Pursuing Medicare reimbursement amidst the altered legislative landscape - Health Policy Issues

AORN Journal, Jan, 2002 by Karen Sealander

Editor's note: Karen Sealander is AORN's legislative counsel and federal lobbyist in the Washington, DC, office of McDermott, Will & Emery--the international law firm AORN employed in August 1999 to advance certified RN first assistant (CRNFA) reimbursement legislation. Sealander and her colleague, Maggie Mitchell, helped orchestrate AORN's successful Federal Affairs Conference and Lobby Day, June 25 to 26, 2001. Sealander will be speaking at the 2002 Congress in Anaheim, Calif. In this column, she provides an update on AORN's CRNFA reimbursement efforts.

The attacks of Sept 11, 2001, the detection of anthrax spores in several congressional office buildings, and the dwindling of the budget surplus have combined to fundamentally reshape the nation's domestic policy agenda. The president and members of the US Congress remain focused on responding to terrorism and its deleterious effect on the nation's economy. Accordingly, much attention is being diverted from once looming health care issues to the more urgent public health menace of bioterrorism.

For example, although Republicans and Democrats agreed early in 2001 that a Medicare prescription drug benefit should be enacted before the end of 2001, this did not occur, and the outlook for enactment in 2002 remains muddled. The combination of a lagging economy, increasingly severe federal budget constraints, and the overlay of election year politics may limit the 2002 agenda on other health care issues, as well.

Despite these pressures, efforts are expected to advance a scaled-back Medicare/health bill in 2002. Certified RN first assistant (CRNFA) reimbursement, like other targeted adjustments to Medicare, must be folded into a larger Medicare bill or "vehicle" because it will not progress through the legislative process as a free-standing bill. In line with this, it is vital that AORN members continue to be the best possible advocates for their profession.

EDUCATION--OUR PRIMARY OBJECTIVE

Guiding all AORN state and federal legislative and regulatory efforts is our chief goal--educating policymakers about the vital role of perioperative RNs. This education effort furthers all of AORN's legislative and regulatory goals, including our efforts to achieve Medicare reimbursement for CRNFAs. If policymakers understand the critical role perioperative RNs play, appropriate decisions about reimbursement, supervision, education, and other issues will follow.

REP COLLINS INTRODUCES REIMBURSEMENT LEGISLATION

For the second year, Rep Mac Collins (R-Ga) introduced legislation to require Medicare reimbursement for the surgical first assisting services of CRNFAs at 13.6% of the surgeon's fee. The Certified Registered Nurse First Assistant Direct Reimbursement Act of 2001, HR 822, was introduced in the US House of Representatives on March 1, 2001. The 2000 bill, HR 3911, terminated when the 106th Congress concluded in December 2000. AORN's activities regarding HR 822 are highlighted in Table 1.

In the Congressional Record, the official journal of Congressional proceedings, Rep Collins asked his colleagues for support for CRNFA reimbursement, saying that CRNFAs not only

   ... have more clinical experience and education [in first assisting] than
   other non-physician providers, but they also provide continuity of care to
   patients enabling higher quality and better patient outcomes. (1)

He noted that CRNFAs also provide the additional benefit of cost efficiency. Rep Collins expressed his appreciation for the hard work of AORN members and described their help in contacting their legislators as "indispensable."

AORN members should take pride in this recognition. Based on your hard work, CRNFA reimbursement legislation enjoys broad bipartisan support among legislators. At press time, 87 members of Congress, including 43 Republicans and 44 Democrats, had cosponsored HR 822. Moreover, CRNFA reimbursement has gained significant support from the House committees that have jurisdiction over Medicare. Cosponsors include nine members of the Ways and Means Committee, including Rep Collins, and 17 members of the Energy and Commerce Committee.

Importantly, six of the 13 members of the Ways and Means Health Subcommittee, along with 12 of the 31 members of the Energy and Commerce Health Subcommittee, have cosponsored HR 822. AORN members who live in the districts of Health Subcommittee representatives who have not cosponsored CRNFA reimbursement are urged to redouble their efforts. Targeted legislators on the Ways and Means Health Subcommittee include Reps

* Nancy Johnson (R-Conn) (chair),

* Jim McCrery (R-La),

* Philip Crane (R-Ill),

* Sam Johnson (R-Tex),

* Jennifer Dunn (R-Wash),

* Pete Stark (D-Calif), and

* Gerald Kleczka (D-Wis).

Targeted legislators on the Energy and Commerce Health Subcommittee include Reps

* Michael Bilirakis (R-Fla) (chair),

* Joe Barton (R-Tex),

* Richard Burr (R-NC),

* Barbara Cubin (R-Wyo),

* John Shadegg (R-Ariz),

* Ed Bryant (R-Tenn),

* Robert Ehrlich, Jr (R-Md),

* Steve Buyer (R-Ind),

* Joseph Pitts (R-Pa),