The Report to Congress on the Centers for Medicare and Medicaid Services (CMS) Graduate Nurse Education Demonstration found that Medicare funding of graduate clinical education of APRNs, including clinical nurse specialists, would help meet national health care workforce needs similar to residency training for physicians.
The $200 million initiative is the first to test this theory. The report concluded: “The GNE demonstration had a positive impact on APRN growth, and helped transform clinical education within participating GNE schools of nursing.” The evaluation documented better clinical training outcomes for demonstration schools of nursing compared to schools not affiliated with the demonstration. Specific findings include:
- Significantly greater APRN enrollment and graduation growth in demonstration schools than comparison schools, thus enhancing healthcare workforce capacity.
- The majority of all clinical training hours took place in community settings, a significant achievement in view of the national shortage of community-based primary care, and demonstrating that Medicare funding to hospitals could achieve training in community settings where it is most needed.
- The cost of clinical training of an APRN to graduation was estimated to be less than $30,000, a very good investment compared to the cost of community-based residency training of primary care physicians in the Teaching Health Center demonstration of $150,000 per year.
- The APRNs trained under the demonstration have entered practice in a variety of settings in both rural and urban areas including federally qualified health centers, nurse-managed clinics, ambulatory medical practices, and retail clinics as well as hospital practice.
The Demonstration shows that it is feasible and affordable for Medicare to pay hospitals to facilitate the expansion of clinical training opportunities for APRNs in the community as well as hospital settings, similarly to Medicare’s support of clinical residency training for physicians.
The GNE demonstration will conclude at the end of June 2018.