U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376
by HRSA Administrator Mary K. Wakefield, PhD, RN
February 2, 2012
The White House
Good morning! It’s nice to see all of you and to have the opportunity – particularly as a nurse colleague – to be with you again. A lot has happened at HRSA in the year since I last spoke to you, and I’ll go into detail about it in a few minutes.
But one thing has stayed the same over the past year. And that is President Obama’s recognition of nurses as a source of expertise to help guide key health care programs and policies. That recognition is reflected not only in my position as head of HRSA but also in his recent appointment of Marilyn Tavenner, a nurse, as acting administrator of the Centers for Medicare and Medicaid Services. And it’s reflected over and over in the provisions of the Affordable Care Act.
I’m also proud to tell you that among the nurses contributing to health care programs and policy are black nursing leaders that have joined HRSA’s top ranks over the past year. They are:
- Michelle Allender-Smith, RN, who directs of HRSA’s Office of Health Equity;
- Dr. Alexis Bakos, RN, PhD, deputy director of our Division of Nursing;
- Juliette Jenkins, RN, MSN, the deputy director of the Division of Medicine and Dentistry; and
- Dr. Shanita Williams, RN, PhD, chief of our Nursing Diversity and Development Branch in the Bureau of Health Professions.
We’re working across HRSA to expand diversity, not just in terms of ethnic and racial background but in clinical experience, too. So we are proud to have added these four women leaders to our team.
I also want to call out our director of the Division of Nursing, Dr. Julie Sochalski. I’m so appreciative of both Julie’s and Alexis’ commitment and expertise at the helm of HRSA’s nursing workforce programs. And I want you all to know that we always have opportunities at HRSA. We need – and want – the best experts we can find to help meet the agency’s mission.
Well, today I want to talk about the Affordable Care Act’s impact on nursing from my perspective as HRSA administrator. Mayra Alvarez will speak to you later about the many ways the ACA is improving health care for all Americans, so I want to focus on the law’s impact at HRSA.
The Affordable Care Act codifies nursing’s value by expanding primary and preventive care programs in which nurses play a vital role; by crafting new roles for advanced practice nurses in delivering that care; and by boosting funds for nurse education and training.
In two HRSA programs – health centers and the National Health Service Corps – the ACA made enormous new investments intended to expand access to primary and preventive health care in communities that need it most. And there’s a lot of need out there: according to a recent Gallup survey, more than 50 million Americans still have no health insurance.
To help address that head on, in 2010 HRSA’s health center network delivered primary and preventive care – including oral and behavioral health care – to 19.5 million patients at more than 8,500 sites. As you probably know, health centers are an essential part of the national health care safety net because they serve anyone who walks in, whether they have health insurance or not.
Since the start of 2009, the number of health center patients has grown by 2.4 million, in large part because of investments from the Recovery Act and the Affordable Care Act. The ACA invests $11 billion over five years to support and expand health center operations.
Nurses are an important component of the health center workforce. Right now about 16,000 nurses – including 4,300 in advanced practice – work at health centers. Since 2008, health centers have added about 3,000 nurses, including 800 in advanced practice. Again, that occurred because of the Recovery Act and ACA investments.
With ACA funding continuing through FY 2014, the number of nurses almost certainly will grow. So when I look to nursing’s future, I look to health centers as a critical opportunity for our profession.
Our National Health Service Corps places primary care providers in underserved areas for at least two years in exchange for paying down their student loans. Eligible providers include advanced practice nurses, certified nurse midwives and others. The ACA allocated $1.5 billion over five years to grow the NHSC, whose members represent a crucial staffing resource for health centers.
As of now, the number of NHSC clinicians has reached 10,000, almost three times the number when President Obama took office. Over that same period, the number of nurse practitioners in the Corps has more than doubled to 1,750, with 260 of them self-reporting as black/African American – that’s 15 percent of all nurse practitioners.
And of the total Corps field strength of 10,000, more than 1,200 self-reported as black/African American – the same percentage as African Americans in the general population. The NHSC is a critically important program that supports health professionals in paying down their debt while ensuring access to top-flight clinicians for people who need it most.
