Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

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  • Data Insights

    As urbanization increases, an older, sicker and poorer population remains in rural America. Despite the health care challenges posed by these changes, promising initiatives can improve rural health.

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  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • Awards

    NIHCM Foundation hosted the 25th Annual NIHCM Awards at the Organization of American States in Washington, D.C. to recognize outstanding health care research and journalism.

    Press Release Winners Finalists
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

November 18, 2019
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Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar will explore how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
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Meeting the Demand for Primary Care: Nurse Practitioners Answer the Call

John Iglehart, Founding Editor, Health Affairs

Rapidly expanding insurance coverage and a growing and aging population are increasing the demand for health care services and the personnel who provide them. Despite a robust increase in the supply of physicians following unprecedented increases in medical school capacity in recent years, the Association of American Medical Colleges (AAMC) still projects a shortage of 130,000 physicians by 2025, split almost equally between primary and specialty care.1 At the same time, delivery and payment system reforms may already be changing the mix of personnel needed to respond to the rising demand for health care services. In this essay I consider the potential role that nurse practitioners (NPs) can play in supplementing physician supply, describing trends in the profession and developments related to state laws regulating their scopes of practice (SOP).

Nurse Practitioners "On the March"

Nurse practitioners are one of several types of personnel considered to be advanced practice registered nurses (APRNs); nurse anesthetists, nurse midwives, and clinical nurse specialists are also APRNs. The vast majority of current NPs hold a master’s degree (86 percent) or a doctorate (5 percent) in nursing. As of 2012, there were an estimated 154,000 licensed NPs in the U.S., 127,000 of whom were providing patient care. Slightly under half of those worked in primary care.2 Over the past decade, the annual number of NP graduates more than doubled to reach 14,400 graduates in 2012, and continued growth is expected. One study projects a near doubling of the total NP workforce by 20253 while another predicts the number of NPs providing primary care will increase by 30 percent by 2020.4

The shorter and less costly training pipeline for NPs relative to physicians, combined with evidence that NPs provide high quality care and achieve high patient satisfaction,5,6,7 argue in favor of the profession’s ability to quickly and effectively meet growing demand for health care services. Numerous provisions of the Affordable Care Act – including grants for nurse-managed clinics, significant financial support for NP training, and emphasis on team-based models of care – clearly envision NPs as an integral part of the future health care workforce. Recent evidence points to consumer acceptance of NPs,8 and the profession has strong backing from influential consumer advocates, including the AARP and the Robert Wood Johnson Foundation. Major corporations are also relying on NPs to staff their expanding networks of retail health clinics.

Despite this momentum, however, the efforts of NPs have been stymied in some states by laws preventing them from providing all services they are trained to provide and by requirements for physician oversight. Reflecting long-simmering disputes over “turf” and citing concerns about patient safety and quality of care due to the shorter training period, the American Medical Association (AMA), the American Academy of Family Physicians and their allies oppose SOP expansions and advocate that NPs should provide primary care within the construct of a patient-centered, physician-led team.

The Move to Expand Scopes of Practice

SOP battles are playing out across the country. The National Conference of State Legislatures reports that 100 bills related to NP scope of practice were introduced in 22 states between 2011 and mid-2013, with about one-quarter enacted. The combatants spend enormous sums of energy, money and time arguing their cases before state legislatures at a time when, ironically, collaborative care is seen as the goal at the practice level.

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Events

November 18, 2019
alliance-image-111819

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar will explore how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
aces-in-the-news 4

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

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Investigator-Initiated Research Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. A small number of applicants will be invited to submit a full proposal in September.

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Awards

Winners Named in the 25th Annual Research and Journalism Awards

Winners Announcment 2018 1

Congratulations to all of the winners of the 25th Annual NIHCM Foundation Research and Journalism Awards! The winners and finalists were honored at a banquet in Washington, DC, in May.

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