The Nurse Practitioner Workforce is Booming — And That’s Good for Home Health Providers

From 2010 to 2017, the amount of nurse practitioners in the United States more than doubled from 91,000 to 190,000, a new study published in Health Affairs found. The study draws from the Census Bureau’s American Community Survey.

Although researchers didn’t analyze the nurse practitioner (NP) boom’s effect on home-based care directly, there are some key takeaways providers need to recognize. For starters, the larger pool of NPs to work with will likely bring new hiring opportunities for providers, perhaps shaking up their current workforce breakdown.

“In general, as there are more NPs available, they should be more able to serve in the [home care] setting as well,” David Auerbach, the Health Affairs study’s author, told Home Health Care News.

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David Auerbach is an adjunct faculty member at Montana State University and an expert on the nursing and advanced-practice nursing workforce. He was formerly a principal analyst with the Congressional Budget Office (CBO) in the Health and Human Resources Division.

So far, the increase in NPs has helped fill critical gaps in health care delivery nationwide, according to the study. Auerbach and his fellow authors also noted that the increase in NPs has reduced the size of the registered nurse (RN) workforce by up to 80,000 over the 2010 to 2017 time period.

The increase in NP jobs occurred in every U.S. region and was driven by the expansion of educational programs that attracted nurses, particularly those in the millennial generation. Inflation-adjusted earnings also grew by 5.5% over the course of seven years.

In 2019, the national average hourly rate for NPs working in the home setting was slightly more than $52, according to the most recent Home Care Salary & Benefits Report, published by the Hospital & Healthcare Compensation Service (HCS) and the National Association for Home Care & Hospice (NAHC).

If one piece of legislation ends up becoming law, home health providers big and small may start scrambling for NPs.

The Home Health Care Planning Improvement Act of 2019, introduced last April, aims to allow NPs, among other groups, to certify home health care services under Medicare. Historically, only physicians have been able to order home health services and certify patients to receive the home health benefit.

Home health providers have been critical about that process, which can be burdensome, especially when providers don’t have strong relationships and open communication with the physicians they work with. There’s often costly delays when physicians are not readily available.

An additional finding from the study: The number of NPs and physicians is now approaching parity.

Auerbach and the other authors were attempting to fill gaps in data with the study.

“We didn’t have a consistent data source to really track NPs in the workforce since 2008,” Auerbach said. “We were taking advantage of the fact that the census started identifying NPs in 2010, and has been doing so ever since then. We had enough time to be able to look every from 2010 through 2017 to be able to say ‘What does this trend really look like?’ There was really no other source that could do something quite like that.”

Part of what created the gap was that the Health Resources and Services Administration previously conducted a survey every four years — then stopped in 2008. The survey was reinstated in 2018.

“The workforce has grown so incredibly fast over the last seven years — more than doubled — which is just massive for any large profession,” Auerbach said. “Especially in the context of health care, given just what key role nurse practitioners play in health care provision.”

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