Newswise — PHILADELPHIA (October 24, 2017) – The Report to Congress on the Centers for Medicare and Medicaid Services (CMS) Graduate Nurse Education Demonstration has just been released documenting health care workforce gains addressing the nation’s shortage of primary care. The $200 million initiative is the first to test whether Medicare funding of graduate clinical education of Advanced Practice Registered Nurses (APRNs) would help meet national health care workforce needs similar to residency training for physicians.  The answer is yes. Access the full report here.

The evaluation report to Congress concluded, “The GNE demonstration had a positive impact on APRN growth, and helped transform clinical education within participating GNE schools of nursing.” The evaluation documented better clinical training outcomes for demonstration schools of nursing compared to schools not affiliated with the demonstration. Specific findings include:

In 2012, five US hospitals were competitively selected by CMS to partner with schools of nursing with clinical graduate programs and community health care providers to increase the number of APRNs including Nurse Practitioners, Nurse Midwives, Nurse Anesthetists, and Clinical Nurse Specialists.  The demonstration is currently in its sixth year and according to the independent CMS evaluation it has resulted in a significant increase in primary care providers.

The funded hospitals are Duke University Hospital, Durham, NC; Hospital of the University of Pennsylvania, Philadelphia, PA; Memorial Hermann-Texas Medical Center, Houston, TX; Rush University Medical Center, Chicago IL; and HonorHealth Scottsdale Osborn Medical Center, Scottsdale, AZ.  These hospitals are affiliated with 19 university schools of nursing* and hundreds of community clinical partners and collaborating health systems. 

The GNE demonstration will conclude at the end of June 2018.  In the meantime, the five GNE projects are collaborating with major national stakeholders interested in improving access to affordable health care to design and promote consideration of national permanent funding to roll out this successful program nationally.

The original Medicare legislation enacted in 1965 recognized in its funding policies the value to Medicare beneficiaries of excellent clinical training of physicians, nurses, and allied health professionals.  Since the passage of Medicare, important new advanced practice roles for nurses have developed.  Many studies show that advanced practice nurses contribute to improving access to affordable care, especially in primary care which is nationally in short supply.  Advanced Practice Nurses (APRNs) are specialty certified RNs with master’s in nursing or doctor of nursing practice (DNP) degrees. They have a broad scope of practice depending upon their specialty that includes people of all ages. They provide primary care including wellness care and treatment of common acute illnesses, and they contribute to the management and symptom control for people with stable chronic illness.  They provide maternity and women’s health care, anesthesia services, and care of acutely ill hospitalized patients. 

While Medicare is a major source of funding for the clinical training of physicians and allied health professions, APRNs did not exist when Medicare was implemented and thus their clinical training does not generally qualify for Medicare educational support for historical reasons despite their important roles in care of the elderly and improving access to affordable care for underserved people.  The CMS GNE demonstration was undertaken to determine if Medicare reimbursements through hospitals to practicing clinicians to supervise the clinical training of APRN students would result in increasing the number of APRNs available to meet the health needs of the US population. 

The Demonstration shows that it is feasible and affordable for Medicare to pay hospitals to facilitate the expansion of clinical training opportunities for APRNs in the community as well as hospital settings, similarly to Medicare’s support of clinical residency training for physicians.

The following schools of nursing participated:

  1. University of Pennsylvania
  2. Thomas Jefferson University
  3. Gwynedd Mercy University
  4. Neumann University
  5. LaSalle University
  6. Widener University
  7. Drexel University
  8. Temple University
  9. Villanova University
  10. Duke University
  11. Rush University
  12. Arizona State University
  13. Grand Canyon University
  14. Northern Arizona University
  15. University of Arizona
  16. Prairie View A& M University
  17. University of Texas Health Science Center – Houston
  18. University of Texas Medical Branch- Galveston
  19. Texas Woman’s University