Texas Gulf Coast (TGC) Graduate Nurse Education (GNE) Demonstration Lori Hull-Grommesh, DNP ACNP-BC CCRN NEA-BC Director, Texas Gulf Coast Graduate Nurse.

Texas Gulf Coast (TGC)Graduate Nurse Education (GNE)

Demonstration

Lori Hull-Grommesh, DNP ACNP-BC CCRN NEA-BC

Director, Texas Gulf Coast Graduate Nurse Education Demonstration

Shortages of APRNs/MDs

• Texas, as well as, the country face a shortage of physicians and other health care providers and it is expected to grow worse as more people gain health insurance and with the aging and growing population

• The total number of people expected to gain health insurance is expected to increase to 30 million by year 2016

• By 2019, the demand for primary care in the US will increase between 15 million and 25 million visit per year

• Texas has a critical shortage of APRNs – national ratio is 27.7 per 100,000 – Texas ratio is 17.7 per 100,000

• CRNAs are in short supply – national average of 8.1 per 100,000 – Texas average is 6.3 per 100,000

• Requiring between 4,000-7,000 more physician to meet this new demand

Purpose of Demonstration

• Memorial Hermann - one in five nationwide hospitals selected to receive federal funding from the Centers for Medicare and Medicaid Services (CMS) for participation in the GNE Demonstration (July 2013)

• Funding- $200M over 4 years to the five selected sites: CMS authority for up to $50M/year (2012-2016)

• GNE Demonstration payment for reasonable costs for qualified clinical training for Advance Practice Registered Nurses (APRNs)

• Purpose: Provide Texas Medicare beneficiaries with improved access to

health care provider services by significantly increasing the number of APRNs educated in the Texas Gulf Coast Region

Create an efficient partnership collaborative, replicatable, networking model between hospitals, regional nursing schools and clinical partners

Allows monitoring, collection and information exchange (‘best practices,” etc.) through coordinated communication between regional health care systems, nursing programs, and clinical partners

Partnerships

• Schools of Nursing– Prairie View A&M University– Texas Woman’s University– University of Texas Health Science Center at Houston – University of Texas Medical Branch at Galveston

• Gateway to Care• Community Healthcare Partnerships

– Fourteen (14) hospitals – 11 - Memorial Hermann– Four (4) hospital-based physician partners– Approximately 50 community-based partners with a

number of clinical preceptor sites

Demonstration Footprint

Community Healthcare Partnerships across eight counties with over fifty partners consisting of over 300 clinical preceptors. Partnership includes: GNE partners:

Hospital based physician partners University physician practices Community Clinics Federally Qualified Health Clinics Physician Practice Clinics Advance Practice Provider Clinics

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Preceptor Placement Sites

Placement Outreach Strategy

• Recruit facilities that have no APRNs or students

• Explain benefits

Facilities with no

APRN or students

• Place students with facilities

Students in Training • Facilities see

benefit and hire APRN

Facilities have APRNs

Advance Practice Registered Nurses --Vital to Our Community

• Will be utilized to the full extent of their education and training.• Provide independent assessment, diagnosis and management of

acute and chronic health care problems.• Increase the quality of outcome for patients• Enhance patient satisfaction• Reduce patient readmissions and reduce healthcare cost• Increase healthcare services to underserved areas• Provide education that promotes healthcare wellness and

maintenance• Advance health care• Drive, assist and create new healthcare models• Provide transitional care for patients from hospital to the home

setting

APRN Requirements

• Current State of Texas license to practice professional nursing and a BSN

• Graduate of a Nurse Practitioner Program approved by the State of Texas

• Certification by the American Nurse Credentialing Center or National Certification Center in area of specialty

• Collaborative practice agreement

Demonstration Year 1 Highlights

Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013

Aug 2012GNE Partners Work session

Aug 2012Demonstration Team formed

Aug 2012SONs/Project Team Committee formed

Mar 2013Summer Student

Placement process began

Dec 2012Spring Student

Placementbegan

Jan 2013Data/Metric Workgroup

created

Feb 2013Marketing/Public Relations

Planning Workgroup created

Mar 2013Invoicing Process

Began

Nov 20121st CMS payment

rec’d

Nov 2012Steering Committee

formed

Jul 2012CMS awarded Memorial

Herman demonstration

Jan 2013Clinical Training

began

Dec 2012Implementation Plan

submitted

Feb 2013Semi-Annual Report Submitted to CMS

Nov 2012Budget approved

Sep 2012Preceptor Guidelines

approved

Jun 2013DY2 Budget Submitted

Jun 2013CMS Evaluators Site Mtg

Jun 2013Data Collection

Submitted

Oct 2012Business/Affiliation

Agreement process began

Apr 2013Publication Talking

Points

Apr 2013Funds Distributed

Apr 2013Web

Landing Page

May 2013Press Release

Going Forward – Year 21st Quarter

CMS Budget approved

Legislators Reception/Site Visit

CMS Site Visit

Renew current agreements

Student Placement

Collect Data

APRN Awareness Health Policy

Obtain new preceptors

Standardize processes

2nd Quarter

Submit reports to CMS

3rd Quarter

Branding/Logo

Web site

4th Quarter

CMS Qualitative Site Visit

Best Practice Conference

Feedback from APRN Students and Preceptor• “I’m confident that when I graduate as an APRN, I will be ready to fill in

the gaps in our health care system that are currently underserved.”

• “It was a fantastic experience and I didn't realize how much I learned until this current semester. Your knowledge has “stuck” with me greatly.”

• “My preceptors, Mark, Kristie and Beth helped me tremendously.  They never tired of my many questions and always found material or ways to explain issues that helped me gain a better understanding of the overall clinical picture.”

• “I wanted to let you know that overall I have had a positive experience as a first-time physician preceptor this summer in my pediatric office.”

13http://www.memorialhermann.org/careers/graduate-nursing-education-demonstration/

Senate Bill 406

• Eliminates the current site-based requirements• Standardized prescriptive authority agreement• Non-hospital physicians can delegate prescriptive

authority to seven APRNs as opposed to four previously• Physicians can delegate prescriptive authority for

Schedule IIs Controlled Substances to APRNs and PAs in hospitals and hospice

• Ensures that APRNs and PAs are recognized the same as physicians in Medicaid and CHIP for reimbursement Recognized as Primary Care Provider

• Effective November 1, 2013

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Questions