Indiana State University Newsroom

Andrew Mathis and Alli Milliner are at the forefront of sweeping changes in American health care policy.

They're part of a team of Indiana State University graduate students that is helping health care providers prepare for the implementation of a key provision of the Affordable Care Act.

Mathis, Milliner and 13 other master's degree students in physician assistant studies rotate among four Terre Haute area nursing homes each week. "We check in on the patients and see if they're having any changes, and make sure their care is continued on through their doctor's visits," Milliner explained.

Students are assigned to the same patients each week so they can develop a relationship with them and be able to check on them more efficiently, she said.

"If they were to have an issue ... hopefully we and the nursing staff can catch it early before it becomes a problem," Mathis added.

Therein lies the primary reason for a pilot program involving Indiana State's College of Nursing, Health, and Human Services; the university's Center for Health, Wellness and Life Enrichment, the Franciscan Union Accountable Care Organization; and the Rural Health Innovation Collaborative.

"Under the Affordable Care Act, hospitals will be penalized if patients have to come back within 30 days of (being) discharged," said Dr. Jim Buechler, medical director at Meadows Manor North, one of the nursing homes participating in the pilot program.

"Nursing home patients are often admitted from a hospital and the goal is for them to go home," Buechler said.

But all too frequently, those patients get sick again or have another fall and end up back in the hospital. "This project was designed to utilize students to look at these high-risk patients that come into the skilled nursing facility and say, ‘Are there any interventions we should be doing to keep them from having to go back to the hospital?'" he said.

In only its third week, an incident occurred that suggests the program is paying off, Milliner said.

"One of our patients actually was beginning to get sick and Dr. Buechler ... called and wanted to start her on medication," she said. "Our being here actually helped her to maybe prevent an infection that could have gotten a lot worse."

Buechler, a practicing physician for more than 40 years and director emeritus of the Richard G. Lugar Center for Rural Health, said he is excited about the program.

"Students are getting an opportunity to learn in a clinical environment, to see people who are really glad to see them, and to try to be detectives, to learn about the patients and say, ‘Well, why is this patient here? How did all this happen? What can we do to keep this patient from going back to the hospital?'" he said. "They're very enthusiastic about it. They look for little things and they find things that are important that maybe sometimes we more experienced people miss."

Plans call for the pilot program to expand in the spring semester to include 300 students from the College of Nursing, Health, and Human Services and other colleges at Indiana State. That would bring in such fields as psychology, occupational therapy, social work, community health, education and insurance and risk management.

"If you look at people in nursing homes, many of the issues that they have are social, and many are psychological," Buechler noted. "If we bring those professionals in ... you have a team of people that is looking at the patient as a whole. They have various areas of expertise and they work together and collaborate, and the patient will end up being better off - I'm totally convinced of that. So I look forward to seeing some of the other disciplines as a part of this project."

Participating students say the program is also helping them better prepare by offering real-world experience that could not be duplicated in a classroom or a lab.

"This program is probably the most hands-on experience we've been able to have, with just seeing patients who have some of the abnormal things that we learn about in the classroom," said Milliner, a South Bend native. "We practice on each other, but we all have normal heart sounds, we all have normal lung sounds, so we're just taught what we're supposed to hear. And coming here and getting out into the community helps us to practice some of our skills and to just see some of these things that we're learning about."

Mathis, a Terre Haute native who gave up a career as a science teacher at Terre Haute North Vigo High School to go into health care, said the timing for such a decision amid implementation of the Affordable Care Act couldn't have been better.

"(Our) class is pretty fortunate to be coming through during this transition time because hopefully things will be set by the time we graduate," he said. "We're in a good spot with Indiana State in how they have helped us understand and ... be a part of this transition as it happens."

Photo: http://isuphoto.smugmug.com/Other/Media-Services/Media-Arts-and-Sciences/Accountable-Care-program/i-vF7d4Qp/0/D/November%2005%2C%202013%20Accountable%20Care%204188-D.jpg - Andrew Mathis, a student in Indiana State University's master's degree program in physician assistant studies, checks Loretta Harden's breathing during his rounds at Meadows Manor North nursing home Nov. 5, 2013. (ISU/Rachel Keyes)

Photo: http://isuphoto.smugmug.com/Other/Media-Services/Media-Arts-and-Sciences/Accountable-Care-program/i-rpSCwLq/0/D/November%2005%2C%202013%20Accountable%20Care%204229-D.jpg - Indiana State University physician assistant studies students Alli Milliner of South Bend (left) and Anna Brown of Kalamazoo, Mich. check patients' records at Meadows Manor North nursing home Nov. 5, 2013 as part of a pilot program on accountable care. (ISU/Rachel Keyes)

Contact: Stephanie Laws, executive director, Rural Health Innovation Collaborative, 812-237-3630 or slaws@uhhg.org

Writer: Dave Taylor, media relations director, Office of Communications and Marketing, Indiana State University, 812-237-3743 or dave.taylor@indstate.edu