In 2010, Congress enacted the Affordable Care Act (ACA), which took historic steps to support the practice of nurse practitioners (NPs).
In the years since, Congress has appropriated considerable sums to support several of the law’s NP-related provisions. But it hasn’t appropriated the full amounts authorized by the law for all provisions that affect NP-practice, according to a new study by Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar J. Margo Brooks Carthon.
An assistant professor of nursing at the University of Pennsylvania, Carthon, PhD, APRN, hopes the study will raise awareness about the effects of federal policy on NPs.
Policy discussions in the NP community tend to focus on state-level regulations that determine whether NPs and other advanced practice registered nurses (APRNs) are able to practice to the full extent of their knowledge and training, Carthon said. But few understand the effects of federal policies on NP practice. “We don’t talk as much about how federal policy informs state scope of practice, and vice versa,” she said. “I wanted to highlight that.”
The RWJF-supported study was published in May in the Journal for Nurse Practitioners. Carthon’s co-authors are Hilary Barnes, PhD, CRNP, and Danielle Altares Sarik, MSN, CRNP, both of whom are research fellows affiliated with the Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania.
Surging Demand for NP-Provided Care
Demand for NP-provided care is surging thanks to physician shortages and an increasing, and increasingly complex, population of patients, Carthon and her colleagues write. In response, Congress included a number of provisions in the ACA to bolster primary care provided by NPs, which has been shown to be comparable to similar care provided by physicians.
One key provision is the Medicare Graduate Nurse Education (GNE) Demonstration, which supports the clinical education and training of NPs and other graduate nursing students. Congress made available the full $200 million that was authorized in the ACA for the project, and initial reports are showing that it has great promise.
The Centers for Medicare & Medicaid Services recently extended funding for the demonstration, noted Linda Aiken, PhD, RN, FAAN, who directs the research center at the University of Pennsylvania as well as one of the GNE’s five program sites. The sites are expected to stay active until 2017, when an independent evaluation of the demonstration will be submitted to Congress.
Other provisions in the ACA that support NPs include funding increases for the National Health Services Corps (NHSCs) program, which provides loan repayment and scholarships to NPs and other clinicians; federally qualified health centers (FQHCs), which utilize NPs to provide comprehensive, affordable care to underserved populations; and nurse-managed health centers (NMHCs), which are staffed mainly by NPs.
But the promise of two of those provisions has yet to be fully realized, Carthon writes. Over the last five years, actual funding levels for FQHCs and NMHCs have fallen short of the amounts authorized by the ACA. That has limited access to NP-provided care and forced some NMHCs to close, reducing training and employment opportunities for NPs.
The ACA also could have gone further in supporting NP practice relating to the Independence at Home Demonstration and Patient-Centered Medical Homes models of care, Carthon adds. The law recognizes NPs as potential leaders of these models but gives the final say about leadership to states. This “may hamper NPs’ ability to function in primary care provider roles within these models of care,” Carthon writes.
Still, the news is good overall, says Peter Reinecke, a consultant to AARP and its Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF that is coordinating a national Campaign to transform nursing to improve health and health care. “While some provisions have not been fully funded, the net impact of the ACA on support for APRN training and practice has been very positive,” he said. “The ACA has meant substantial boosts for the NHSC, FQHCs, and the historic Medicare GNE Demonstration.”
Read a new report about the Graduate Nursing Education Demonstration by the AARP Public Policy Institute.