































 |
|
AHA Announces Agreement To "Do Our Part" On Reform That Expands Coverage
It's time for NIWI!
Support the Senate Dear Colleague Letter: Now is the Time to Invest in Nursing!
Government Affairs Report October 2008
New California rules re MRSA
Nurse in Washington Internship Program (NIWI) Scholarship Information
ALERT - Call your Senators in Support of HR 6331
Support for Nursing Workforce Development! Urge Your Representative and Senators to Keep Funding Increases
New York Times Questions Quality of U.S. Health Care
Advance practice nurses are asking for our assistance.
Re: Nurse in Washington Program Scholarship Information
WOCN Government Relations Board Report - Jan/Feb
Government Affairs report for PCR fall conference, October 2007
Government Affairs update June 2007
AHA Announces Agreement To "Do Our Part" On Reform That Expands Coverage
July 8, 2009, Special Bulletin
The AHA today announced its support for an agreement on health care reform that expands health coverage to 95% of Americans while capping at $155 billion over 10 years the amount of hospital spending cuts that would be used to help achieve that goal. As coverage expands and more Americans are insured, the AHA estimates conservatively that hospitals would see reduced uncompensated care of at least $171 billion over 10 years. Click here to download the pdf to read more. |
It's time for NIWI!
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 29-31, 2009 in Washington, D.C.
Please note that six scholarships will be awarded this year; one scholarship will include full compensation for both the registration fee and travel costs and the remaining five will reimburse the $725 registration fee only.
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 National Office at: 888/224-9626. The application deadline is December 12, 2008, 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 16, 2009.
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 2009. |
Support the Senate Dear Colleague Letter: Now is the Time to Invest in Nursing!
Senators Barbara Mikulski (D-MD) and Olympia Snowe (R-ME) have circulated a letter soliciting support for an increase in funding for nursing workforce development programs. This Dear Colleague solicitation asks other Members of the U.S. Senate to sign-on to a statement supporting $215 million in fiscal year (FY) 2010 funding for the Nursing Workforce Development programs administered by the Health Resources and Services Administration (HRSA). If nurses can urge a large number of Senators to sign onto the Mikulski/Snowe letter, we will be more likely to receive this funding increase. Do not delay! Contact your Senators today! The deadline for Senators to sign onto the Dear Colleague letter is Monday, May 11th! To learn more about nursing workforce development programs, please click here. |
Government Affairs Report October 2008 Marilyn Magoffin RN, CWOCN, FNP G/A chair
Important legislative and regulatory events of 2008 affecting WOCN practice:
Inpatient Prospective Payment center (IPPS)
Beginning Oct 2008 there are 11 conditions that Medicare will no longer cover if they occur during hospitalization. Payment would be received if these hospital acquired conditions (HAC) are proven to be present on admission (POA). Pressure ulcers and catheter acquired urinary tract infections are 2 of these conditions. This new regulation offers new opportunities and challenges for WOC nurses.
To assist their members WOCN has the following resource Inpatient Prospective Payment Changes: A Guide for the WOC Nurse This guide explains the new regulations and what they mean for WOC nurses. Available at WOCN: www.wocn.org/About_Us/advocacy_and_policy/ipps_guidance
New California rules re MRSA Gov. Arnold Schwarzenegger (R) signed two measures that will increase the state's scrutiny of hospital-acquired infections. Under SB 1058 by Sen. Elaine Alquist (D-San Jose), hospitals will have to:
- Screen high-risk patients for methicillin-resistant staphylococcus aureus within 24 hours of admission to the hospital; and
- Report rates for the most serious infection outbreaks to the state.
The law will take effect next year, and the state Department of Public Health will begin posting infection rates for individual hospitals online in 2011. In addition, SB 158, by Sen. Dean Florez (D-Shafter), will require hospitals and skilled nursing facilities to develop patient safety plans and new staff training procedures aimed at preventing hospital-acquired infections (Schultz, Fresno Bee, 9/25).
Reporting requirements to the Department of Health Services for Stage 3-4 pressure ulcers A reminder: In July of 2007 Senate Bill 1301 added sections to the Health and Safety Code mandating California hospitals report "Never 27 Adverse Events" to DHS "Never 27 Adverse Events" is a list of serious reportable events in health care that should never occur. One the adverse events is Stage 3 or 4 ulcer acquired after admission. Stage 3 pressure ulcers may be excluded from this if they were a stage 2 was recognized on admission and progressed. Reporting was effective July 1, 2007. Specific adverse events must be reported to DHS within 5 days of discovery and within 24 hours if the adverse event is an ongoing urgent or emergent threat to the safety of patients, staff, or visitors. DHS will assess fines if the event is not reported in the defined time frame.
