FACT SHEET: Creating Health Care Jobs by Addressing Primary Care Workforce Needs

Primary care providers are critical for ensuring better coordinated care and better health outcomes for all Americans. To meet the health needs of Americans, the Obama Administration has made the recruitment, training and retention of primary care professionals a top priority. 

Expanding the Primary Health Care Workforce

Together, the Affordable Care Act, the American Recovery and Reinvestment Act of 2009 (Recovery Act), and ongoing federal investments in the health care workforce have led to significant progress in training new primary care providers – including physicians, nurse practitioners and physician assistants – and encouraging primary care providers to practice in underserved areas, including:

• Nearly Tripling the National Health Service Corps in Three Years:  By 2011, more than 10,000 doctors, nurses and other health care providers were caring for Americans in communities nationwide, thanks to investments over the past three years in the National Health Service Corps (NHSC) through the Affordable Care Act, the Recovery Act and annual appropriations. The NHSC has awarded nearly $900 million in scholarships and loan repayment to health care professionals to help expand the country’s primary care workforce and meet the health care needs of communities across the country. In 2008, approximately 3.7 million patients were provided service by 3,600 National Health Service Corps providers.  In 2011, with field strength of more than 10,000 clinicians, the NHSC provided health care services to about 10.5 million patients.
• Training New Primary Care Providers: The Affordable Care Act invests in the training of new primary care providers, including providing nearly $230 million to increase the number of medical residents, nurse practitioners and physician assistants trained in primary care.  With these investments, by 2015, more than 1,700 new primary care providers will have been trained and enter primary care practice. The President’s Fiscal Year 2013 budget includes $677 million, an increase of $49 million over FY 2012, within the Health Resources and Services Administration to expand the capacity and improve the training and distribution of primary care, dental, and pediatric health providers. The Budget will support the placement of more than 1,500 new primary care providers in underserved areas and begin investments that expand the capacity of institutions to train 2,800 additional primary care providers over five years.
• Training Physicians in Community-Based Settings: The Affordable Care Act created the Teaching Health Center Program to help move primary care training into community-based settings. The five-year investment in this program is expected to supportthe community-based training of over 600 new primary care physician residents by 2015. 
• Supporting Mental Health Training: Mental health issues rank in the top five chronic illnesses in the United States. In Fiscal Year 2012, the Affordable Care Act will invest $10 million to support training to help close the gap in access to mental and behavioral health care services by increasing the number of adequately prepared mental and behavioral health providers.
• Expanding Residency Slots for Primary Care: To encourage more medical residents to pursue careers in primary care, the Affordable Care Act redistributes unused residency positions and directs those slots for the training of primary care physicians. In distributing the residency slots, priority for awarding residents is given to hospitals that have rural training tracks, train residents in geriatrics, use the additional slots to create or expand a primary care program, demonstrate focus in training residents to pursue careers in primary care, or are located in a primary care health professional shortage area.
• Expanding Training of Advanced Practice Nurses: The Affordable Care Act allows up to five hospitals to receive $50 million each year, for fiscal years 2012 to 2015, to train advanced practice nurses, including nurses in community-based settings through the Centers for Medicare and Medicaid Services. 

Modernizing Primary Care Training and Practice

Implementation of the Affordable Care Act provisions is strengthening the primary care training infrastructure, creating new primary care clinical training opportunities, and supporting primary care practice. These efforts include:

• Encouraging Physician Training in the Community: The Affordable Care Act provides incentives for hospitals to train primary care physicians in the community by providing flexibility in Medicare residency training requirements. Prior to the law, hospitals had to bear the cost of education in non-hospital sites, often by paying both the resident’s and teaching physician’s salary. This requirement discouraged training in community settings, which encourages primary care practice. The Affordable Care Act changed this policy and requires hospitals to only pay the resident salaries.
• Encouraging Health Homes:  Under the Affordable Care Act, States are incentivized to create Medicaid “health homes” for individuals with chronic health conditions. Health homes encourage the use of primary care providers to provide integrated care to help patients better manage their health. States that create health homes will receive enhanced federal matching funds for care coordination services for the first eight quarters a health home state plan amendment is in effect.

