One recent call came late at night from a veteran living in a remote part of the state. The man had run out of food and was desperate. The nurse on the other end of the line called state police, who agreed to help. Another call came from a woman living in a safe house with her infant son. He had burned himself with his mother’s hair-straightening iron, and she wasn’t sure if he needed emergency care.
“She didn’t know where to turn,” recalled the nurse, Stephanie Quintana. But then the woman found NurseAdvice New Mexico’s phone number posted on a wall of the safe house.
For the last decade, NurseAdvice has been providing residents across the state with free, 24-hour access to nurses by telephone. The U.S. Centers for Disease Control and Prevention recognized the nonprofit last year as a national model. A University of New Mexico economist has estimated the phone line saves the state’s health care system over $5 million a year. And Quintana said it’s more than a triage center — nurses there build relationships with patients and keep their doctors informed about calls.
But revenues for the organization have declined, and it is facing the threat of a shutdown by the year’s end, largely because managed care companies that long supported the program have switched to lower-cost services, most of them based out of state. Records show that even though they aren’t funding NurseAdvice, many of the firms’ patients continue to call the line.
Former state Sen. Dede Feldman, an Albuquerque Democrat who advocated for legislative startup funds to get NurseAdvice online, said a shutdown would be “a real tragedy. … It’s a crime as far as I’m concerned.” The results, she predicted, will be a rise in medical expenses for the state and a strain on health workers.
She and other government leaders launched NurseAdvice New Mexico in 2006 as a public-private partnership to help reduce medical care costs and ease the strain on rural health clinics and hospitals overwhelmed with unnecessary emergency room visits. The program also was aimed at ensuring that patients across New Mexico — even those in the most remote reaches of the state — would always be able to get an in-state health professional on the line.
Feldman and NurseAdvice Director Connie Fiorenzio say nurses based in New Mexico have a better understanding of a caller’s culture and of the medical services available in their community. Feldman cited one woman’s call to a nurse line in Canada about a skin reaction to green chile. The nurse, who had never heard of the New Mexico staple, was stumped.
The state initially required Medicaid contractors to partner with the nonprofit and contribute funding, generating a sustainable revenue stream to cover operating costs. But that mandate eventually was removed.
Fiorenzio said most managed care firms continued to support the phone line, and even used it for their commercial and Medicare health plans, until a state Medicaid overhaul in 2014. Companies that contract with the new Medicaid program, Centennial Care, have started their own nurse lines, she said, or have outsourced the job to lower-cost phone lines based out of state, or even out of the country.
But that doesn’t mean New Mexicans have stopped calling their home state nurse line.
“We take hundreds of calls every month for Centennial Care members,” Fiorenzio said. Insurers don’t have to cover the costs of those calls. Hospitals across the state refer patients to the nurse line, she said — and data show they all benefit — but few of them contribute funding.
NurseAdvice fields more than 11,000 calls a month, according to the group’s 2015-16 annual report. Quintana said they range from new mothers with fears about feverish newborns to people experiencing strokes, head trauma or respiratory distress. No patient is ever turned away.
A report to lawmakers in November 2015 said NurseAdvice had served more than 1.4 million callers by then, and an analysis shows that many of them were Medicaid members and uninsured patients.
Before Centennial Care took effect, Medicaid contractors had been providing the phone line with about $1.3 million annually, including fees for their commercial and Medicare plans. That was the largest share of the nonprofit’s $2.1 million operating budget, Fiorenzio said.
The nonprofit has been able to replace some of that funding by developing new partnerships with primary care doctors, community health centers, hospitals and health plans, she said. But the revenue hasn’t been enough to fill the gap. NurseAdvice has used up its cash reserves and is now scrambling to find a funding solution before it is forced to close its doors Dec. 31.
“We’re running out of time,” Fiorenzio said.
University of New Mexico medical economist Sam Howarth said in a fiscal year 2015 analysis that the advice line saves up to $5.7 million annually for hospitals, insurers and the state and federal governments by diverting patients away from emergency rooms and sending them to a more appropriate facility, such as a primary care doctor, or by advising them on home care. The amount includes more than $2.4 million in savings from unnecessary ER visits by Medicaid members and $670,000 for uninsured patients.
The nurse line was “a win-win all the way around,” Feldman said. “Shame on New Mexico for letting this die.”
State Sen. Gerald Ortiz y Pino, D-Albuquerque, introduced a measure in this year’s legislative session to help shore up the phone line’s budget by requiring Medicaid contractors to contribute. The bill faced opposition from managed care organizations, he said, as well as the Human Services Department. The groups agreed to a compromise Senate memorial calling for a task force to study the issue.
He may introduce another bill in the upcoming session, Ortiz y Pino said, but he’s certain the bill, like the one he pushed this year, will fail unless Gov. Susana Martinez gets behind it.
Martinez spokesman Michael Lonergan declined to comment on the phone line, instead referring questions to the Human Services Department.
Human Services spokesman Kyler Nerison said in an email that each Medicaid health plan must have a 24-hour nurse advice line available for its members. “That said,” he added, “there has never been a requirement for the plans to use any particular service.” He provided a contract dated 2008 that says firms can use any nurse line that meets certain qualifications.
Fiorenzio doesn’t dispute that, but she believes having a nurse line in New Mexico improves the quality of care for all state residents. “NurseAdvice actually gets calls from these out-of-state lines,” she said in an email, “transferring the members back to us at NurseAdvice to find out local resource information.”
As chairman of the Legislative Health and Human Services Committee, Ortiz y Pino said he will press the issue during an upcoming committee meeting, asking state Medicaid and Human Services Department officials to provide stop-gap funds to keep the service alive until lawmakers can consider a longer-term solution during the 2017 legislative session, which begins in January.
Meanwhile, the nurse line’s 41 staff members, most of them registered nurses, have stuck by the nonprofit as it faces a holiday-season shutdown. “I’ve had a lot of people tell me that they want to hang on as long as possible,” Fiorenzio said.
Quintana, who has been with NurseAdvice for three years, said, “We’re all at risk of losing our jobs.” But what she and her colleagues worry about most, she said, is how the loss of the phone line is going to affect the state. “We’re a great resource for the state, and it would be sad to see that go.”
Contact Cynthia Miller at 505-986-3095 or firstname.lastname@example.org.