FYI

Even though California is not on the list it never hurts to call your Senator so they know they how much supporty they have for this legislation.

Thanks, Marilyn

Call your Senators in Support of HR 6331 - The Medicare Improvements for Patients and Providers Act TODAY!

H.R. 6331 would enact a number of changes to current Medicare law, including: reversing a 10.6 percent reduction in Medicare reimbursements for advanced practice registered nurses (APRNs) and physicians that took effect on July 1; ensuring parity for mental health services under Medicare; and providing incentives to APRNs and physicians to successfully implement electronic prescribing.

We need your help to ensure that support in the Senate remains strong enough to override a promised Presidential veto. If your Senators are on the target list below, your call is especially important.

Message: "I am                 , a constituent calling to urge the Senator to stay strong in support of the recently passed Medicare bill (H.R. 6331) and press the President to sign the bill immediately. As a nurse, I understand that this legislation is desperately needed to ensure access for beneficiaries and provide for long overdue mental health parity in the program.

Background : Enactment of this critically needed legislation is within reach. Unfortunately, the President is expected to veto the Medicare bill this week, despite its widespread support and overwhelming passage in both the House and Senate. We will need a two-thirds vote in each chamber to override the anticipated veto. Those votes are expected will occur on Tuesday, Wednesday or Thursday (July 15 to 17). If all of the current YES votes stay with us, our champions will be able to override the veto and finally enact the bill.

Targets

• Alaska - Lisa Murkowski (202-224-6665)
• Alaska - Ted Stevens (202-224-3004)
• Florida - Mel Martinez* (202-224-3041)
• Georgia - Saxby Chambliss* (202-224-3521)
• Georgia - Johnny Isakson* (202-224-3643)
• Kansas - Pat Roberts (202-224-4774)
• Maine - Susan Collins ( 202-224-2523)
• Maine - Olympia Snowe (202-224-5344)
• Minnesota - Norm Coleman (202-224-5641)
• North Carolina - Elizabeth Dole (202-224-6342)
• Ohio - George Voinovich (202-224-3353)
• Pennsylvania - Arlen Specter* (202-224-4254)
• Tennessee - Lamar Alexander* (202-224-4944)
• Tennessee - Bob Corker* (202-224-3344)
• Texas - John Cornyn* (202-224-2934)
• Texas - Kay Bailey Hutchison* (202-224-5922)
• Virginia - John Warner* (202-224-2023)

WOCN Government Relations Strategic Activities
January/February, 2008

The WOCN Washington, DC office (Bryan Cave Strategies) remains at a very high level of activity during the first month and a half of 2008 and the Second Session of the 110th Session of Congress.  The Society's activities have led to greater visibility for the organization on Capitol Hill and within the broader nursing community.

During the first six weeks of 2008, WOCN government relations staff/lobbyists in Washington, DC have been engaged in the following targeted activities:

*  WOCN met with the nursing community Wash, DC representatives and Capitol Hill leaders to discuss the reauthorization of the Nurse Reinvestment Act in 2008.  During the meeting Senator Barbara Mikulski's, D-MD, office confirmed that the Senate Health, Education, Labor and Pensions Committee plans to reauthorize the Nurse Reinvestment Act this year.  Mikulski's staff requested that the nursing community put together a single document detailing re-authorization priorities.

* WOCN hosted the first Wash, DC meeting of a series of three gatherings (Bryan Cave Strategies offices in Wash, DC) with the nursing community ad hoc Task Force to develop a draft document outlining the community's priorities for Senator Mikulski and the Senate HELP committee to consider in the development of the Nurse Reinvestment Act.
The task force members attending the first meeting at WOCN's DC offices included:
NONPF
AANA
AWHONN
AONE
WOCN
ARN
NLN
ENA
NACNS
AACN
ANA

* WOCN Endorses Joint Nursing Community Proposed Request for $200 million to Fund Title VIII Nursing Workforce Development Programs in 2009.

WOCN Washington, DC representatives met with the broader nursing community to discuss, identify and support a funding level request of $200 Title VIII Nursing Workforce Development Programs in 2009.  The community's request will be communicated in a joint letter to the U.S. House of Representatives and U.S. Senate.

* WOCN Participated in the Centers for Medicare & Medicaid Services (CMS) audio conference/Q&A session regarding Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier accreditation.  The audio conference was the first in a series of four designed to provide guidance to DMEPOS suppliers regarding accreditation. The discussion focused on compliance issues with the DMEPOS Quality Standards and the accreditation process.