Modernizing Payment and Improving Financial Incentives for Coordinated Care

• Creating Primary Care Payment Incentives:  The Affordable Care Act authorizes a ten percent Medicare payment bonus from 2011 to 2015 for physicians who specialize in family medicine, internal medicine, geriatric medicine, or pediatric medicine, nurse practitioners, clinical nurse specialists, or physician assistants for whom primary care services account for at least 60 percent of their Medicare allowed charges. The Affordable Care Act also increases primary care physician payment rates in the Medicaid program to match Medicare payment levels in 2013 and 2014. 
• Realigning financial incentives in Accountable Care Organizations (ACOs):Under old payment systems, care coordination – the hallmark of effective primary care – wasn’t rewarded financially. Medicare’s shared savings program changes that model by rewarding physicians and other primary care practitioners for high-quality care and preventing the need for care in the first place. Already, 27 ACOs have joined the program and over 150 more potential ACOs have submitted an application. CMS has also created two demonstration programs to supplement the shared savings program: the Pioneer ACO initiative for 32 large and experienced health systems ready to move into accountable care quickly; and the Advanced Payment ACO, for smaller practices that need help with startup costs. Together, these initiatives are improving primary care for 1.1 million people with Medicare.
• Innovation Center: The Center for Medicare & Medicaid Innovation has launched 16 initiatives involving over 50,000 health care providers that will touch the lives of Medicare and Medicaid beneficiaries in all 50 States. Many of those are explicitly designed to promote primary care.
  • Comprehensive Primary Care Initiative Demonstration: A public-private partnership to enhance access to primary care services by establishing medical homes supported by multiple payers. Funding of up to $322 million is available to support 75 practices in 5-7 States starting this year.
  • Federal Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration: This initiative makes almost $50 million available to support 500 FQHCs in 44 States with care coordination payments that will allow the Centers to become medical homes, the hub of a patient’s primary care needs. This initiative started in 2011.
  • Multi-payer Advanced Primary Care Practice Demonstration: This initiative, launched in 2011, is a State-led, multi-payer collaboration to help primary care practices transform into medical homes. It makes $283 million available in 8 States.
  • Independence at Home: This initiative supports home-based care for patients with multiple chronic conditions that would benefit from primary care coordination. It provides up to $15 million to support up to 50 practices and will launch later this year.

President Obama Announces More Key Administration Posts

WASHINGTON, DC – Today, President Barack Obama announced his intent to nominate the following individuals to key Administration posts:

• Jay N. Anania – Ambassador to the Republic of Suriname, Department of State
• Gene A. Cretz – Ambassador to the Republic of Ghana, Department of State
• Susan Marsh Elliott – Ambassador to the Republic of Tajikistan, Department of State
• David J. Lane – Rank of Ambassador during his tenure of service as the United States Representative to the United Nations Agencies for Food and Agriculture, Department of State
• Charles P. Rose – Member, Board of Trustees of the Morris K. and Stewart L. Udall Foundation

The President also announced his intent to appoint the following individual to a key Administration post:

• Carol W. Greider – Member, President’s Committee on the National Medal of Science

President Obama said, “I am honored that these talented individuals have decided to join this Administration and serve our country.  I look forward to working with them in the months and years to come.”

President Obama announced his intent to nominate the following individuals to key Administration posts:

Jay N. Anania, Nominee for Ambassador to the Republic of Suriname, Department of State
Jay N. Anania, a career member of the Senior Foreign Service with the rank of Minister-Counselor, currently serves as Management Counselor at the U.S. Embassy in Baghdad.  From 2009 to 2011, he served at the State Department as Executive Director of the Bureau of Near Eastern Affairs and the Bureau of South and Central Asian Affairs.  From 2006 to 2009, Mr. Anania was the Minister-Counselor for Management Affairs at the U.S. Embassy in Berlin, where he served for seven months as Acting Deputy Chief of Mission.  Prior positions in Washington include Acting Chief Information Officer in the Bureau of Information Resource Management (2005-2006) and Director of the Office of Management Policy (2002-2005).  Additional overseas posts include assignments at the U.S. Consulates General in Hong Kong and Tijuana, Mexico; U.S. Embassies in Jordan and the United Arab Emirates, and at the U.S Interests Section in Havana, Cuba.  Mr. Anania holds a B.A. from Kenyon College and an M.B.A. from the University of North Carolina, Chapel Hill.

