The United States Government Accountability Office (GAO) Dec. 18 released a report on providing Medicare graduate medical education (GME) funding for nurse practitioner (NP) and physician assistant (PA) graduate training. The report was requested as part of the Departments of Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill in 2018 (S. Rep. No. 115-150).

Specifically, GAO examined the possibility of diverting Medicare GME funding for medical residents to NPs and Pas. The report also provided limited estimates of NP and PA graduate training costs. GAO noted that some members of Congress suggested that “expanding the scope of the Medicare GME program to include NPs and PAs could help mitigate the effects of a physician shortage.”



GAO noted that Medicare GME would provide more stable funding for NP and PA graduates than current funding through various Health Resources and Services Administration (HRSA) grants. Stable funding, they stated, may enable NP and PA training programs to recruit additional preceptors, which may attract additional trainees.



The report also included a discussion of several challenges with providing graduate NP and PA training through the Medicare GME program. Some interviewees expressed concern that shifting Medicare GME funding to NPs and PAs without increasing overall program funding would negatively impact the available funding for physician training and exacerbate the existing funding shortage for GME training. Moreover, the Medicare GME program is currently structured to fund physician residency training based on physician clinical training requirements. Physician training requirements vary greatly from the training requirements for NPs and PAs, meaning that substantial changes to current payment formulas would be necessary to align payment allocation with the training requirements for physicians, NPs, and PAs.



GAO estimated the cost of training NPs to be roughly $47,000 per trainee per year, and $45,000 for PAs. However, GAO notes that the estimates were both limited and incomplete. Specifically, they note that reported costs for NPs were limited to five institutions, and that costs were underreported, because classroom training, certification, and licensure were not included in the estimates. Additionally, PA graduate training cost estimates did not include in-kind contributions from clinical sites, such as preceptor volunteering.