Here’s a quick look at the Graduate Nurse Education Demonstration Project.

Medicare has been funding the clinical training of physicians through hospital residency programs for decades. Could a similar model work for advanced practice registered nurses (APRNs)?

Starting in 2012, the Graduate Nurse Education (GNE) Demonstration Project began testing the feasibility of using Medicare funding to support clinical training for APRNs. One objective of the project was to enable nursing schools to enroll and graduate more APRNs ready to practice primary care in community-based settings. Additional objectives included increasing access to chronic care management, pain management, and women’s health care. A shortage of clinical practice sites limits enrollment of APRN students in graduate programs. Funds were sought from the Centers for Medicare and Medicaid Services (CMS) to increase educational opportunities by offsetting the costs associated with supervising students in clinical settings.

• $200 million in CMS funding secured for four years (2012–2016)
• Program extended to 2018 with unused funds from the original grant
• Five selected demonstration sites with a national footprint
  • Duke University Hospital
  • Rush University Hospital
  • Hospital University of Pennsylvania (Philadelphia)
  • Memorial Hermann-Texas Medical Center (Gulf Coast)
  • HonorHealth: State of Arizona
• 19 participating nursing schools
• Cost of clinical training of one APRN to graduation is $30,000 compared to $150,000 per year to train a primary care physician. (Figures do not include tuition costs.)
• Funding pursued by a coalition led by the American Association of Colleges of Nursing and AARP.

Outcomes:

• Majority of clinical training occurred in community settings, not hospitals
• APRN enrollment and graduation rates grew significantly more at GNE schools than at comparison schools
• Increase in nurse practitioner students drove enrollment and graduation rate growth
• Students placed in training sites in 48 states and the District of Columbia

Sources:
U.S. Department of Health and Human Services. Evaluation of the Graduate Nurse Education Demonstration Project: Report to Congress. September, 2017. Retrieved from: https://innovation.cms.gov/Files/reports/gne-rtc.pdf

Linda Aiken, University of Pennsylvania School of Nursing