*  Society Joins and Endorses the Coalition for Healthcare's letter to Congress outlining healthcare funding needs/priorities for the 2009 federal appropriations cycle:

February 14, 2008

Dear Member of Congress:

Our nation struggles with escalating health care costs, growing numbers of uninsured, and the prospect of declining health measured by overall morbidity and mortality. The President¹s budget for FY 2009 continues to seriously underfund and undermine an important part of the solution: public health activities and programs. The investment in disease prevention and health promotion programs for all Americans needs to increase not decrease!
The undersigned organizations urge you to increase funding for all aspects of public health included in the Function 550/discretionary budget allocation in Fiscal Year 2009 by an amount that will: 1) restore funding cuts to public health programs enacted in FY 2006; 2) restore lost purchasing power that flat-funding for at least five years has eroded and 3) provide investments that begin to truly meet health challenges facing the nation.
It is estimated that an additional $5.3 billion will be needed in FY 2009 to meet this goal.
These challenges include:
•  Biomedical and Behavioral Research: Maintaining a vigorous portfolio of investigator-initiated basic research and pivotal translational and clinical studies to address the myriad health challenges that confront the American people and to develop a stable pool of talented new investigators whose ideas and fresh perspectives are vital to invigorating the research enterprise.
•  Disease Prevention and Health Promotion: Improving community-based prevention and early intervention activities that address costly chronic diseases, infectious diseases, including those that are becoming increasingly drug-resistant, strengthening public health capacity and ensuring those with disabilities reach their highest potential in function and health.
•  Access to Safety Net Health Care Services: Assuring access to basic and targeted health care services for the growing numbers of Americans who lack health insurance.
•  Health Professions Education: Assuring that there is a well-trained, diverse health and public health workforce to serve as the foundation for the nation¹s health care system.
•  Mental Health and Substance Abuse: Assuring access to needed mental health and substance abuse services for hundreds of thousands who must wait months for care, including Veterans returning from Iraq and Afghanistan; reducing the 15-20 year lag from bench to bedside of promising new treatments.
•  Health Services Research: Building the evidence needed to ensure patients get the right care at the right time, every time; providing decision makers with information that will help control unsustainable costs.
•  Health care for American Indians and Alaska Natives: Reversing current health disparities for this population that now suffers a life expectancy that is four years lower than the general population.
•  Food and Drug Safety: Assuring the nation has a safe food supply and a safe and effective supply of drugs and medical devices.
Our recommendation does not include, but rather is over and above, emergency funding requests."

* WOCN President to Attend Political Events and Spend Day on Capitol Hill Meeting With Targeted Congressional Offices to Advance the Society's Public Policy Agenda.

In February, WOCN's President will travel to Capitol Hill to meet with Members of the:

* House Ways and Means Subcommittee on Committee,
* House Energy and Commerce Subcommittee on Health,
* Senate Finance Committee, and
* House and Senate HHS Appropriations Subcommittees.

These Congressional Committees have jurisdiction over Medicare, Medicaid and the annual federal funding of nursing programs.

* WOCN NIWI Participants to Meet with Capitol Hill Leaders in March.  The Society's President and Government Relations Chairwoman will travel to Capitol Hill during the annual NIWI Capitol Hill Day.  Targeted meetings are being scheduled WOCN's leadership delegation.  The Society's NIWI participants will be invited to join WOCN's President and GR Committee Chairwoman for senior level meetings with Members of Congress, key Capitol Hill staff, and CMS officials.

* WOCN's Washington, DC office (Bryan Cave Strategies) has also represented the Society at weekly political events on Capitol Hill with the Congressional Nursing Caucus and other Members supportive of the nursing community. The Society's DC-based staff have been discussing an upcoming Capitol Hill Staff Briefing "WOCN Nursing 101" and other initiatives to be implemented in 2008.

--------------------------

William H. Applegate
Senior Vice President
Bryan Cave Strategies LLC
Government Relations
(202) 508-6355 direct
(202) 258-4989 cell
(202) 508-6310 fax
Bill@bryancavestrategies.com

700 13th Street, N.W.
Suite 500
Washington, DC 20005
www.bryancave.com
www.bryancavestrategies.com

In an attempt to overcome the President's veto, Congressional leaders are developing a new health spending plan for next year. This new plan is expected to cut proposed funding by $11 billion. We need your help to make sure that funding for nursing workforce development is not included in these cuts!

