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Workforce Composition, Development, and Distribution

Indian Health Service Programs:  A Retention Analysis, 3/13/2018

This study expanded upon the analysis of the National Health Service Corps (NHSC) begun in “Provider Retention in High Need Areas” and continued in “The National Health Service Corps:  An Extended Analysis” by using the same techniques used in these earlier studies to examine retention patterns in Indian Health providers.  The study found that approximately 81% of the Indian Health Service (IHS) program participants served in the same Indian/Tribal/Urban (I/T/U) site one year after completion of their service obligation.  Their retention in the same site where they practiced while in IHS service remained high in the following years: 75% after 2 years, 65% after 3 years, but dropped in the 4th year after obligation completion to about 50%.  Some of the IHS participants who stopped serving in the same site after obligation completion moved to other I/T/U sites, such that the retention of IHS participants in any I/T/U site was, respectively: 90%, 87%, 85% and 76% in each of the 4 years after obligation completion.  Retention of program participants was more likely to be higher in sites that offered a larger array of services, and/or were located in more urban or more easily accessible areas. 

While the Indian Health Service loan and scholarship programs provide significant benefits to their participants, the high retention rates illustrate the value of this program to the Indian healthcare system as a whole.

The National Health Service Corps:  An Extended Analysis, 1/17/2017

This study continued the analysis of the National Health Service Corps (NHSC) begun in “Provider Retention in High Need Areas.”  It’s objectives were to examine recent retention trends of NHSC program alumni in HPSAs (more frequent moves from “same HPSA” to any HPSA” than previous study); analyze the retention patterns of those NHSC participants who served in Indian Health Service sites and compare them with that of all NHSC participants (retention in “same HPSA” and “any HPSA” similar to overall NHSC), and examine the recruiting and retention effects.  Estimates of recruiting and retention effects indicated substantial increases in the number of FTE-years generated by NHSC in HPSAs.

This report laid the groundwork for examination of retention of providers in Indian/Tribal/Urban (ITU) sites which took place the following year.

Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform, 1/13/2016

Community Health Workers (CHWs) can provide cost-effective, high quality, and culturally competent health services within team-based care models.  This report reviewed health services research findings on utilization of CHWs.  The report found that the apparent benefits of integrating CHWs into health care teams appeared to depend on context with the strongest evidence supporting use of CHWs to deliver deliver certain specific, high-value, preventive services to low-income, minority or other underserved populations.  The report also found that questions remained with regards to standardizing CHW training, certification, and licensure; establishing strong economic and other evidence to support their use; and securing reimbursement for their services to ensure financial sustainability of CHW programs.

Impact of State Scope of Practice Laws and Other Factors on the Practice and Supply of Primary Care Nurse Practitioners, 12/30/2015

This study assessed individual and state-level factors affecting decisions by Nurse Practitioners (NPs) about whether to practice in primary care.  Of particular interest was the impact of state scope of practice (SOP) requirements on elements of NP practice such as patient load, the flow of patient care, and the management of a patient panel decision.  Results of this study suggested that SOP is an important driver of many practice outcomes for NPs.  Both practice authority and prescriptive authority had independent and cumulative effects on the decision to practice in patient care.  For most outcomes, significant effects were found only among NPs working in states with both full practice and full prescriptive authority.  However, the strongest predictor for most outcomes was the rurality of NP’s practice location.  The analysis did not find evidence that states liberalizing their SOP over time experienced larger growth in the share of claims billed by NPs.

Health Practitioner Bonuses and Their Impact on the Availability and Utilization of Primary Care Services, 1/1/2015

This study examined the impact of three provider incentive payments: the Affordable Care Act Primary Care Incentive (PCIP), the short-lived Physician Shortage Area payment, and the Health Professional Shortage Area incentive payment on the availability of primary care practitioners and primary care services.

The study focused on the Medicare PCIP which increased the number of Medicare primary care providers by an average of 2.8 per county.  Also, the number of primary care physicians with a bonus eligible specialty increased by approximately 10 percent.  There were more PCIP eligible claims per provider for one type of claim: the 25-minute visit for established patients.  This was especially true of allowed charges for the eligibility threshold.  While there was no significant incentive payment impact on allowed charges for the full sample of providers, for those who were near the PCIP eligibility threshold in 2009, increased charges of about $5600 annually were found in response to the policy.  The study also modeled a fourth incentive payment, the ACA provision that for the years 2013 and 2014 primary care physicians providing Medicaid services be paid at no less Medicare rates.  The PCIP expired at the end of 2015.

Provider Retention in High Need Areas, 12/22/2014

This study was the first in a series of ASPE reports that examined retention of providers who had received scholarship or loan forgiveness in exchange for service in high need areas.  Using a variety of data sources, this report examined retention of National Health Service Corps (NHSC) personnel in Health Professional Shortage Areas (HPSAs) following completion of service obligations over time.  It examined retention patterns by discipline and by demographic characteristics.  It also compared NHSC retention in high need areas to retention of similar providers who had not received this incentive.  The study found that NHSC participants had a high rate of retention in HPSAs (although not necessarily the same one) over time, HPSA retention rose with age and local characteristics, but differences by gender, discipline, and Census division were small.  Further, regression analyses suggested that providers select into HPSAs based on their preferences for serving underserved populations.  In addition to the useful information this study provided about the NHSC, its methods have been used in subsequent retention studies supported by ASPE.