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Researchers Call for New Medicare Model to Support Advanced Practice Nurses


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With APRNs providing an increased proportion of primary care in the U.S., experts are calling to modernize how Medicare pays for nurse training to produce more APRNs to practice community-based primary care.

In a new article in the New England Journal of Medicine (NEJM), researchers from the University of Pennsylvania shared their findings from a five-state demonstration of an innovative model of graduate nurse education. The Graduate Nurse Education (GNE) Demonstration, authorized by the Affordable Care Act, encompassed GNE sites managed by a single teaching-hospital hub that combined the training capacity of entire communities of healthcare providers, including health systems, hospitals, clinics, private practices, long-term care facilities, and universities. The demonstration offered payment to Medicare providers, which allowed communities to offer high-quality clinical training for advanced practice nurses (APRN) in settings experiencing provider shortages.

Studies have shown that APRNs are capable of producing quality, financial, and clinical outcomes equal to or better than primary care physicians. The GNE Demonstration reinforces the financial benefits of APRNs, especially for Medicare providers: according to an independent evaluation of the demonstration, the cost of educating each APRN in the program ranged from $28,000 to $57,000, compared to the $158,000 per year over multiple years to train a primary care physician.

The authors of the NEJM article would like to see Medicare replace the outdated funding model and adopt this nurse training model nationally. They call for a shift from the funding diploma nursing programs that produce entry-level RNs to funding APRN training programs instead. Their research found that Medicare funds for nurse education have decreased 30% from 1991 to 2015, and most of that goes to diploma programs that train less than 5% of registered nurses.

The researchers also discovered that the current Medicare funding model for nurse training led to an inequitable distribution of Medicare funds by state. Hospitals in six states received 53% of Medicare nurse-training funds in 2015, because those states have a disproportionate number of diploma nursing schools, while other states did not receive and funding for nurse education.

“The GNE Demonstration 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,” said co-author Barbara Todd, DNP, Director of the Graduate Nurse Education Demonstration at the Hospital of the University of Pennsylvania. “The Demonstration shows that it is feasible and affordable for Medicare to pay hospitals to facilitate the expansion of clinical training opportunities for APRNs in the community as well as hospital settings, similarly to Medicare’s support of clinical residency training for physicians.”