Contact Congress today! Tell them now is the time to invest in nursing!

Send a letter to the following decision maker(s):

Your Congressperson

Your Senators

Below is the sample letter:

We are pleased to announce the availability of WOCN NIWI Tuition Scholarships to assist Region/Affiliate members attend the Nurse in Washington Internship Program. These scholarships cover the $725 cost of registration. This program will be held March 9-11, 2008 in Washington, D.C.

It is hoped that, through the availability of these scholarships, your Region/Affiliate will be better able to co-sponsor and send individuals to this worthwhile educational program. The Nurse in Washington Internship Program offers an intense learning experience for WOCN leaders interested in becoming more involved in the legislative and regulatory aspects of healthcare.

The WOCN NIWI Tuition Scholarship Application may be downloaded from the WOCN webpage or may be obtained by calling the WOCN Central Office at: 888/224-9626. The application deadline is December 15, 2007, so please promptly complete and return your application to:
WOCN
15000 Commerce Parkway
Suite C
Mt. Laurel, NJ 08054

Scholarship winners will be notified by January 15, 2008.

For more information about the Nurse in Washington Internship Program, you may call the Nursing Organizations Alliance at 859/514-9157 for a brochure or go to their website at www.nursing-alliance.org.

Good luck. We hope to see you in Washington, D.C. in March 2008.

Marilyn Magoffin

1. New rulings by CMS (Centers for Medicare and Medicaid Services) will be affecting our practice in acute care (read: Opportunities)
The Centers for Medicare and Medicaid Services (CMS) has created a completely new set of DRGs and payment rates based on patient severity. The intent is to better match the payment to the severity of the patient. Included in the rule are provisions that provide less payment for certain hospital-acquired conditions including pressure ulcers. In order to qualify for the higher paying MS-DRG rate, the hospital will need to document a pressure ulcer within the first 1-2 days of admission. If the pressure ulcer is "facility acquired" ie not present on admission, the hospital will not qualify for the higher payment. The new MS-DRGs go into effect on October 1, 2007. The new payment rates go into effect on October 1, 2008.

As a result of comments and feedback they have received, CMS has offered the following clarifications to the rule change:

• Stage I and Stage II pressure ulcers present on admission will not qualify for the higher MS-DRG payment.
• Stage III or Stage IV pressure ulcers present on admission will qualify for the higher MS-DRG payment (except elbow ulcers or those of an unspecified location)
• Pressure ulcers will be considered present on admission if they are documented by the end of the second hospital day. (ie: If a patient is admitted on Monday, the pressure ulcer must be detected and documented by 11:59 p.m. on Tuesday)
• CMS recognizes that many patients who get pressure ulcers are very sick and often have other comorbidities and complicating conditions that will qualify the patient for the higher paying MS-DRG. This fact should not preclude physicians and hospitals from screening all patients for pressure ulcers on admission.

The current ICD-9 codes for pressure ulcers in place are specific to location, but do not delineate differences in severity to include size, stage, and presence of necrotic tissue or infection. The goal is to eventually use the pressure ulcer codes as a quality reporting measure and to eventually have the pressure ulcer data published on the "Hospital Report Card.". The Centers for Disease Control is considering a new code group for pressure ulcers. They will be holding a hearing on the matter at the end of September 2007, and WOCN has been invited to present testimony at this hearing.

2. CMS Proposed Changes to the Home Health Prospective Payment Systems and Fiscal Year 2008 Rates.
CMS also has made adjustments in reimbursements to Home Health agencies for pressure ulcers, stasis ulcers and ostomies to take effect in 2008. Simple and uncomplicated conditions will receive less reimbursement while more complex and complicated conditions will receive more. Essentially this change is considered "budget neutral" so no significant financial impact is expected. WOCN did comment favorably on these changes to CMS and also requested that the location of venous ulcers be taken into consideration instead of just the number. An ulcer on each leg would be twice the cost as 2 ulcers located on the same lower extremity. Opportunities for WOCN nurses are provided as complete and accurate documentation will be critical to capture the dollars for the more complex conditions.