Competitive bidding:
Background:
- The Balanced Budget Act of 1997gave CMS (Center for Medicare and Medicaid Services the authority to implement a competitive bidding process for Durable Medical Equipment (DME). Suppliers would bid on services and products they could provide .CMS would then select providers with lowest bid.
- Unwanted effects included reduced access to equipment and supplies for beneficiaries, reduced quality of services that beneficiaries receive and the elimination of small businesses that are not able to reduce their costs enough to have bids equal to larger suppliers
- The first phase of bidding was scheduled to begin July 1, 2008 and the second phase was scheduled for early 2009.
Passage of HR.6331, the Medicare Improvements for Patients and Providers Act, delayed both phases of competitive bidding. It is not gone but we will have more time to petition congress on regulations that have the fairest process for both the Medicare beneficiaries and the suppliers.
Physician and APRN provider fees:
HR.6331 also delayed 10.6% cut in physician and APRN (advance practice nurses) provider fees for Medicare payments in 2008, and another 5% cut scheduled for 2009. Nearly 24 percent of physicians in all specialties were going to limit or not accept new Medicare patients, reducing patient access to healthcare. HR.6331 removed the cuts and authorized a 1.1% increase for next year.
Grass roots politics in action:
What is important to note with regard to HR.6331, the Medicare Improvements for Patients and Providers Act is that President Bush vetoed the bill. This meant that a two-thirds vote by both House and Senate were needed override a presidential veto. In June 2008 the House passed it 383 to 41. The Senate, having difficulty gaining enough positive votes, recessed for the July 4th holiday. An alert went out to nurses (including to WOC nurses) and physicians requesting that each contact their Senators over the holiday break and implore them to vote in favor of HR.6331. By the time the Senate had resumed their session they had received so many requests from constituents to pass HR.6331, that they voted 70/26 for the bill. On July 15, 2008 HR.6331 became law, in
large part, due to the grass roots efforts of individuals.
To aid with educating and activating members WOCN is offering "Advocacy and Grassroots Toolkit- Influencing Public Policy: Strengthening the Voice of the Wound, Ostomy and Continence Nursing Community". This is a great new educational tool available on their web page. Go to the WOCN web page Global Learning Center at www.amedcouniversity.com/wocn, register, click on the Professional Practice banner and locate the class. The cost is only $10 and you earn 1.0 CEU.
Nurse in Washington Internship Program (NIWI) Scholarship Information
NIWI is open to any RN that is interested in learning more about the legislative process. The next NIWI will be held March 29-31, 2009 in Washington, D.C.
Program objectives:
- Demonstrate how nurses can be involved and influence policy at the local and national level.
- Discuss how to work effectively with legislative staff to advance policy agendas.
- Network with other nurses with similar clinical/political interests.
- Describe key steps to effect change in the legislative process.
- Identify techniques to advance legislative issues at the grassroots level. Identify legislative, political, and economic forces driving health care policy and delivery changes today.
WOCN society will award six scholarships; one scholarship will include full compensation for both the registration fee and travel costs and the remaining five will reimburse the $725 registration fee only. Scholarship application can be downloaded from the WOCN web page at www.wocn.org/pdfs/About_Us/News/NIWI_application.pdf
The deadline for application submission is December 12, 2008. Scholarship winners will be notified by January 16, 2009.
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/niwi.cfm
PCR Scholarship to NIWI
PCR is pleased to support attendance to NIWI through offering a $1500 scholarship. Application is available on the web page. Please note the eligibility criteria. Due date is Jan 15, 2009.
