Medicare contributes approximately $150 million per year to support nursing education compared to $12 billion currently going to hospitals for physician education. Because so few nurses receive their primary training in hospital-based programs today, Medicare should instead support the education and training of nurses who care for Medicare beneficiaries whether in the hospital, ambulatory, nursing home, or home care venues, and training for nurses in administrative and leadership positions to implement delivery system reforms.
Payments could continue to be made to hospitals but should also be available for the costs of graduate nursing education in communities, outpatient, and other clinical settings through contractual agreements. This education could be provided—and the funding flow directly—through organizations that have affiliations with accredited schools of nursing, which in turn partner with nonhospital, community-based care settings.
Medicare reimbursement would be expanded to include graduate nursing education costs that are attributable to the preparation of advanced practice nurses with the skills necessary to provide primary and preventive care, transitional care as patients are discharged from hospitals, chronic care management, and other nursing services appropriate for the Medicare population. This includes training programs for advanced practice nurses such as nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.
The Senate bill includes such a provision—a graduate school nurse education demonstration program—and directs the secretary of Health and Human Services to establish a program to increase graduate nurse education training under Medicare and authorizes $50 million to be appropriated from the Medicare Hospital Insurance Trust Fund for each of the fiscal years 2012 through 2015.
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