3. Negative Wound Pressure Therapy crackdown on the horizon:
A review of medical records for patients receiving NWPT by the Dept of Health and Human services revealed that almost one-quarter of pump claims in 2004 did not meet Medicare coverage criteria, resulting in approximately $21 million in "improper payments". Based on an independent review of medical records, 24 percent of the claims for these pumps did not meet Medicare coverage criteria. An additional $6 million in improper payments were made for supplies associated with these claims. For 44 percent of the claims, the information on the supplier prepared statement was not fully supported by the medical record.

As a result CMS states that it will work with its contractors to:

1. Prioritize medical reviews of pump claims with other high-risk services,
2. Require that medical reviews of pump claims be based on the entire medical record,
3. Direct its contractors to develop an education article based on these findings.
4. A further recommendation is that of requiring the supplier to obtain pertinent parts of the patient's medical record prior to submitting a claim.

4. Reimbursement for compression therapy
At this time there is no update on the changes in compression therapy initiated by the CMS intermediaries for Nevada (Noridian) resulting in non payment for multilayer compression wraps. No changes have been enacted yet for California. WOCN continues to monitor this issue. A sample letter is available for Nevada members to send to Noridian.

5. Other news:

NIWI (Nurses in Washington Internship) will be occurring March 9-11 2008. You must apply for the WOCN scholarship first in order to qualify for the PCR scholarship. The application for the NIWI scholarship will be available soon on the WOCN web page. Annual Report of the Public Policy Committee for 2007

NIWI

The Public Policy Committee selected and prepared a team of 11 members to attend the Nurse in Washington Internship in March 2007. We were able to award 6 partial scholarships this year.

WOCN Day on the Hill

We held our very first "WOCN Day on the Hill" this year. It was scheduled following the NIWI Program in order to maximize the organization's resources. Margaret Goldberg, President and Leanne Richbourg, of the Public Policy Committee joined our 11 NIWI participants in storming Capitol Hill. While there, they met with influential committee chairs and legislative leaders important to the organization.

White Paper on Bariatric Health

Together with the Bariatric Subcommittee, the Public Policy Committee drafted a legislative position paper on Bariatric health. This position statement is in support of the American Nurses' Association's efforts towards safe patient handling. This position statement, as well as all of the WOCN's legislative positions, is available for the members on our website under "White Papers."

Compression Therapy for Venous Insufficiency

In the past year, there have been changes on reimbursement for various types of compression therapy by some of the Medicare fiscal intermediaries. This has been a very complicated issue that the Public Policy Committee has been monitoring. They have drafted a summary of the issue for your information at this conference. They will continue to keep the organization in the loop as regulatory changes are made.

Competitive Bidding of Electric Wheelchairs and Scooters

The Public Policy Committee prepared a letter of comment to CMS when they included wheelchair cushions as an accessory item eligible for competitive bidding.

Position Paper on Clean intermittent Catheterization

The Public Policy Committee prepared an organizational comment to address concerns raised by industry and individuals who wish to change the current reimbursement for sterile catheters. WOCN cannot recommend a change based on current available research but agrees this research needs to be done.

Noridian Administrative Services
Medicare B
P.O. Box 6711
Fargo, N.D. 58108-6711

To Whom It May Concern:

I am writing in response to your recent billing clarification regarding high compression bandage systems. I am a certified wound nurse and have clinical experience with these multiplayer wraps. From my personal experience in caring for patients with venous stasis leg ulcers, the suggestion that the patient and/or caregiver can safely apply these products independently is simply unfounded.

Sustained, graduated compression delivered by the multiplayer wraps is more therapeutic. The disadvantage is that the application of them is actually more complex than an Unna boot and requires advanced skill, training and experience of a health care professional. My rationale is as follows:

An Unna boot delivers a pressure range between 12-18 mmHg. When applied to a leg with a venous ulcer, the main function is the protection of the wound with the application of minimal compression. Ideally, the most effective therapeutic compression to treat venous ulcers requires 25-45 mmHg at the ankle reducing to 15-20 mmHg at the knee.

Sustained, graduated compression delivered by a multiplayer-wrap is a more complex procedure than the application of an Unna boot. There is an application of multiple layers, usually 3-4 layers. Each layer is applied with a different technique and pressure such as spiral or figure-eight. Additionally, each layer must be applied in a specific order as instructed per the manufacturer's recommendations. Evidence has shown that the effectiveness of these wraps is dependent upon the training, skill and experience of the health care professional applying the compression. Application of this system requires more time, skill and training when compared to the application of an Unna boot.

