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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. - PowerPoint PPT Presentation
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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 benefitsFacilities 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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