CLINICIAN
RECRUITMENT AND SERVICE
Programs
included in this section are:
NATIONAL HEALTH SERVICE CORPS
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Improve the distribution of
health professionals in underserved areas |
4.I.C.1 |
Increase
the number of individuals served through the
placement and retention of NHSC clinicians.
(Baseline-2001:
4.44 M) |
3.8 M |
4.44M |
4.1 M |
4.47 M |
3.8 M |
Jul-08 |
3.48 M |
3.39 M |
2010:
20%
over baseline |
4.1 |
Increase
the number of individuals served in all communities
seeking NHSC assistance through NHSC placement,
retention and other sources.
(Baseline:
5.9 M) |
|
|
|
|
|
|
|
|
2010:
7.08
M |
4.I.C.2 |
Increase the field strength of the NHSC
through scholarship and loan repayment agreements. |
3,943 |
4,602 |
4,147 |
4,109 |
3,706a |
Jul-08 |
3,563b |
3,466b |
|
4.I.C.4 |
Increase the percent of NHSC clinicians
retained in service to the underserved. |
DNAc |
DNAc |
79% |
76% |
79% |
Nov-08 |
79% |
79% |
|
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Improve the distribution of
health professionals in underserved areas |
4.I.C.3 |
Increase the number of NHSC-list vacancies
filled through all sources |
2,660 |
3,141 |
2,200 |
2,662 |
1,746 |
Jul-08 |
1,776 |
2,200d |
|
4.I.C.5 |
Increase the average HPSA score of the sites
receiving NHSC clinicians, as a proxy for
service to communities of greatest need. |
12.9 |
12.2 |
13 |
13.7 |
13.6 |
Jul-08 |
13.6 |
13.6 |
2010:14.2 |
Efficiency
Measure |
4.E |
Maintain or decrease the average cost to
the NHSC program of a patient encounter |
$5.09 |
$4.97 |
$4.21 |
$4.72 |
$4.19 |
Jul-08 |
$4.17 |
$4.15 |
|
Appropriated
Amount($ Million) |
$169.9 |
$131.4 |
|
$125.4 |
|
$125.7 |
$123.5 |
$121.0 |
|
Notes:
a The targeted field strength for FY 07
may differ from that shown in the NHSC waterfall table.
Whereas the waterfall table is continually updated,
the performance reporting guidelines do no permit
changing a previously established target for the "reporting"
year.
b The FY 08 target differs from that shown
in the FY 2008 Congressional Justification, as this
is an updated estimate consistent with the NHSC waterfall
table.
c DNA = Data Not Available. Retention data
was not available in FY 04 and FY 05 due to incomplete
data collection. The program has reformatted the survey
to reduce ambiguity.
d The FY 09 target is lower than latest
result reported (FY 06), reflecting an anticipated
decrease in the number of new loan repayment contracts
due to increased amendments to previously awarded
contracts.
INTRODUCTION
The
statutory purpose of the National Health Service Corps
(NHSC) is to eliminate "...health manpower
shortages in health professional shortage areas,"
(Section 331(a)(1) of the Public Health Service Act
[42 USC 254d]). The performance measures gauge the
NHSC's contribution to the HRSA strategic goals
of improving access to health care and improving the
health care systems through the recruitment and retention
of NHSC clinicians.
Most
of these measures are dependent on the size of the
Field Strength (4.I.C.2.). The larger the Field Strength,
the greater number of people served, and the pool
of clinicians who fulfill the service commitment to
be potentially retained increases. Also, as the NHSC
has been able to shift more funding to the NHSC Loan
Repayment Program (LRP), the cost per patient encounter
decreases. In managing performance, the NHSC uses
these data to inform policy decisions regarding distribution
of Recruitment Line funding between the Scholarship
and Loan Repayment Programs. Another strategy used
by the program is to target sites that need recruitment
and retention technical assistance.
The
dependence of many of the performance measures on
the size of the Field Strength represents the major
challenge for the NHSC: to increase, or at least maintain,
a Field Strength that will enable the program to meet
its targets while remaining within statutory and budgetary
limits. To this end, the NHSC constantly evaluates
its options regarding distribution of funds between
the programs or limiting the size and/or duration
of awards and contracts, always balancing the options
against the attraction of the program to both clinicians
and sites.
DISCUSSION OF RESULTS AND TARGETS
Long-Term
Objective: Improve the distribution of health professionals
in underserved areas.
4.I.C.1.
Increase the number of individuals served through
the placement and retention of NHSC clinicians.
The
FY 01 baseline of individuals served is 4.44 million.
The FY 06 estimate of 4.47 million exceeds the target
by 9 percent, and is a function of an increased number
of clinicians retained out of the increased number
of loan repayers recruited in previous years. These
encounters are adjusted for both type of site and
by primary care, dental, and mental and behavioral
health disciplines, and include patients seen by NHSC
alumni in their first year post completion of the
service commitment. The projected decreases through
the FY 09 target of 3.39 million reflect the decreasing
number of vacancies filled by new NHSC loan repayers
as the number of loan repayment amendments is projected
to increase, leading to the decline in the Field Strength
described below.