Because the sustained, graduated compression wrap delivers a high amount of pressure, confirmation of adequate circulation is required before and after application. This is more critical than with the Unna boot application and requires more advanced assessment skills of a health care practitioner.

Because venous insufficiency can result in very delicate skin, maceration and dermatitis, additional skin preparation is usually needed with emollient lotions, steroid creams or barrier ointments prior to the application of a sustained, graduated compression wrap. The clinical judgments of the health care professional in this regard are necessary to prevent further skin injury.

The decision by Noridian to deny reimbursement for these wraps as not medically reasonable and necessary because patients and/or their caregivers can independently apply them is not based in fact. I am asking for a reconsideration of this ruling.

A "growing body of evidence" indicates that the U.S. is not a "leader in providing good medical care" but a "laggard," a New York Times editorial states. Read more here.

The Public Policy committee for WOCN has been very busy this past 2 months responding to several rule changes proposed by CMS, which if implemented, would affect the practice of WOC nurses. Click here for a summary of those actions.

Currently APNs, Physician Assistants and Clinical Nurse Specialists are not legally recognized as case managers for fee for service Medi cal/ Medicaid patients even though current law requires that these clinicians be reimbursed for providing case management. The legislation described below corrects this oversight. A sample letter is included below that you may copy and paste to your representative who can be found in the following links. Easier still is going to the ANA web page and if you haven't signed up you can sign up (you do not have to be a member) and this letter will be automatically be sent to the appropriate congress person.

Thank you for your time and attention to this matter.

Marilyn Magoffin G/A chair

Senators CA
http://www.senate.gov/general/contact_information/senators_cfm.cfm?State=CA

Senators NV
http://www.senate.gov/general/contact_information/senators_cfm.cfm?State=NV
or:
http://www.senate.gov/general/contact_information/senators_cfm.cfm

US Representatives
http://www.house.gov/writerep/

Or ANA web page

http://www.nursingworld.org/gova/

and click on "Take Action"

The more access to care the better the care we can provide!

Urge Your Members of Congress To Co-Sponsor S.59/H.R. 2066!

Today: Tell them to Support APRNs as Medicaid Providers.
Congress is about to take up legislation reauthorizing Medicaid programs. Now is the time to tell your Congressional delegation to remove legal barriers that keep advanced practice registered nurses (APRNs) from fully participating in Medicaid. The more cosponsors we can secure for these bills, the more likely we will be successful in expanding Medicaid coverage of APRNs this year.

Urge your U.S. Representative and Senators to cosponsor the Medicaid Advanced Practice Nurses and Physician Assistants Access Act (S. 59/H.R. 2066)!

Send a letter to the following decision maker(s):
Your Congressperson
Your Senators

Below is the sample letter:

Marilyn Magoffin RN, CWOCN

Senators CA
http://www.senate.gov/general/contact_information/senators_cfm.cfm?State=CA

Senators NV
http://www.senate.gov/general/contact_information/senators_cfm.cfm?State=NV
or:
http://www.senate.gov/general/contact_information/senators_cfm.cfm

US Representatives
http://www.house.gov/writerep/

General CA info:
http://www.ca.gov/Government/State.html

Arnold Schwarzenegger
http://gov.ca.gov/

CA Senators:
http://www.senate.ca.gov/
or if you know your Representative:
http://www.senate.ca.gov/~newsen/senators/senators.htp

CA Assembly:
www.assembly.ca.gov/acs/acsframeset7text.htm
or if you don't know your Representative:
http://www.assembly.ca.gov/acs/defaulttext.asp

Nevada: Gov and Senate
http://nevada.gov/new_StateGovernment.htm

Representatives
http://nevada.gov/new_StateGovernment.htm

To apply for the Nurse in Washington Internship (NIWI) Scholarship, please download an application form:

PC Word file (compressed zip file)
Mac Word file (compressed .sit file)
PDF Portable Document Format

1. Go to the ana website www.ana.org. Click on "nursing issues/programs" then "government affairs" and, if not an ana member, sign up to be a "power user" (it's free).
2. That's it. whenever you receive a notice to contact your congress member about any issue all you do is log on. the web site takes you through the rest. it:
   • Tells you who your representative is
   • Tells you if they support that issue
   • Has a prewritten letter you can modify if you want
   • You submit it

VIOLA!

Further questions? Contact me

Marilyn Magoffin marilynm@mcn.org