Creating Jobs by Addressing Primary Care Workforce Needs
Primary care providers are critical for ensuring better coordinated care and better health outcomes for all Americans. To meet the health needs of Americans, the Obama Administration has made the recruitment, training and retention of primary care professionals a top priority.
Expanding the Primary Health Care Workforce
Together, the Affordable Care Act, the American Recovery and Reinvestment Act of 2009 (Recovery Act), and ongoing federal investments in the health care workforce have led to significant progress in training new primary care providers – including physicians, nurse practitioners and physician assistants – and encouraging primary care providers to practice in underserved areas, including:
- Nearly Tripling the National Health Service Corps: As a result of historic investments by the Obama Administration, the numbers of primary care providers in the National Health Service Corps (NHSC) are at all-time highs, nearly tripling between 2008 and 2012. Today, 10.4 million people in communities nationwide receive health care from nearly 10,000 National Health Service Corps clinicians. The National Health Service Corps has invested nearly $900 million in providing scholarship and loan repayment incentives to primary care providers and students in return for service in the areas that need them most.
- Supporting Community Health Centers: The Affordable Care Act created the Community Health Center Fund, which provides $11 billion over five years for the operation, expansion and construction of health centers nationwide. Today, more than 1,200 health centers operate nearly 9,000 service delivery sites that provide primary care to more than 20 million patients nationwide, a third of whom are children. Since the beginning of 2009, health centers have added an additional 2,200 full-time physicians and 2,400 full-time nurse practitioners, physician assistants, and certified nurse midwives.
- Training New Primary Care Providers: The Affordable Care Act invests in the training of new primary care providers, including providing nearly $230 million to increase the number of medical residents, as well as funding to increase the number of nurse practitioners and physician assistants trained in primary care. With these investments, by 2015, more than 1,700 new primary care providers will have been trained and enter primary care practice. The Fiscal Year 2014 budget includes investments that will expand the capacity of institutions to train 2,800 additional primary care providers over five years.
- Training Physicians in Community-Based Settings: The Affordable Care Act created the Teaching Health Center Program to help move primary care training into community-based settings. The five-year investment in this program is expected to support the community-based training of over 600 new primary care physician and dental residents by 2015.
- Supporting Mental Health Training: Mental health issues rank in the top five chronic illnesses in the United States. In Fiscal Year 2012, the Affordable Care Act invested $10 million to support training to help close the gap in access to mental and behavioral health care services by increasing the number of adequately prepared mental health and substance use health providers.
- Expanding Residency Slots for Primary Care: To encourage more medical residents to pursue careers in primary care, the Affordable Care Act redistributed unused residency positions and directed those slots for the training of primary care physicians. In distributing the residency slots, priority for awarding residents was given to hospitals that have rural training tracks, train residents in geriatrics, are using the additional slots to create or expand a primary care program, demonstrate focus in training residents to pursue careers in primary care, or serve a primary care health professional shortage area.
- Expanding Training of Advanced Practice Nurses: The Affordable Care Act allows up to five hospitals, named last year, to receive $50 million each year after a competitive application process, for fiscal years 2012 to 2015, to train advanced practice nurses, including nurses in community-based settings.
Modernizing Primary Care Training and Practice
Implementation of the Affordable Care Act provisions is strengthening the primary care training infrastructure, creating new primary care clinical training opportunities, and supporting primary care practice. These efforts include:
- Encouraging Physician Training in the Community: The Affordable Care Act provides incentives for hospitals to train primary care physicians in the community by providing flexibility in Medicare residency training requirements. Prior to the law, hospitals had to bear the cost of education in non-hospital sites, often by paying both the resident’s and teaching physician’s salary. This requirement discouraged training in community settings, which encourages primary care practice. The Affordable Care Act changed this policy and requires hospitals to only pay the resident salaries.
- Encouraging Health Homes: Under the Affordable Care Act, States are incentivized to create Medicaid “health homes” for individuals with chronic health conditions. Health homes encourage the use of integrated care to help patients better manage their health. States that create health homes will receive enhanced federal matching funds for care coordination services for the first eight quarters a health home state plan amendment is in effect.
Modernizing Payment and Improving Financial Incentives for Coordinated Care
- Creating Primary Care Payment Incentives: The Affordable Care Act authorizes a ten percent Medicare payment bonus from 2011 to 2015 for physicians who specialize in family medicine, internal medicine, geriatric medicine, or pediatric medicine, nurse practitioners, clinical nurse specialists, or physician assistants for whom primary care services account for at least 60 percent of their Medicare allowed charges. The Affordable Care Act also increases primary care physician payment rates in the Medicaid program to match Medicare payment levels in 2013 and 2014.
- Realigning financial incentives in Accountable Care Organizations (ACOs): Under old payment systems, care coordination – the hallmark of effective primary care – wasn’t rewarded financially. Medicare’s shared savings program changes that model by rewarding physicians and other primary care practitioners for high-quality care and preventing the need for care in the first place. Already, more than 250 ACOs have joined one of the ACO programs offered by CMS. 220 ACOs have joined the permanent shared savings program. CMS has also created two demonstration programs to supplement the shared savings program: the Pioneer ACO initiative for 32 large and experienced health systems ready to move into accountable care quickly; and the Advanced Payment ACO, for smaller practices that need help with startup costs. Together, these initiatives are improving primary care for nearly 4 million people with Medicare.
- Innovation Center: The Center for Medicare & Medicaid Innovation has launched a number of initiatives involving over 50,000 health care providers that will touch the lives of Medicare and Medicaid beneficiaries in all 50 States, the District of Columbia, and Puerto Rico. Many of those are explicitly designed to promote primary care.
- Comprehensive Primary Care Initiative: A public-private multi-payer partnership in which Medicare is working with commercial and state health insurance payers to strengthen primary care. 497 practices representing approximately 2,300 providers are providing enhanced primary care services for an estimated 315,000 Medicare beneficiaries in 7 markets across the country.
- Bundled Payments for Care Improvement: Under this initiative, health care organizations enter into payment arrangements that include financial and performance accountability for episodes of care that will lead to improved quality of care and better coordinated care for Medicare beneficiaries. More than 400 health care organizations are participating across four broadly defined models of care.
- Federal Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration: This initiative makes approximately $42 million available over three years to support 492 FQHCs in 44 States with care coordination payments that will allow the FQHCs to become medical homes, the hub of a patient’s primary care needs. This initiative started in 2011.
- Multi-payer Advanced Primary Care Practice Demonstration: Under this initiative, Medicare is participating in existing state multi-payer reform efforts that already include Medicaid and private health plans to make medical homes more broadly available. Launched in 2011, 8 states are currently participating in the initiative.
- Independence at Home: This initiative supports home-based care for patients with multiple chronic conditions that would benefit from primary care coordination. 15 independent physician practices and 3 consortia of additional physician practices are participating in the initiative to provide primary care services in the homes of up to 10,000 Medicare beneficiaries with complex health needs.
- State Innovation Models: This initiative is providing up to $300 million for states committed to planning, designing, and testing new state-based payment and service delivery models. 6 states will be implementing their State Health Care Innovation Plan that describes their strategy of how it will reform its health care delivery system while 19 states are working to produce their plans.
- Health Care Innovation Awards: This initiative is funding up to $2 billion in awards to organizations that are implementing the most compelling new ideas to deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees. 107 participants are implementing innovative projects, including projects that focus on primary care delivery, across the country. A second round of Health Care Innovation Awards was recently announced to solicit proposals from a broad array of organizations in four defined categories, with an emphasis on outpatient care.
Last Updated: June 21, 2013