4.1. By 2010, increase the number of individuals served
in all communities seeking NHSC assistance through
NHSC placement, retention and other sources by 20%.
(Baseline - 5.9 M)
4.I.C.2.
Increase the field strength of the National Health
Service Corps through scholarship and loan repayment
agreements.
In
FY 06, NHSC Field Strength 4,109, which is 99 percent
of the target. This decrease from the FY 05 level
was anticipated, due to large numbers of loan repayers
have fulfilled the service commitment and are no longer
counted in the Field Strength. This trend is expected
to continue through FY 09 for the reason noted in
4.I.C.1 above, at which point the number of new loan
repayment contracts and amendments will achieve a
balance, and the Field Strength will stabilize at
the FY 09 target of 3,466.
4.I.C.4.
Increase the percent of NHSC clinicians retained in
service to the underserved.
Retention
of NHSC clinicians preserves access to care for the
underserved beyond the period of service commitment.
The NHSC measures retention at one year after fulfillment
of the service commitment. Retention data was not
available in FY 04 and 05 due to incomplete data collection,
resulting in too small a sample to be considered representative.
For FY 06, the survey was revised to minimize ambiguities,
and produced a retention percentage of 76 percent,
which was 96 percent of the target. The target for
FY 09 is 79 percent.
4.I.C.3.
Increase the number of NHSC-list vacancies filled
through all sources.
In
FY 06, 2,662 vacancies were filled, which exceeded
the target due to an increased number of vacancies
filled by non-NHSC clinicians. Targets are based on
the number of projected new loan repayment awards,
plus the number of new scholars beginning service,
plus the assumption that an equal number of non-NHSC
clinicians will fill NHSC-listed vacancies. Because
of a shift in the proportion of recruitment line budget
to LRP in FY 03, an unusually large number of new
LRP awards were made that year, providing a high baseline.
The rise and fall in the target numbers from FY 05
through FY 09 reflect the cyclical nature of the NHSC
Loan Repayment Program: as the number of loan repayment
amendments increases, the number of new contracts
falls, resulting in fewer total vacancies filled from
all sources. The target for FY 09 is 2,200.
4.I.C.5.
Increase the average HPSA score of the sites receiving
NHSC clinicians, as a proxy for service to communities
of greatest need.
The
HPSA score is a proxy measure for the degree of need
for health professionals in an area. Scores range
from 1 to 25, with 25 representing the greatest need.
Increasing the average HPSA score of site vacancies
filled through NHSC assistance indicates success in
targeting vacancies of greatest need. The FY 06 actual
average score was 13.7, which exceeded the target
by 5 percent. This is a function of the fact that
the program did not award all qualified loan repayment
applications in 2006: no loan repayment contracts
were awarded to a clinician working at a facility
with a HPSA score below 8, resulting in a higher average
score. The FY 09 target is 13.6, while the long-term
goal is to increase the average HPSA score to 14.2
by FY 10.
4.E. Maintain or decrease the average cost to the
NHSC program of a patient encounter.
This
average cost of patient encounter is the benchmark
which the NHSC will track over time. The measure of
management efficiency will be how well the Program
can maintain or even lower this cost regardless of
changes in annual appropriations and the resulting
fluctuation of the Field Strength from year to year.
Though the estimated cost of an encounter in FY 06
is 12 percent above the target, it still represents
a 7.3 percent decline from the baseline. As the program
continues to gather data to track this measure, future
targets will be estimated more accurately. The FY
09 target is $4.15.
NURSING EDUCATION LOAN REPAYMENT AND SCHOLARSHIP PROGRAMS
|
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Improve the distribution of
health professionals in underserved areas |
5.1 |
Increase the number of individuals enrolled
in professional nursing education programs(Baseline-2002-2003:
240,500) |
|
|
|
|
|
|
|
|
2010:10%
over baseline |
5.I.C.1 |
Increase the proportion of nursing scholarship
recipients working in a facility with a
critical shortage of nurses within 4 months
of licensure |
43% |
DNAa |
85% |
DNAb |
85% |
Jul-08 |
85% |
85% |
|
5.I.C.2 |
Increase the proportion of NELRP participants
working in shortage facilities such as:
Disproportionate Share Hospitals for Medicare
and Medicaid, Nursing Homes, Public Health
Departments (State and local) and Public
Health Clinics contained in these Departments |
100% |
100% |
90% |
100% |
90% |
Dec-08 |
90% |
90% |
2010:90% |
5.I.C.4 |
Reduce Federal investment per year of direct
support by increasing the proportion of
program participants who extend their service
contracts to commit to work at a critical
shortage facility for an additional year |
44% |
38% |
45% |
45% |
45% |
Dec-08 |
45% |
45% |
|
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Improve the distribution of
health professionals in underserved areas |
5.I.C.3 |
Increase the percent of States in which
NELRP contract recipients work |
98% |
86%c |
93% |
92% |
93% |
Dec-08 |
93% |
93% |
|
Efficiency
Measure |
5.E |
Increase the proportion of NELRP participants
who remain employed at a critical shortage
facility for at least one year beyond the
termination of their NELRP service |
90%(est.)d |
DNAa |
40% |
Dec-08 |
50% |
Dec-09 |
50% |
50% |
|
|
Appropriated
Amount($ Million) |
$26.7 |
$31.5 |
$31.0 |
|
$31.1 |
|
$30.5 |
$43.7 |
|
Notes:
a DNA = Data not available. Data were not
collected for FY 05.
