1. 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

2. 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

3. 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

4. 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

5. 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 5

6. Preceptor Placement Sites

7. 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

8. 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

9. 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

10. Demonstration Year 1 Highlights

11. Going Forward – Year 2 1 st Quarter CMS Budget approved Legislators Reception/Site Visit CMS Site Visit Renew current agreements Student PlacementCollect Data APRN Awareness Health Policy Obtain new preceptors Standardize processes 2 nd Quarter Submit reports to CMS 3 rd QuarterBranding/LogoWeb site4 th Quarter CMS Qualitative Site Visit Best Practice Conference

12. 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.”

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

14. 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 14

15. Questions