Most patients we've seen have a lot of concerns about their health, " says Dr. Mundinger. "They are in search of a provider who can give them more time and can help them manage multiple health issues. " She says, for example, a CAPNA provider may especially appeal to a patient with diabetes and high blood pressure, for whom careful health management is essential.

 CAPNA is staffed by Nancy K. Boccuzzi, SON assistant dean for practice development, who has nursing and MPH degrees; Renee D'Aiuta, assistant professor of clinical nursing and an advanced practice nurse; Dr. Noreen W. Esposito, assistant professor of nursing and is a certified practitioner in family primary care and in women's health; Marlene McHugh, assistant professor of clinical nursing and an advanced practice nurse in family primary care; and Edwidge J. Thomas, assistant professor of clinical nursing and an advanced practice nurse specializing in adult and geriatric care. Further information about CAPNA can be obtained by calling (212) 326-5650.