OK, what do you say about this? Any thoughts or comments? Community based nursing reminds me of County Health Dept. http://news.yahoo.com/doctor-prescri...5R73MA.CrQtDMD

MILWAUKEE (Reuters) - Home nursing and social work can significantly drive down healthcare costs caused by overuse of hospitals and nursing homes, a family doctor who practices in one of the poorest U.S. cities told a group of governors on Friday.

Jeffrey Brenner, the founder of Camden Coalition of Healthcare Providers, encouraged governors attending the National Governors Association summer meeting in Milwaukee to work with healthcare providers in their state to consolidate and de-institutionalize their systems.

"You regulate these facilities and you regulate the providers. Everyone that needs to be here to fix the American healthcare system is right here in this room," said Brenner, who works in Camden, New Jersey, where 40 percent of the population lives in poverty.

Brenner made his remarks during the opening session of the three-day event, attended by 23 state governors and the governors from Virgin Islands and Puerto Rico.

The governors are participating in presentations and discussions regarding economic development and commerce, natural resources, military veterans and cybersecurity.

Brenner's organization found that a large part of healthcare spending happens in large facilities such as hospitals, nursing homes and hospice facilities, where costs tend to be higher.

Brenner cited a Pennsylvania study that found community-based nursing of elderly patients over a 10-year period decreased hospitalization by a third, Medicare costs by a fifth and risk of death by a fourth.

"You have to go way back in medical history to find anything with that kind of impact," he said. "This is a stunning impact."

Brenner recommended creation of systems in which nurses and social workers work in the field to help the chronically sick navigate the complex healthcare system. This approach, he said, will ultimately decrease the number of expensive hospital visits.

One of the biggest challenges governors have is to "overcome the tremendous amount of money and clout and connections (hospitals) have," said Iowa Governor Terry Branstad.

Branstad said Brenner's remarks resonated with him after a tough legislative session in which hospital association "threw everything they had" at the state's effort to come up with a healthcare plan.

The United States spends $2.8 trillion, twice as much as every other country, on healthcare each year, representing 18 percent of the country's total economy, Brenner said.

"We have to re-invest this money on the front line of care, rather than building more hospitals, expanding emergency rooms and buying more scanners," Brenner said. "The problem in America, we set a very high price to cut, scan, zap and hospitalize and set a very low price if you talk to people."