b DNA = Data not available. Data were not
collected for FY 06
c Recalculation of the FY 05 data for 5.I.C.3
showed that the actual result was 86% and not 92%
as previously reported.
d This replaces 40% estimate provided previously,
based on a survey of NELRP participants who completed
service. This led to the revision of targets for FY
06 and FY 07.
INTRODUCTION
The
Nurse Education Loan Repayment Program (NELRP) and
the Nursing Scholarship Program (NSP) are authorized
under Section 846 of the Public Health Service Act
[42 USC 297n] to work in partnership with other HHS
programs to encourage more people to consider nursing
careers and motivate them to serve in areas of critical
shortage. The performance measures gauge these programs'
contribution to the HRSA strategic goals of improving
access to health care and improving the health care
systems through the recruitment and retention of nurses
working in Critical Shortage Facilities.
The
major challenge facing NELRP is that the pool of qualified
nurses is shrinking. Since the implementation of the
NSP, the large number of applications received by
the program is evidence of increased interest in nursing
careers, but in the short-run, enrollment increases
are constrained by a shortage of nursing faculty.
As one strategy to assure better targeting of program
resources to areas and facilities of greatest need,
the programs will test the methodology for identifying
Critical Shortage Facilities for nurses.
The
other major challenge for the programs is the current
difficulty with data collection and analysis. The
programs had been using a Nursing Information System
which was deactivated in anticipation of another system
being brought online. This has not yet occurred. Both
NSP and NELRP will participate in the new information
management system of the Bureau of Clinician Recruitment
and Service, which is scheduled to be operational
at the end of FY 08.
Long-Term
Goal: Increase by 2010 the number of individuals enrolled
in professional nursing education programs by 10%
over the baseline.
(Baseline - 2002-2003: 240,500)
5.I.C.1.
Increase the proportion of nursing scholarship recipients
working in a facility with a critical shortage of
nurses within 4 months of graduation.
The
NSP is expected to attract more students into nursing
education by providing financial support during the
training years. Data is unavailable for this measure
for FY 05 through 07 due to deactivation of the program's
information management system as described above.
The FY 09 target is 85%.
5.I.C.2.
Increase the proportion of NELRP participants working
in shortage facilities such as: Disproportionate Share
Hospitals for Medicare and Medicaid; nursing homes,
public health departments (State and local) and public
health clinics contained in these departments.
Data
for this measure is obtained by monitoring automated
data on NELRP contracts. NELRP applicants working
in shortage facilities, such as Disproportionate Share
Hospitals for Medicare and Medicaid; nursing homes,
public health departments (State and local) and public
health clinics contained in these departments are
in the first preference category for awards.
These data indicate the degree to which NELRP resources
are being successfully targeted to facilities experiencing
the most critical shortages of nurses. All available
funds for initial awards were expended to nurses working
in those facility types in FY 06. Data is not yet
available for FY 07. The target for FY 09 is 90 percent.
5.I.C.4.
Reduce Federal investment per year of direct support
by increasing the proportion of program participants
who extend their service contracts and commit to work
at a critical shortage facility for an additional
year.
NELRP
initial contracts are for two years of service. This
indicator will provide a measure of the degree to
which registered nurses participating in NELRP are
willing to serve in a critical shortage facility for
at least one additional year. The target of 45% for
FY 06 was met after the program modified its method
of contacting participants regarding the third year
amendment option. Data is not yet available for FY
07. The target for FY 09 is 45 percent.
5.I.C.3.
Increase the percent of States in which NELRP contract
recipients work.
Prior
to FY 02, information about this program was not widely
distributed and contract recipients were limited to
a small number of States. Increased funding and marketing
strategies in FY 02 resulted in broader distribution
of contract awards in more States.
In
FY 06 NELRP participants were working in 86 percent
of the States, which was 93 percent of the target.
Data for FY 07 are not available. Some fluctuation
from year to year is expected because awards are based
on financial need and type of facility rather than
the State in which the recipient plans to work. The
target for FY 09 is 93 percent.
5.E.
Increase the proportion of NELRP participants who
remain employed at a critical shortage facility for
at least one year beyond the termination of their
NELRP service.
This
indicator will address the issue of retention by providing
a measure of the degree to which trained nurses participating
in NELRP are willing to serve in a critical shortage
facility for at least one additional year beyond the
termination of their NELRP service. The FY 04 result
was an estimated 90 percent. Data were not collected
in FY 05, and data for FY 06 and 07 are not yet available.
The target for FY 09 is 50 percent.
|