Ambassador Gene A. Cretz, Nominee for Ambassador to the Republic of Ghana, Department of State
Ambassador Gene A. Cretz, a career member of the Senior Foreign Service with the rank of Minister-Counselor, is currently the U.S. Ambassador to Libya.   In 2008, Ambassador Cretz served as Deputy Assistant Secretary of State in the Bureau of Near Eastern Affairs.  From 2004 to 2007, he was the Deputy Chief of Mission at the U.S. Embassy in Tel Aviv.  From 2003 to 2004, he was assigned to the U.S. Embassy in Damascus where he served as Deputy Chief of Mission and Charge d’Affaires.  From 2001 to 2003, he was Minister-Counselor for Economic and Political Affairs at the U.S. Embassy in Egypt.  Other overseas assignments include service in Beijing, New Delhi, and Islamabad.  Assignments in Washington include State Department posts in the Bureau of International Organizations, the Operations Center, and in the Bureau of Near Eastern Affairs.  From 1975 to 1977, Ambassador Cretz served as a Peace Corps Volunteer in Afghanistan.  He received a B.A. from the University of Rochester and a M.Sc. from the State University College at Buffalo.

Susan Marsh Elliott, Nominee for Ambassador to the Republic of Tajikistan, Department of State
Susan Marsh Elliott, a career member of the Senior Foreign Service with the rank of Counselor, currently serves as Deputy Assistant Secretary in the Bureau of South and Central Asian Affairs at the Department of State.  Prior to this role, Ms. Elliott served as Minister-Counselor for Political Affairs at the U.S. Embassy in Moscow (2009-2010) and as Principal Officer at the U.S. Consulate General in Belfast (2007-2009).   Other assignments have included Deputy Executive Secretary (2005-2007), Office Director of the Executive Secretariat Staff (2003-2005), Visa Section Chief at the U.S. Embassy in Athens (2001-2003), Deputy Economic Counselor at the U.S. Embassy in Athens (1999-2001), and Desk Officer in the Office of the Coordinator for Regional Conflicts in the New Independent States (1994-1995).  Ms. Elliott joined the Foreign Service in 1990 after serving as a nurse at the U.S. Embassy in Tegucigalpa.  Ms. Elliott received a B.S. from Skidmore College, an M.S. from Russell Sage College, and a D.S.N. from Indiana University.

David J. Lane, Nominee for the rank of Ambassador during his tenure of service as the United States Representative to the United Nations Agencies for Food and Agriculture, Department of State
David J. Lane currently serves as Assistant to the President and Counselor to the Chief of Staff at the White House.  From 2007 to 2011, he was President and Chief Executive Officer of ONE.  Prior to joining ONE, Mr. Lane was the Director of Public Policy and External Affairs and Director of the East Coast Office for the Bill & Melinda Gates Foundation.  From 1993 to 2000, he served in a number of senior positions in the federal government, including Executive Director of the National Economic Council at the White House and Chief of Staff to the U.S. Secretary of Commerce.  He received a B.A. from the University of Virginia and an M.P.A. from the Woodrow Wilson School at Princeton University.