Just recently we made a policy change in the Corps to encourage clinicians to practice in areas that really need their help. Health professionals who work in the neediest areas (HPSA score of 14 or higher) now qualify for up to $60,000 in annual loan repayments; those who work in less-needy areas qualify for up to $40,000 in loan repayments.
The Corps is a great opportunity for health professionals who want to pay off their loans and practice in underserved communities. To learn more about the benefits of joining the NHSC, please go to www.nhsc.hrsa.gov and take a minute to look around. We’re also on Facebook at nationalhealthservicecorps – one word – to take questions and to share stories from the field.
The expansion in health centers and the NHSC mean greater access to primary and preventive care for communities and populations that need it most. We know that non-Hispanic blacks have higher rates of heart disease, stroke, asthma and diabetes than non-Hispanic whites. The Affordable Care Act is a vitally important tool to eliminate these disparities in health outcomes and, from my vantage point, any achievement short of that isn’t good enough. It’s one of the reasons this law is so important.
The Affordable Care Act also created a new, five-year, $1.5 billion program that assigns considerable responsibility – and new opportunities – to nurses: the Maternal, Infant, and Early Childhood Home Visitation Program. In 2009 the infant mortality rate among infants born to black women (including Hispanics) was 2.4 times higher than for non-Hispanic white women. America is long overdue for a program like this.
Under the Home Visiting program, nurses, social workers and others visit pregnant women, young children and their families in high-risk communities. There, they provide counseling and intervention services that – based on evidence – are known to have improved health outcomes.
Last year, the Home Visiting program got fully under way, and in September HRSA announced the award of $224 million to state agencies to implement it. States use most of the funds to implement one or more of nine evidence-based home visiting models.
To date, 29 states have selected Nurse-Family Partnerships – one of the nine models – as the basis for their work. Nurse-Family Partnerships are a tested, proven, nurse-led home visiting model that partners low-income, first-time moms with maternal and child health nurses. The ACA, then, has facilitated nurses’ ability to contribute even more directly to the health of families and communities.
The Affordable Care Act also values nurses’ role in delivering primary health care by investing in a variety of nurse-training and education programs that HRSA administers.
For example, the Act directs $15 million for Nurse-Managed Health Clinics, which are run by advanced practice nurses and affiliated with schools of nursing. These clinics provide training opportunities for nurses while delivering community-based, primary care to vulnerable populations, like public housing residents.
Earlier I mentioned the ACA’s expansion of the health center system. Included in the overall funding is an investment of $200 million to expand school-based health centers, which allow even the most disadvantaged kids to get care before major health problems take root. Nurses, of course, are the backbone of school-based care.
In addition, HRSA’s Nursing Education Loan Repayment Program has seen its budget more than double since 2009 to almost $94 million today. Under this program, RNs who opt to work for two years in a facility with a critical nursing shortage can get 60 percent of their education debt paid off.
And HRSA has just taken steps to ensure that more nurse practitioners take advantage of the loan repayment program. In December we released guidance for the program’s operation in FY 2012. One part of that guidance reserves 50 percent of available 2012 funds to repay the loans of nurse practitioners. We took this step in direct response to HHS Secretary Kathleen Sebelius’ determination to strengthen access to primary care.
The application cycle for these loans is open until February 15. To find out more about this opportunity, go to www.hrsa.gov and type in the name of the program in the search block: “nursing education loan repayment.” That will take you to a site that explains how to qualify.
The ACA also provided $31 million to 26 schools of nursing to boost the number of nurse practitioners and nurse midwives by 600 over five years, again emphasizing the critically important role that those two professions play in expanding primary health care.
Yet another program created under the Act – the Medicare Graduate Nursing Education Demonstration Program – will increase the number of advanced practice nurses with skills in chronic care management and care coordination.
Regarding the ACA, there’s a great Website that will keep you up-to-date with everything we’re doing in the Administration to implement its many provisions. It’s called www.healthcare.gov. I urge you to bookmark that site and go there often.
Another site I want to mention lets you track what HRSA is doing in your area to improve health care. It’s called “HRSA in Your State” and you can access it off the HRSA home page. You’ll find that Website useful because it contains information on HRSA programs and HRSA grants awarded in your state, down to the county level.
