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
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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
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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:
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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
Students in
Training
• Place students
with facilities
• 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
Apr 2013
Nov 2012
Feb 2013
Funds
Distributed
Steering Committee
Jun 2013
Semi-Annual Report
formed
Dec 2012
Aug 2012
CMS
Evaluators
Site Mtg
Submitted to CMS
Implementation Plan
Demonstration Team formed
Sep 2012
submitted
Apr 2013
Preceptor Guidelines
Mar
2013
Jan
2013
Jul 2012
Publication Talking
approved
Aug 2012
Nov 2012
Clinical Training Summer Student Points
CMS awarded Memorial
Jun 2013
SONs/Project Team
1st CMS payment
Placement
began
Herman
Data Collection
Committee formed
rec’d
process began
demonstration
Submitted
Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013
Jun 2013
DY2 Budget
Submitted
Mar 2013
Invoicing Process Apr 2013
Began
Dec 2012
Web
Spring Student
Landing Page
Feb 2013
Placement
Marketing/Public Relations
May 2013
began
Planning Workgroup created
Press Release
Nov 2012
Budget approved
Aug 2012
GNE Partners Work session Oct 2012
Business/Affiliation
Agreement
process began
Jan 2013
Data/Metric
Workgroup
created
Going Forward – Year 2
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
CMS Budget
approved
Submit reports to
CMS
Branding/Logo
CMS Qualitative
Site Visit
Web site
Best Practice
Conference
Legislators
Reception/Site Visit
CMS Site Visit
Renew current
agreements
Student Placement
Collect Data
APRN Awareness
Health Policy
Obtain new
preceptors
Standardize
processes
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.”
http://www.memorialhermann.org/careers/graduate-nursing-education-demonstration/
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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