New Medicare model produces nurses to address shortage of primary care, says NEJM

Medicare could modernize the way it pays for training nurses, and there has emerged a successful new model of cost-effectively training more advanced practice nurses to deliver community-based primary care, according to University of Pennsylvania researchers.

Nurse practitioners, or NPs, are providing an increasing proportion of primary care, which is in short supply in many areas of the country. NPs deliver care in retail clinics, community health centers, rural clinics and in primary care and specialty medical practices. And while the ranks of primary care physicians continues to decline, the number of NPs are on the rise in both rural and nonrural settings, making for more diverse practice care teams, as revealed in a study earlier this month.

The new findings, published in the New England Journal of Medicine, come from a recently completed five-state demonstration of a new model of graduate nurse education, authorized by the Affordable Care Act. In three projects, each GNE site, managed by one teaching hospital hub, combined the training capacity of entire communities across health systems, hospitals, private medical practices, clinics, long-term care and universities.

Offering payment to Medicare providers allowed communities to scale up high-quality clinical training for advanced practice nurses in the settings where they're most needed when they graduate. Researchers at the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research and the Hospital of the University of Pennsylvania led the largest demonstration site, which included nine universities, multiple health systems and more than 600 community health care providers in the greater Philadelphia region.

The authors call for Medicare to adopt, and fund, the nurse training model nationally, as there are potentially significant economies of scale that can be achieved. 

According to an independent evaluation, the cost of educating each nurse practitioner varied from $28,000 to $57,000, compared to the cost of training a primary care doctor of close to $158,000 a year for multiple years.

Although Medicare spends more than $15 billion annually on graduate medical education for physicians, it spends very little on clinical training for NPs, according to the report. How Medicare pays for nurse training is based on formulas that predate the existence of most advance practice programs.

The researchers call for a shift in Medicare funding from diploma nursing programs that produce entry-level RNs to permanent, national funding of training for advance practice registered nurses. To underscore their point, they analyzed how Medicare currently allocates funds for nurse training. They found that Medicare funds for nurse training have decreased 30 percent -- from $174 million in 1991 to $122 million in 2015 -- and that most funding still goes to hospital-operated diploma programs that now train less than 5 percent of RNs.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com