More than 60% of training took place in community-based settings, and primary care nurse practitioners accounted for most of the growth.
Medicare should adopt, and fund, the model nationally, which would help mitigate the shortages of nurses and physicians, said Barbara Todd, co-author of the article and director of the graduate nurse education demonstration at the Hospital of the University of Pennsylvania.
"The graduate nurse education (program) shows how Medicare could achieve greater value for its investments in nurse training while contributing to the development of a workforce that can better deliver the care that Medicare beneficiaries want and need," she said.
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. While there is some disagreement among healthcare researchers, certain studies show that nurse practitioners provide primary care that matches or exceeds the quality of physician-provided care. It is also less expensive and improves access in underserved areas. But although Medicare spends more than $15 billion annually on graduate medical education for physicians, it spends very little on clinical training for nurse practitioners.
The pilot program shows that it is feasible for Medicare to pay hospitals to help train advanced nurse practitioners, said Kurt Mosley, vice president of strategic alliances for Merritt Hawkins and Staff Care, companies owned by the staffing agency AMN Healthcare.
"The formulas Medicare use to pay for nurse training are archaic and funds need to be reallocated," said Mosley, adding that demand for nurse practitioners is at an all-time high. The number of search assignments Merritt Hawkins conducted for nurse practitioners increased by 61% from 2017 to 2018 as more fill openings at urgent care centers, retail clinics, community health centers, rural facilities and specialty medical practices.
The researchers call for a shift in Medicare funding from diploma nursing programs that produce entry-level registered nurses to permanent, national funding for advanced practice registered nurse training. They found that Medicare funds for nurse training have decreased 30%, 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% of RNs.
There is also an inequitable distribution of Medicare funds for nurse training by state. Hospitals in Pennsylvania, Illinois, Ohio, New York, Virginia and Missouri received 53% of Medicare nurse-training funds in 2015, largely because they have historically been home to a disproportionate number of diploma nursing schools, researchers found.
Meanwhile, shortages in primary care physicians and nursing are limiting access and pinching hospital margins.
By 2030, the U.S. could face a shortfall of between 7,300 and 43,100 primary care physicians, according to a study commissioned by the Association of American Medical Colleges. The consequences are harsher in rural areas that have difficulty attracting and retaining doctors.
The nursing shortage is expected to persist until 2025. Doctoral nursing graduates, which are the largest source of nursing educators, are projected to add nearly 2 million new entrants into the nursing profession by 2025, but a lack of supply will hurt the industry in the short term, according to a report from Moody's Investors Service.
While incentives like student debt forgiveness and new partnerships with higher education institutions are helping boost the supply, it will take years for supply to meet the expected demand, experts said.
A big part of the problem stems from a lack of qualified faculty, said Susan Sanders, vice president of Kaplan Nursing and an adjunct professor at Middle Tennessee State University.
"Many are turned away from nursing programs each year based on faculty shortage and ability to fund them," she said.
Nurse practitioners are uniquely equipped to manage care for chronically ill patients that overwhelm the healthcare industry, Sanders said. They provide access to care in rural areas, teach patients and families about treatment, and connect them with community resources, she said.
"They are also more cost effective for patients and definitely more cost effective for education," Sanders said. "If you look at some of the literature too, patient satisfaction and quality of care is equivalent or higher than the physician model."