Charles P. Rose, Nominee for Member, Board of Trustees of the Morris K. and Stewart L. Udall Foundation
Charles P. Rose is a partner at the law firm of Drinker Biddle & Reath LLP, where he focuses on representing businesses, educational institutions, and Indian tribal governments in labor and employment matters, education law and regulatory compliance.  Mr. Rose was General Counsel of the U.S. Department of Education from 2009 until 2011, where he also served as the Secretary's designee to the Board of Trustees of the Udall Foundation.  Before joining the Department of Education, he was a founding partner of Franczek Radelet PC in Chicago.  Mr. Rose is a member of the Board of Directors of the Alliance for Excellent Education, a member of the National Association of College and University Attorneys, and a member of the National and Illinois Councils of School Attorneys.  He was a founding member of the Board of Directors of Advance Illinois and formerly served on the Chicago Advisory Board of Facing History and Ourselves.  Mr. Rose received the Illinois Association of School Administrators Exemplary Service to Education Award in 2011 and Champion of Public Education Award from FED-ED in 2009. He was elected as Fellow of the College of Labor & Employment Lawyers in 2008 and received the Vision in Education Award from ED-RED in 2006.  Mr. Rose received a B.A. in Economics from Villanova University and a J.D. from DePaul University.

President Obama also announced his intent to appoint the following individual to a key Administration post:

Dr. Carol W. Greider, Appointee for Member, President’s Committee on the National Medal of Science
Dr. Carol W. Greider is the Daniel Nathans Professor and Director of Molecular Biology and Genetics at the Institute for Basic Biomedical Sciences at the Johns Hopkins University School of Medicine.  In 2009, Dr. Greider won the Nobel Prize in Medicine with Drs. Elizabeth Blackburn and Jack Szostak for their work on telomeres as well as telomerase, an enzyme that maintains chromosome ends, which Drs. Greider and Blackburn discovered in 1984.  Before working at Johns Hopkins, Dr. Greider joined Cold Spring Harbor Laboratory as a Fellow in 1988 and served as an Investigator from 1994 to 1997.  Dr. Greider received a B.A. in Biology from the University of California, Santa Barbara, and a Ph.D. in Molecular Biology from the University of California, Berkeley.

Statement by the Press Secretary on the Situation in Bahrain

The United States continues to be deeply concerned about the situation in Bahrain, and we urge all parties to reject violence in all its forms.  We condemn the violence directed against police and government institutions, including recent incidents that have resulted in serious injuries to police officers.  We also call on the police to exercise maximum restraint, and condemn the use of excessive force and indiscriminate use of tear gas against protestors, which has resulted in civilian casualties.

We continue to underscore, both to the government and citizens of Bahrain, the importance of working together to address the underlying causes of mistrust and to promote reconciliation.  In this respect, we note our continued concern for the well-being of jailed activist Abdulhadi Al-Khawaja and call on the Government of Bahrain to consider urgently all available options to resolve his case.  More broadly, we urge the government to redouble its ongoing efforts to implement the recommendations of the Bahrain Independent Commission of Inquiry, and renew our call for the government, opposition parties, and all segments of Bahraini society to engage in a genuine dialogue leading to meaningful reforms that address the legitimate aspirations of all Bahrainis.

America's Nurses Join Forces with the First Lady and Dr. Biden to support Veterans and Military Families

3 million nurses, through 150 nursing organizations and 500 nursing schools will be educated on Post-Traumatic Stress Disorder (PTSD) & Traumatic Brain Injury (TBI) in the coming years

Today at the University of Pennsylvania, home to one of America’s top Nursing Schools, First Lady Michelle Obama and Dr. Jill Biden will announce a commitment from nurses across the country eager to serve our veterans and military families as well as they have served us. In a broad, coordinated effort, more than 150 state and national nursing organizations and over 500 nursing schools have committed to further educate our nation’s 3 million nurses so they are prepared to meet the unique health needs of service members, veterans, and their families. Led by the American Nurses Association, American Academy of Nurse Practitioners, American Association of Colleges of Nursing, and the National League for Nursing, in coordination with the Departments of Veterans Affairs and Defense, nursing organizations and schools have committed to educating current and future nurses on how to recognize and care for veterans impacted by post-traumatic stress disorder, traumatic brain injury, depression, and other combat-related issues, in ways appropriate to each nurse’s practice setting. 

