The AAFP is urging CMS to take concrete steps to ensure that a Graduate Nurse Education Demonstration project helps address the current shortage of primary care health professionals by actually producing advanced practice registered nurses (APRNs) that will work in primary care.
The Graduate Nurse Education Demonstration(innovation.cms.gov) was created by the Patient Protection and Affordable Care Act. It provides $200 million during the next four years to five teaching hospitals to produce more APRNs. According to CMS, the project is intended to "increase the base of primary care providers" and to "provide APRNs with the clinical skills necessary to provide primary care, preventive care, transitional care, chronic care management and other services appropriate for Medicare beneficiaries." The demonstration requires that half of clinical training occur in nonhospital settings in the community.
The AAFP expressed its concerns with the program as outlined by CMS in an April 4 letter(2 page PDF) from AAFP Board Chair Roland Goetz, M.D., M.B.A. "CMS … seems to assume that increasing the number of APRNs will result in more primary care providers," said Goertz in the letter, which was sent to CMS Acting Administrator Marilyn Tavenner, M.A.
"The AAFP is concerned with this assumption, since research from the Agency for Healthcare Research and Quality found that only 52 percent (approximately 56,000) of nurse practitioners actually practiced primary care in 2010," said Goertz.
He urged CMS to take four steps so that the project can truly address the shortage of primary care health professionals:
- specify that participants in the demonstration project train APRNs as part of a health care team that includes physicians and operates within a patient-centered medical home;
- allocate demonstration funds exclusively to train APRNs who have committed to providing primary care services on graduation and for at least the following five years;
- require the five participants in the demonstration to focus on a true primary care curriculum; and
- exclude certified registered nurse anesthetists, clinical nurse specialists and nurse midwives because the training they receive and the services they provide are unrelated to the delivery of comprehensive primary care services.
"The AAFP recognizes both the valuable contributions of the nursing profession and that the expansion of health insurance under the Affordable Care Act will significantly increase the demand for primary care services," said Goertz in the letter.
He noted that the Academy has the highest regard and professional respect for educated, dedicated and caring APRNs, and that the comments to CMS are offered "to strengthen and orient the Graduate Nurse Education Demonstration toward primary care providers."
Meanwhile, the AAFP will continue its efforts to address the current shortage of primary care physicians by "actively working with Congress to ensure steady funding for health professions grants and the National Health Service Corps," Goertz said.
"We are simultaneously working with Congress to pass the Primary Care Workforce Improvement Act (H.R. 3667), which creates a pilot program to demonstrate direct graduate medical education funding for nonhospital medical training sites," said Goertz. "As such, we believe that the Graduate Nurse Education Demonstration for primary care nursing should require that most of the clinical training occur in nonhospital settings."
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