Just now I mentioned care coordination. It’s a topic that receives special focus in the ACA. The law recognizes that better care coordination is at the core of efforts to improve health care quality and safety – and it’s an intervention that nurses have been leaders on.
The ACA’s emphasis on team-based care comes from a realization that the way health care is currently delivered results in compromised care quality. As Secretary Sebelius told the Senate Finance Committee last year:
“Too often, health care takes place in a series of fragments or episodes. We need to make it possible for entirely new levels of seamlessness, coordination, and cooperation to emerge among the people and the entities that provide health care.”
The Secretary clearly knows what nurses know: there are gaps in health care between settings and among health care providers. And these gaps put the health of patients at risk while driving inefficiency and increasing costs.
Our view at HRSA – with our responsibility for many health workforce programs – is that we can help resolve the problem the Secretary identified by changing the way we educate and deploy our health care workforce. In the Obama administration, HRSA has become deeply involved in efforts to join with partners across the health care spectrum to push forward the concept of “interprofessional education.”
For more than a year now, HRSA has partnered with health-related foundations and experts from government and academia to promote team-based care. Last May we announced the creation of a set of interprofessional competencies to be disseminated for use in health professions education and practice.
We’re already taking steps to promote interprofessional education in two of our nursing programs. As of this fiscal year, 2012, both our Nurse Education, Quality, Practice and Retention Program and our Advanced Nurse Education Program will support grant proposals that help to develop interprofessional education and practice.
Before I close, let me tell you briefly about three things that may help you in your daily work by helping populations with whom you engage, or help the organizations you work for compete for HRSA grants.
For those of you who work with expectant mothers, I want to make sure you know about HRSA’s partnership with the National Healthy Mothers, Healthy Babies Coalition and other groups to provide new moms with free text messages reminding them to take care of their health and give their babies the best start in life.
Called Text4Baby, the service sends brief texts three times a week to expectant mothers who might otherwise be hard to reach – but who always have their cell phones handy. Text4Baby is an ingenious use of resources and technology, and its usefulness to young African American mothers is evident: non-Hispanic black women are less likely to receive prenatal care beginning in the first trimester than non-Hispanic white women. To sign up for texts, go to: www.text4baby.org.
And for those of you who work with HIV/AIDS patients, last year we released our Guide for HIV/AIDS Clinical Care, which you can access free from the website of our HIV/AIDS Bureau by going to www.hrsa.gov. The manual gives HIV/AIDS clinicians ready access to practical, current treatment information on caring for people living with HIV. It was written and edited by experts from HRSA’s Ryan White HIV/AIDS Program, and it reflects the broad clinical expertise that we’ve developed through the program’s 20-plus years of existence.
We’ve also been very busy recently working to inform the broadest array of people and groups on what they need to do to win HRSA’s competitive grants. About two years ago, I launched the HRSA Technical Assistance Outreach Initiative to target grant information to new applicants and, especially, to organizations in minority communities and underserved areas.
To reach the most people as efficiently and as cheaply as possible, we use Webcasts to get the word out. This past December we began hosting the Webcasts, which covered topics like responding to funding opportunity announcements; how to write and submit good grant proposals; and how to be part of HRSA’s objective review process. On that last topic, let me say that HRSA is always seeking grant reviewers. It’s a great way to incorporate new perspectives into our grants review discussions, and participants learn first-hand how grants are evaluated and scored.
Well, let me tell you, we’ve been gratified by the response to our Webcasts. Hundreds of people tuned in to each one, and hundreds more have gone to the presentations we archived on the HRSA website to learn how to apply for and win HRSA’s competitive grants.
Also: Shanita Williams, whom I mentioned in my opening remarks, will attend at your annual meeting in July in Orlando to host a grants workshop for attendees. So look for her there.
Let me wrap up by asking you to help our Division of Nursing review its Nursing Workforce Diversity portfolio. We want our nursing programs to promote greater participation by underrepresented minorities in the workforce, and we invite you advise us on what we should be doing to ramp up the number of minority nurses. Alexis or Julie from the Division of Nursing will be happy to hear from you.
I thank you for the invitation to be with you today, and now I’ll be happy to answer any questions you may have.