“Whether we’re in a hospital, a doctor’s office or a community health center, nurses are often the first people we see when we walk through the door. Because of their expertise, they are trusted to be the frontline of America’s health care system,” said First Lady Michelle Obama. “That’s why Jill and I knew we could turn to America’s nurses and nursing students to help our veterans and military families get the world-class care that they’ve earned. It’s clear from today’s announcement that the nursing community is well on its way to serving our men and women in uniform and their families.”

“Nurses are at the center of providing lifesaving care in communities across the country -- and their reach is particularly important because our veterans don't always seek care through the VA system,” said Dr. Jill Biden. “This commitment is essential to ensuring our returning service men and women receive the care they deserve.”

“Nurses of every generation have cared for men and women suffering the visible and invisible wounds of war. Today, there are new, evidence based strategies and treatments for PTSD and TBI – and new hope. The American Nurses Association is coordinating the engagement of more than 500 nursing schools and more than 160 nursing organizations to reach every nurse in the country -- 3.1 million nurses.  Some military service members, veterans and their families may avoid seeking care for TBI, PTSD and post combat depression because of a stigma, or because they live far away from military or veterans’ health care facilities.  We want to change that, and ensure that nurses in every community have access to the most current, evidence based treatments and resources on PTSD and TBI,” said Amy Garcia, American Nurses Association Chief Nursing Officer.

The invisible wounds of war, Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI), have impacted approximately 1 in 6 of our troops returning from Afghanistan and Iraq – more than 300,000 veterans. And since 2000, more than 44,000 of those troops have suffered at least a moderate-grade traumatic brain injury. 

Veterans seeking care within the Veterans Affairs (VA) health system are often treated by health care professionals who have received extensive training in mental health issues.  But the majority of veterans in the country seek care outside of the VA system -- they usually visit their local hospital staffed by nurses and doctors in their communities. That’s why today’s announcement will be so significant for our troops and their families. America’s nurses are trusted partners in providing lifesaving and life-sustaining care in nearly every community and every setting where health care is delivered. They can make a dramatic and positive impact on the long-term health of hundreds of thousands of veterans. And they are eager to understand the needs of those who have served, to recognize the warning signs of posttraumatic stress disorder, depression, or suicide, and to know where to send them for help.

Nursing leaders have also committed to disseminating effective models for care and to sharing the most up-to-date information on these conditions across academic and practice settings.   By working to expand the body of clinical knowledge in this arena and by partnering with other health care providers and institutions, nursing leaders across the country will continue to advance high quality treatment for these conditions in every community. 

Key Commitments Include:

American Nurses Association (ANA): Commits to reaching 3.1 million registered nurses in America by 2015 to raise awareness of PTSD, TBI and depression among veterans, military service members, and their families.  The ANA is coordinating a major campaign involving over 150 nursing organizations that will reach millions of nurses on health issues relevant to veterans and their families. Partnering organizations include the American Association of Colleges of Nursing, American Organization of Nurse Executives, American Academy of Nurse Practitioners, American Psychiatric Nurses Association, American Association of Neuroscience Nurses, Association of Rehabilitation Nurses, the National League of Nurses, federal nurses of the military and public health services, and the Department of Veterans Affairs. Together with these partnering organizations, ANA will:
• Educate America’s future nurses to care for our nation's veterans, service members, and their families facing post-traumatic stress disorder, traumatic brain injury, depression, and other clinical issues;
• Enrich nursing education to ensure that current and future nurses are educated and trained in the unique clinical challenges and best practices associated with caring for military service members, veterans, and their families;
• Disseminate the most up-to-date information as it relates to traumatic brain injury (TBI) and psychological health conditions, such as post-traumatic stress disorder (PTSD);
• Grow the body of knowledge leading to improvements in health care and wellness for our military service members, veterans, and their families; and
• Lead and advance the supportive community of nurses, institutions, and health care providers dedicated to improving the health of military service members, veterans, and their families.

