Medicare Investment in APRN Education Important Benefit for Consumers

In recent years, they’ve also come together in the halls of government to push for system-wide change to health and health care—and they scored a historic victory this summer when the Centers for Medicare and Medicaid Services (CMS) launched its first-ever initiative to support the training of advanced practice registered nurses (APRNs). 

 

“We are thrilled, absolutely thrilled, that we were able to come together with the nursing community and help make this happen,” said Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF). 

The victory was years in the making. 

 

Nurses, consumers and health care leaders first began calling on CMS decades ago to scrap an outdated nurse education policy that they said did not recognize the crucial role of APRNs in improving access to and the quality and affordability of care, but political factors intervened. These constituent groups saw a golden opportunity to renew the call four years ago, just as the national debate over health care reform was beginning to heat up.

 

AARP—representing millions of older Americans who are both health care consumers and Medicare beneficiaries—worked with 13 nursing organizations in a nurse-led coalition that educated lawmakers about the need to overhaul CMS nurse education policy. 

 

This time, the political timing was right. In 2010, Congress passed a health reform law that set aside $200 million over four years to test the idea of providing Medicare funding for graduate nurse education. Under the pilot project—called the Graduate Nurse Education Demonstration—Medicare is funding five hospitals to train more APRNs. Selected hospitals are partnering with accredited schools of nursing and non-hospital community-based care settings to expand training within and beyond the hospital setting.

Consumers, nurses and health care groups issued a collective cheer when the selected institutions—the Hospital of the University of Pennsylvania, Duke University Hospital, Scottsdale Healthcare Medical Center, Rush University Medical Center, and Memorial Hermann-Texas Medical Center Hospital—were announced in July.

 

“This announcement marks a historic moment of investment in the crucial and growing role of nurses in our health care system,” RWJF President and CEO, Risa Lavizzo-Mourey, MD, said in a statement. 

 

The project is a “monumental victory” for nursing and for consumers, added Suzanne Miyamoto, PhD, RN, director of government affairs at the American Association of Colleges of Nursing. “With this money, the government is essentially saying: ‘Nurses play a valuable role in our health care system, and we’re committed to making an investment in their education.’”

 

 

Consumer demand for highly skilled nursing care is indeed strong, and growing, said Linda Aiken, PhD, RN, FAAN, the Claire M. Fagin professor of nursing and sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania. 

 

There is currently a national shortage of primary care providers, and the shortage will become more acute as the population ages and as millions more people enter the health care system under the new health reform law. At the same time, the health care system leaves many consumers struggling with fragmented, uncoordinated care, which can lead to costly and avoidable hospital readmissions and complications, she said. 

 

A larger supply of highly educated nurses is a key way to address the primary care shortage, improve patient outcomes and reduce costs, Aiken added. She cited a 2010 report on the future of nursing by the Institute of Medicine (IOM), which found that more APRNs can help meet surging demands for primary care and can improve the quality and coordination of care and patient satisfaction with it. The report made a specific call on Medicare to change its policies regarding funding for nurse education.

 

The major source of federal funding for graduate nurse education, according to the report, is a relatively small pot of discretionary dollars that must win approval from Congress every year. 

 

Medicare, meanwhile, supports diploma programs to educate a small portion of registered nurses. But graduate nurse education training programs at colleges and universities—where most APRNs are educated today—are ineligible for reimbursement, which leaves many without the resources they needed to expand clinical training sites and accept more students.

The Graduate Nurse Education Demonstration program will enable the selected graduate nurse training programs to expand access to clinical training sites—especially in community-based clinics, which are ideal for training APRNs and other primary care providers, Aiken said. If the demonstration program is deemed a success, it could prompt Medicare to change its current nursing education payment policies and create a permanent funding stream to boost graduate nursing education nationwide.

 

The plan is receiving a warm welcome from the institutions that were selected to participate. 

 

Melanie Brewer, DNSc, RN, FNP-BC, director of nursing research for Scottsdale Healthcare and director of the Graduate Nursing Education Demonstration Project for Arizona, said Arizona colleges of nursing will be able to accept about 200 additional APRN students who otherwise wouldn’t be able to enroll.  The GNE Demonstration Project will support students in clinical settings that go beyond the hospital and into the community to enhance APRN skills in primary care settings, she said.

Kathleen Delaney, PhD, PMH-NP, FAAN, a professor at the College of Nursing at Rush University, echoed her comments. The program will allow us to “train nurses to develop the type of care that we need to transform a sick care system into a health care system,” she said.

 

Although still savoring their legislative and policy victories, the coalition of consumer, nursing and health care groups is already eying its next goal: ensuring the success of the demonstration program and working to make it permanent. “For consumers this is certainly a major step in the right direction to ensure we have the highly skilled health professionals we need,” Reinhard said.  “But it was only one step.  There’s more work to do.”