Successful Medicare initiative increases the supply of nurse practitioners to address primary care shortages

A new study published today in Health Affairs shows that Medicare support for clinical training for nurse practitioners would increase their numbers and address the national shortage of primary care. The study, by researchers at the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, the Hospital of the University of Pennsylvania, and the Leonard Davis Institute of Health Economics shows that universities participating in the $200 million Graduate Nurse Education (GNE) Demonstration significantly increased the number of primary care NPs they graduated. Co-author Linda Aiken, Ph.D., RN, said “One in four Americans, or over 80 million people, lack a primary care provider. Nurse practitioners with advanced clinical training in primary care help the public obtain health care when they need it. There are plenty of qualified applicants to university NP programs but admissions are limited because we don’t have enough primary care clinicians to supervise student learners in their practices.”

The Graduate Nurse Education Demonstration, launched under the Affordable Care Act, provided selected hospitals with Medicare funding to help offset costs associated with clinical training of NPs. The funded hospitals were the Hospital of the University of Pennsylvania in Philadelphia, PA; Duke University Hospital in Durham, NC; Rush University Hospital in Chicago, IL; Scottsdale Healthcare Medical Center in Scottsdale, AZ: and Memorial Hermann-Texas Medical Center in Houston. These hospitals created partnerships with university NP educational programs. The largest of the funded sites was the Hospital of the University of Pennsylvania, which served as a regional hub for a network comprising 9 universities with NP graduate programs, multiple hospitals and health systems, and many community-based primary care practices.

Co-author Regina Cunningham, Ph.D., RN, Chief Executive Officer of the Hospital of the University of Pennsylvania, said, “The GNE Demonstration shows that longstanding challenges in health care like the shortage of primary care providers can be successfully addressed when health care organizations in communities band together for the common good. Working together in Philadelphia across health systems, public clinics, private medical practices, and schools of nursing, we were able to recruit a larger number of practicing physicians and nurse practitioners to mentor NP students to help them meet their clinical training requirements of 500 or more hours thus enabling nursing schools to accept more student NPs.”

First author Joshua Porat-Dahlerbruch notes, “The cost of clinical training for one nurse practitioner in the GNE Demonstration was about $47,000 compared to the cost of clinical training for a primary care physician of over $157,000.” The GNE funds were used to support preceptors mostly practicing in community-based settings.

The GNE Demonstration also showed the success and feasibility of using regional consortia to distribute Medicare training funds to a limited number of hospitals for training nurse practitioner students. This is a promising way to modernize Medicare graduate medical education to produce more of primary care providers that this country needs.