Applications will be judged by the Vice President and Government Affairs Chair. Scholarship winner(s) will be notified by Feb 2, 2009. |
ALERT - Call your Senators in Support of HR 6331
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) |
Support for Nursing Workforce Development! Urge Your Representative and Senators to Keep Funding Increases
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: Subject: Now is the Time to Invest in Nursing Dear [decision maker name automatically inserted here], As a registered nurse, I urge you to make an immediate investment in nursing workforce development by maintaining the $18 million funding increase contained in H.R. 3043. This funding supports the Title VIII nursing programs, the main source of federal support for nursing recruitment, education, and retention. The continuing nursing shortage necessitates this much-needed $18 million increase. Nurses are the primary source of care and support for patients at the most vulnerable points in their lives. Nearly every person's health care experience involves a registered nurse (RN). As a result, a sufficient supply of nurses is critical in providing our nation's population with quality health care. Nurses are expected to play an even larger role in the future. The Health Resources and Services Administration (HRSA) projects that, absent aggressive intervention, the supply of nurses in America will fall 36 percent (more than 1 million nurses) below requirements by the year 2020. Nurses are also the cornerstone of pandemic flu, disaster, and terrorism preparedness. The Government Accountability Office, the American Hospital Association, and the Trust for America's Health have all released reports citing the nursing shortage as a major impediment to these preparedness efforts. The nursing shortage also is posing significant challenges to the delivery of health care to our nation's armed services. The Army, Navy, and Air Force are offering new lucrative RN recruitment packages, yet neither the Army nor the Air Force has met their active service nurse recruitment goals since the 1990s. The Navy has not met its recruitment goal in four years. Army leaders recently warned that they were experiencing shortfalls or more than 30% in certain key combat specialties (anesthesia and critical care). Air Force Nurse Corps leaders testified earlier this year that their 15% nursing shortage was "gravely concerning." Current funding levels fail to meet the growing need for nurses. In FY 2006, HRSA was forced to turn away 85% of the applicants for the Nurse Education Loan Repayment Program, and 96% of the applicants for the Nursing Scholarship program due to inadequate funding. This resulted in 10,000 applicants being turned away from programs designed to direct RNs into facilities with the most critical nursing shortages. Federal funding for the Title VIII programs has decreased over the last three fiscal years - while at the same time the nursing shortage has continued unabated. As a nation we cannot sustain our health care system without sufficient investment in our nursing workforce. I urge you to make this the year that you boost funding for Title VIII programs by maintaining the full $18 million increase contained in H.R. 3043. Sincerely, |
|
Advance practice nurses are asking for our assistance.
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:
|
Subject: Co-Sponsor S. 59/H.R. 2066 TODAY!
Dear [decision maker name automatically inserted here],
I urge you to co-sponsor the Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2007 (S. 59/H.R. 2066). This legislation will increase access to essential health care services and increase state flexibility while helping to control Medicaid spending.
Current law requires fee-for-service Medicaid to cover health care services provided by some Advanced Practice Registered Nurses (APRNs). The Balanced Budget Act (BBA) of 1997 encouraged states to move Medicaid recipients into managed care but failed to recognize APRNs as participants in these plans. The BBA also encouraged states to use primary case managers as gatekeepers to care in the fee for service program, and gave the states the option to recognize pediatric and family nurse practitioners and certified nurse midwives (CNMs) as case managers. Unfortunately, the BBA did not require these APRNs to be recognized, and it precludes the states from recognizing any other type of nurse practitioner as a case manager.
The Medicaid Advanced Practice Nurses and Physician Assistants Access Act would remove these barriers to practice. Fee for service Medicaid coverage would be expanded to include services provided by all nurse practitioners (NPs) and clinical nurse specialists (CNSs). All NPs would be recognized as primary care case managers. In addition, Medicaid managed care plans would be required to cover the services of certified registered nurse anesthetists (CRNAs), CNSs, NPs, and CNMs in their provider panels. Taken together, these changes will greatly increase access to care for Medicaid patients.
Many studies have shown that APRNs provide cost-effective, high quality care. In addition, APRNs are often willing to provide services in rural and inner-city areas where access to physicians is limited. The Medicaid Advanced Practice Nurses and Physician Assistants Access Act will ensure that Medicaid patients receive care in a timely and cost-efficient manner. By properly utilizing the services of APRNs, this bill will increase access to health care and decrease preventable acute care admissions and emergency room visits.
I hope that you can support Medicaid improvements by cosponsoring the Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2007 (S. 59/H.R. 2066). Thank you for your attention to this important matter. I look forward to your response. |
Marilyn Magoffin RN, CWOCN |
Re: Nurse in Washington Program Scholarship Information
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. |
WOCN Government Relations Board Report - Jan/Feb
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 Presidentıs 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 nationıs 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 |
Government Affairs report for PCR fall conference, October 2007
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:
- Prioritize medical reviews of pump claims with other high-risk services,
- Require that medical reviews of pump claims be based on the entire medical record,
- Direct its contractors to develop an education article based on these findings.
- 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. |
Government News Articles Archive: Page 2 |
|