American Academy of Nurse Practitioners (AANP): AANP represents the interests of the more than 148,000 Nurse Practitioners across the country. It has reached out to its members through the creation of a unique Joining Forces section of their website, contacted all Nurse Practitioners and nursing organizations that are AANP group members to ask for their pledge in support of Joining Forces, asked state representatives to contact organizations in their state to render support, committed to publishing a special edition on veterans health in their journal, provided workshops to promote the wellness of veterans and caregivers at its conference, created continuing education programs focusing on issues facing veterans and military families, highlighted veterans’ health during Nurse Practitioners week, and supported research on veterans’ health through their foundation.  AANP has formed an ad hoc committee, composed of Veterans Affairs and Department of Defense leaders, to focus on promoting this initiative.
                                                                     
American Association of Colleges of Nursing (AACN): is making veteran health a priority issue through 2014 and beyond.  AACN is committed to working with the nation’s schools of nursing to promote curriculum integration, faculty development, and student clinical experiences focused on enhancing the care of veterans, service members, and their families. Building on its long history of raising curriculum standards and enhancing quality in nursing care, AACN will identify and showcase best practices in nursing education and disseminate information on curricular models to all schools of nursing through Webinars, conference programming, and our online Collaboration Community. In honor of National Nurses Week scheduled for May 6-12, 2012, AACN is offering a free Webinar series to commence work to support Joining Forces available at http://www.aacn.nche.edu/webinars.  Reflecting the theme of “Educating Future Nurses to Care for Veterans,” three individual Webinars are planned, including a showcase of the innovative work underway at several VA Nursing Academy sites related to veteran care and faculty development; a panel discussion on creative curriculum approaches to caring for veterans; and a special session on meeting the palliative care needs of veterans, which outlines AACN’s work with the City of Hope on the groundbreaking ELNEC-For Veterans initiative. 

The American Psychiatric Nurses Association (APNA): is committed to providing support to veterans and their families by providing educational resources to its more than 7,800 members as well as to all nurses across the country. APNA has created a website, www.apna.org/military that serves as a portal to a wide variety of information on posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The APNA Annual Conference and its Annual Clinical Psychopharmacology Institute, which together are attended by more than 1,500 nurses annually, will include sections dedicated to mental health issues that are military related. These courses will be converted to podcasts and made available via the APNA eLearning Center which can be viewed or downloaded from the APNA website.

Nursing Organizations
Over 150 state and national nursing organizations have committed to the following:
• Educating America’s nurses to care for our nation’s veterans, service members, and their families facing post-traumatic stress disorder, traumatic brain injury, depression, and other clinical issues;
• Enriching nursing education to ensure that current and future nurses are educated and trained in the unique clinical challenges and best practices associated with caring for military service members, veterans, and their families;
• Disseminating the most up-to-date information as it relates to traumatic brain injury (TBI) and psychological health conditions, such as post-traumatic stress disorder (PTSD);
• Growing the body of knowledge leading to improvements in health care and wellness for our military service members, veterans, and their families; and
• Leading and advancing the supportive community of nurses, institutions, and health care providers dedicated to improving the health of military service members, veterans, and their families.

See Addendum for list of nursing organizations that have made this commitment.

Nursing School Commitment
Over 500 nursing schools in all 50 states, DC, and Puerto Rico have committed by 2014 to:

• Educating America’s future nurses to care for our nation's veterans, service members, and their families facing post-traumatic stress disorder, traumatic brain injury, depression, and other clinical issues;
• Enriching nursing education to ensure that current and future nurses are trained in the unique clinical challenges and best practices associated with caring for military service members, veterans, and their families;
• Integrating content that addresses the unique health and wellness challenges of our nation’s service members, veterans, and their families into nursing curricula;
• Sharing teaching resources and applying best practices in the care of service members, veterans, and their families;
• Growing the body of knowledge leading to improvements in health care and wellness for our service members, veterans, and their families; and
• Joining with others to further strengthen the supportive community of nurses, institutions, and healthcare providers dedicated to improving the health of service members, veterans, and their families.

See Addendum for list of nursing schools that have made this commitment.