AORN set for certified RN first assistant Medicare reimbursement in the new year

AORN Journal, Feb, 2000 by Candace L. Romig

By Christmas 1999, all of AORN's legislative pieces were in place, and we were ready to roll. AORN accepted third-party Medicare reimbursement for certified RN first assistants (CRNFAs) as a new federal legislative priority. In this effort, lobbyists Karen Sealander and Michael Romansky, of the international law firm McDermott, Will and Emery, joined AORN lobbyists David Hebert and Greta Todd in spearheading the effort to identify a sponsor and introduce a bill. In addition, an alert was mailed to all legislative state coordinators, chapter presidents, and RNFA Specialty Assembly members, asking them to write letters and schedule meetings with their Congress members in a mass effort to highlight the issue of Medicare reimbursement for CRNFAs. AORN lobbyists began scheduling meetings with senators and Congress members before the holidays, and the AORN Legislative Grassroots Network was activated.

CURRENT STATUTORY AUTHORITY

Under current law, only physicians, physician assistants (PAs), and advanced practice nurses (APNs) may bill Medicare directly as assistants at surgery. The law limits reimbursement to 16% of the surgeon's fee. Physicians now receive 16% reimbursement, and PAs and APNs receive 13.6%. Medicare does not reimburse RNFAs for their surgical first assisting services. In addition, Medicare only reimburses surgical assistant services if such assistants are used in more than 5% of a procedure on a national basis. The list of excluded procedure codes is published annually.

STRATEGIC PLAN TO SECURE MEDICARE REIMBURSEMENT

AORN's federal lobbyists considered many different strategies to obtain Medicare reimbursement for CRNFAs. One plan was to seek only limited access initially to address Medicare's concerns about expanding costs through direct billing. If AORN had taken this route, however, our chance of obtaining national reimbursement would have been delayed or possibly terminated. Moreover, AORN took the bold step to limit our reimbursement efforts to CRNFAs, which lowered the cost estimate from $600 million over a five-year period to $84.6 million.

The Washington state counsel's recommendation is to seek reimbursement at 13.6%, equal to the reimbursement level of PAs and APNs. Counsel members witnessed first hand a surgical procedure in which an RN first assisted and realized the vital role that the RNFA plays in the OR. Consequently, they believe strongly that this reimbursement level is merited.

Support from AORN members in lobbying Congress is critical at this time! Armed with the cost estimate, our lobbyists are approaching members of Congress who have previously expressed interest in CRNFA Medicare reimbursement. AORN's goal is to locate sponsors to introduce this legislation in both the House and the Senate early in the second session of the 106th Congress, which began Jan 3, 2000.

To help in this effort, AORN members are asked to do the following tasks.

* Write your senators and representatives and ask for support of Medicare reimbursement for CRNFAs for surgical assisting services. The names and addresses of these members can be found at http://www.house.gov or http://www.senate.gov, or by calling the AORN Government Affairs Department at (800) 755-2676 x 233. An outline to help you write a letter is described in Table 1. Your letter should state the important role that CRNFAs play in the OR and state that CRNFAs perform the same tasks and duties of other providers who first assist at surgery--the only difference is that other providers are reimbursed. You also can use information from the position document that was prepared by our federal lobbyists (Table 2). Be sure to use your own words.

Table 1

SAMPLE POINTS FOR DRAFTING A LETTER TO SENATORS AND REPRESENTATIVES

Date

The Honorable John Doe United States Congress Washington, DC 20515 (for Members of the House of Representatives) or 20510 (for Senators)

Re: Medicare Reimbursement for CRNFAs

Dear Rep/Sen Doe:

First paragraph

* Introduce yourself as a perioperative nurse and a constituent.

* Explain that you are writing this letter to encourage the legislator to support Medicare reimbursement for the surgical first assisting services of certified RN first assistants (CRNFAs).

* Define what a CRNFA is and explain that other nonphysician providers with less perioperative experience and education are being reimbursed for this service.

Second paragraph

* Explain your role in the OR, including information on what makes your services unique and how these services alone affect patient care.

* Provide information on positive outcomes of your work, such as a personal experience in which you made a difference or objective information depicting positive results when CRNFAs are used (eg, a survey showing increased patient satisfaction or decreased costs).

Third paragraph

* Reiterate that you want the legislator to support Medicare reimbursement of CRNFAs.

* Invite the legislator to the OR to observe your work.

Fourth paragraph

* Provide information on how the legislator and the legislator's staff members may contact you.