Kelly Kennedy

USA TODAY

Growth in people with insurance has spurred concerns about a doctor shortage

Proposal will boost Medicaid provider payments

WASHINGTON — President Obama will propose boosting the National Health Services Corps from 8,900 a year to 15,000 a year over the next five years, as well as spending $5.23 billion to train 13,000 primary care residents over the next 10 years, in his budget next week, administration officials told USA TODAY.

The budget, which Obama will reveal Tuesday, marks the first time Medicare funds will be used to increase the number of medical residents, and it's the largest-ever proposed increase of the corps, officials said.

The administration hopes to boost both team-based care, as well as send residents out to rural areas and areas with lower access to care, officials said.

The president's budget proposal:

• Adds $5.23 billion over 10 years to train 13,000 primary care residents in high-need communities, and in team-based care, such as an accountable care organization.

• Extends higher payments to Medicaid providers, including physician assistants and nurse practitioners, by one year at a cost of about $5.44 billion.

• Adds $3.95 billion over the next six years in the National Health Services Corps to support growing the program from 8,900 primary care providers in 2013 to at least 15,000 annually starting in the 2015 fiscal year.

"This is a booster shot unlike any other before now," said Mary Wakefield, administrator of the Health Resources and Services Administration.

The proposal also addresses a shortage of mental health providers by offering residencies for psychiatrists, psychiatric nurse practitioners and other mental health providers as part of the team-based approach.

The Affordable Care Act opened up health insurance to potentially millions of previously uninsured people — so far, 4 million people have signed up for private plans through the state and federal health exchanges. That means there will be a demand for more doctors. At the same time, Medicare pilot programs as well as hundreds of new Accountable Care Organizations offered by physicians' groups, hospitals and insurers have pushed health care toward a team-oriented approach.

The administration officials said there should be no problem recruiting primary care physicians, although medical students have been drawn to medical fields that pay higher salaries, often to pay off their student loans.

Recruiting primary care practitioners for the residencies makes sense because young people are interested in working with teams of providers, the officials said.

A medical home or ACO means a doctor can quickly get a patient exactly what he or she needs. For example, a heart-disease patient is likely to be more at-risk for depression and may also need physical therapy and nutrition counseling. The team-based approach makes the resources necessary, as well ensuring everyone on the team thinks about a patient's entire health, rather than just the area in which he or she specializes.

Priority for the residents will be given to hospitals and other community-based health groups, such as ACOs or medical homes, that emphasize team-based care in underserved areas, including rural areas, though residencies in other settings will also be awarded. The budget also proposes bringing payments to teaching hospitals in line with the cost of providing care.

The National Health Services Corps now has 8,900 health care providers but would increase to 15,000 people in the service every year for the next five years. The corps provides scholarships and student loan repayments for people who practice in high-need areas. This comes in addition to increases that have more than doubled the number of corps members from 3,600 in 2008.

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