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A strategic view of AORN's federal legislative issues

AORN Journal, April, 2004 by Burke Beu

During a February 2004 meeting in Denver, the AORN Board of Directors asked Government Affairs' staff members to present a review of legislative issues pertinent to perioperative nursing. The purpose of the presentation was to summarize the legislative activities of AORN, as well as to promote an understanding of AORN's legislative priorities as they reflect the strategic vision and plan of the Association.

Each state and federal issue was reviewed within the context of a strategic goal, the history of file issue at AORN, and a plan of action for achieving the goal. Fred Franko, director of state public affairs, presented state issues and will report on these in the future. This article reviews federal issues using the "goal-history-plan of action" framework provided to the AORN Board of Directors.

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MEDICARE REIMBURSEMENT

AORN's goal is to develop a strategy for pursuing Medicare reimbursement for certified RN first assistants (CRNFAs) within the framework of AORN's other legislative priorities and organizational vision. Here is a brief history of the CRCNFA issue.

* A five-state, three-year demonstration project amendment to the recent federal Medicare bill was converted to a study of CRNFA reimbursement by the Medicare Payment Advisory Commission (MedPAC). The MedPAC study will be released in January 2005.

* The Medicare CRNFA Direct Reimbursement Act (ie, HR 1388) continues as a bill in Congress, but it has little political momentum following the contentious debate about Medicare in 2003. In addition, the bill's sponsor, Rep Mac Collins (R-Ga), is concentrating much of his efforts this year on an extremely competitive race for the US Senate.

* Before the introduction of HR 1388 in the 108th Congress, similar bills in the 107th Congress (ie, HR 822) and 106th Congress (ie, HR 3911) were introduced by Rep Collins and professionally lobbied by the Washington, DC, office of McDermott, Will & Emery. The contract for lobbying efforts by this company ended in December 2003 and was not renewed.

* The General Accounting Office (GAO) released a report titled "First Assistants at Surgery" in January 2004, two years after it was due. (1) The GAO report did not highlight CRNFAs as expected; instead it concentrated on all providers of first assisting services and recommended payment under part A of Medicare rather than including CRNFAs in direct billing tamer part B.

The plan of action for achieving reimbursement for CRNFAs, as well as other legislative objectives at AORN, is to assess four areas, including

* external factors affecting the issues,

* AORN's organizational capacity to address an issue,

* the wants and needs of AORN stakeholders, and

* the ethical impact of any decision.

For Medicare CRNFA reimbursement, this means providing pertinent data to MedPAC, which has a reputation for producing timely and focused reports, as well as recognizing that AORN cannot afford significant annual retainers for a federal lobbyist, balancing the interests of members who first assist with those who do not, and fulfilling AORN's longstanding commitment to this issue.

Specifically, the plan of action decided on by the Board is to communicate to all members, especially RNFAs, information clarifying the MedPAC study process and AORN's input into the study, while maximizing opportunities to raise the profile of AORN and perioperative nursing during Advocacy Day 2004. If the MedPAC report is positive, AORN will consider grassroots efforts to re-introduce a Medicare CRNFA bill in Congress without a federal lobbyist. If the MedPAC report is negative, AORN can promote Medicare CRNFA reimbursement by pursuing additional legislation in the states to require third-party reimbursement for RNFAs. Previous MedPAC reports on reimbursement for other non-physician providers of first assisting services highlighted state reimbursement laws as a reason why providers should or should not be allowed to bill Medicare directly.

NURSE REINVESTMENT ACT

The goal for this issue is to strengthen AORN's relationship with other specialty nursing organizations as well as highlight perioperative RN objectives through increased visibility in the nursing community and by supporting the Nurse Reinvestment Act. Support of the Nurse Reinvestment Act was added to AORN's legislative priorities in August 2002, just as the bill was passed by wide margins in both the US House of Representatives and the Senate and before it was signed by President Bush. Rep Lois Capps (D-Calif), one of only three nurses in Congress, introduced the bill in the House. The Nurse Reinvestment Act provides funds for scholarships, recruitment projects, retention incentives, and public awareness of nursing; however it requires annual funding by Congress.

Initially, proponents had hoped for annual appropriations of $250 million, but funding has been cut drastically because of the growing federal deficit and other budgetary needs. For fiscal year 2003, which was the first year of the program, funding was approximately $30 million, only a fraction of the expected amount. For fiscal year 2004, member associations of the Nursing Organization Alliance, which AORN is a member of, have worked to achieve $163 million in funding for the Nurse Reinvestment Act.

Health Care Industry

A strategic view of AORN's federal legislative issues

AORN Journal, April, 2004 by Burke Beu

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