Prorenata in medical parlance means "as needed," and that's just the inspiration for Prorenata Health Inc., launched in January to offer medical services delivered to Rutherford County homes by a nurse practitioner.

 

"Our service really is as needed. Someone may need care at home for a short time, and then they may go back to their regular provider, and some people may need us long-term, especially if they are older and chronically ill," explained Laura Hart, Prorenata's nurse practitioner. She said the focus is on senior citizens, but anyone who's homebound would be a candidate.

 

Hart co-founded the business in Murfreesboro with her husband, John, who serves as president and business manager. "When I was younger at home, my family had taken care of my grandmother, and we recently took care of John's mother during an illness in our home," Hart recalled. "Neither could leave the house, and we realized, 'We're not the only people with loved ones who can't get out.'"

 

According to the American Academy of Home Care Physicians, there are an estimated 2 million homebound patients suffering chronic conditions, and that number is expected to grow. For every elderly person in a nursing home, three more are equally fragile and infirm and living at home without regular medical oversight.

 

With the slogan "Old fashioned health care comes home," Prorenata helps its patients manage chronic illnesses and treats acute problems –– from urinary tract infections and allergic rhinitis to shingles … wound infection, upper respiratory illness or gastroenteritis. Hart said most patients already are on a medication regimen to control problems such as high blood pressure, diabetes, thyroid disorders or arthritis, yet her blood tests occasionally reveal treatable conditions such as high cholesterol. She also monitors her elderly patients' cognitive function.

 

In Tennessee, nurse practitioners must operate under the supervision of a physician, and Hart turns to Frank Perry, MD, a Franklin internist. In accordance with state regulation, Perry reviews 20 percent of Hart's patient charts (he views the charts electronically) and consults with her on cases that may require patient referral to a specialist or hospital admission. Nurse practitioners have prescribing authority in this state for all legend drugs and Schedule II through V narcotics. "I don't do a lot of changing if something is working," Hart said.

 

Prorenata has established relationships with other providers to extend care, including a mobile imaging service, a home-delivery pharmacy and a diagnostic laboratory service to run samples. Hart also works closely with hospitalists at Tri-Star's StoneCrest Medical Center in Smyrna when her patients are admitted.

 

"My office is my car," Hart said. She uses her phone to take notes and then enters data into medical records on her laptop in the car once an appointment is over. "There's a big brown box in the back of my car with extra supplies," she quipped. She's usually ringing a patient's doorbell within 24 hours of a call regarding an illness.

 

While most of her patients are at home, her roster is expanding to include residents of assisted living facilities. The couple is marketing the practice through elderly service organizations, businesses that offer daily living assistance to the homebound and senior citizen centers. "The people who are homebound are hard to find, so you have to find the people who know them," she said.

 

Hart acknowledged that battling health insurance bureaucracies has been challenging. "Ours is not a service that a lot of the preferred providers or the HMOs make easy," she said. "They require prior authorization usually for each visit, and sometimes they require a referral. A bulk of our patients are original Medicare patients, and we do some of the private fee-for-service plans such as the Medicare Advantage plans. Original Medicare does cover this if there's a reason why you need to be seen at home."

 

Home health is the fastest growing segment of Medicare's budget, and experts like Hart believe the result will be a cost savings in the long run. That's because home-care costs are significantly lower than emergency room fees and ambulance transportation. Serving as a nurse in emergency rooms and in critical care settings "made me think that this (Prorenata Health) was a good idea," Hart said. "I would even see patients in the ER who have a doctor, but they couldn't get in to see their doctor, so they would end up going to the emergency room."

 

Hart graduated from the Kirkhof College of Nursing at Grand Valley State University in Allendale, Mich., and earned a bachelor's degree at the University of Alabama in Huntsville. "It was cold in Michigan, and I told my husband that when I got out of school, I was looking for a job somewhere warmer," she said. The couple moved to Murfreesboro in 2004 for her job as an emergency room contract nurse with Sterling Healthcare, working in McMinnville.

 

For more information about Prorenata Health, call 615-896-9389 or e-mail prorenatahealth@bellsouth.net.