Knox plan: Put health clinics in schools

City schools have not replaced more than 100 school nurses who retired or were laid off in recent years, and the district's financial state remains perilous.

Politician and insurance-industry veteran Tom Knox has a proposal to address both problems:

Have the school system get into the health-care business.

Knox envisions that each of the more than 290 district and charter schools would house a walk-in clinic staffed by a nurse-practitioner or physician assistant, who would bill the child's insurance provider $60 per visit. Each clinic also would be staffed by one of the remaining 194 traditional school nurses or by a lower-paid health technician.

More than 1,900 health centers are in schools around the country, according to the nonprofit School-Based Health Alliance. Many are primary care providers and bill at a higher rate.

The clinics Knox has in mind would offer walk-in care, much like the Minute Clinics at CVS stores. Two charter schools in the city have similar clinics, though they are not reimbursed by insurers and are supported by other sources of funds.

By Knox's calculations, the district could make money with such clinics while improving access to health care and reducing absenteeism. Knox figures the plan also would reduce spending on health care, if students visited the clinics instead of going to an emergency room for nonemergency problems.

"It brings needed revenue to the School District, and it enhances the quality of life for the students," said Knox, a former mayoral candidate who is considering another run in 2015. "There's nothing better than to help solve a problem without using tax dollars."

Some details are still to be determined, such as who would oversee the program - if not the district itself, then perhaps a new entity or a hospital system. Also to be seen is whether insurers would pay for care at these clinics, but Knox is betting that they would, given that treatment is far cheaper at a walk-in clinic than an emergency room.

Tine Hansen-Turton, who runs a trade association for nurse-led clinics and helped Knox with the proposal, said another advantage of school-based clinics is that parents do not have to leave work to take children to the doctor.

Through a spokesman, Superintendent William R. Hite Jr. said he appreciated the proposal but wanted to research it further.

"He basically said, in the situation we're in, he's looking at everything," district spokesman Fernando Gallard said.

Knox met with Hite several weeks ago, after an ally, former Gov. Ed Rendell, put the two in touch.

Two prominent members of academia had positive responses. "N.P.'s in schools, working with school nurses, would realize a stunning return on investment in building children's healthy futures and in creating a financially healthier system," said Gloria F. Donnelly, dean of Drexel University's College of Nursing and Health Professions.

"It's a provocative idea that seems to merit further exploration," said J. Larry Jameson, dean of the University of Pennsylvania's Perelman School of Medicine.

One note of concern came from Natalie Levkovich, chief executive officer of the Health Federation of Philadelphia, which represents community health centers that provide the full range of primary care. She worried that some parents would view the school-based walk-in clinics as a substitute for comprehensive care, and that the clinics might not communicate with the child's regular provider.

Jerry Jordan, president of the Philadelphia Federation of Teachers, which represents school nurses, also was critical. He said that instead of hiring lower-paid health technicians to work alongside nurse-practitioners in some of the clinics, the district should rehire the laid-off school nurses, who already know the students.

Several years ago, the district employed more than 300 nurses to cover its schools as well as some parochial and private schools. With layoffs and retirements, that number is now below 200, and some nurses cover multiple schools. When no nurse is present, other school officials sometimes dispense medication.

The two charter schools that have implemented walk-in clinics are Belmont Charter School and Pan American Academy Charter School.

Based on their experience, Knox estimates that under his proposal, there would be 25 billable visits per school per day. At $60 apiece for 195 days in 290 schools, that comes to nearly $85 million in revenue. The payroll for his plan comes to about $55 million, leaving extra money for services such as nutrition, dentistry, mental health, and drug counseling, and even some profit.

Many children have health insurance through a Medicaid managed-care plan. An official at one such plan, a partnership of six local hospitals called Health Partners, said the insurer would be willing to consider providing coverage for care at clinics like those Knox is proposing.