The only game in town

AORN Journal,  Dec, 2002  by Donna S. Watson

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AORN has worked toward federal reimbursement for RNFA services since 1987. (3) In 1987, AORN initiated HR 2918, which was sponsored by Rep Cardiss Collins (D-Ill). This bill included language that required budget neutral reimbursement. It was dropped due to budgetary implications of $25 million. In 1987, AORN attempted to amend the 1987 Omnibus Budget Reconciliation Act to include indirect reimbursement services for RNFAs. The amendment was successfully placed in the House version, but the Senate version had no sponsor. The amendment did not pass during congressional conference.

In 1988, Sen Daniel K. Inouye (D-Hawaii) introduced an amendment to the Technical Corrections Act for RNFA reimbursement services. This was opposed by the American Hospital Association. A compromise amendment was reached that applied only to physician-employed RNFAs. Multiple issues and concerns resulted in this amendment being removed. Senate bill 125 and HR 143 were introduced in 1989 by Sen Inouye and Rep Collins to rectify the disparity the Omnibus Budget Reconciliation Act of 1986 created related to reimbursement between physician assistants and RNFAs. Both bills were unsuccessful.

In 1989, the Physician Payment Review Commission was asked by Congress to study the issue of nonphysician reimbursement; however, the outcome focused on and resulted in a new physician payment system (ie, a resource-based relative value scale). The issue of RNFA reimbursement was not addressed directly.

In 1991, HR 287 and SB 180 were introduced by Rep Collins and Sen Inouye respectively to address RNFA reimbursement. Unfortunately, both bills died in committee. In 1993, Rep Collins introduced HR 1618. This was designed to amend the Social Security Act and allow for direct Medicare payment to RNFAs, and it was unsuccessful. In 1994, AORN attempted to achieve federal RNFA reimbursement by attaching an amendment to the health care reform bill. In 1995, HR 188 was introduced by Rep Collins to amend title XVIII of the Social Security Act to permit direct payment under the Medicare program for RNFA services. The bill failed. During the 105th Congress, no bill was introduced as efforts to secure a sponsor proceeded.

THE DICHOTOMY

In 1999, the AORN Board hired the law firm of McDermott, Will and Emery and, on the recommendation of the RN First Assistant Specialty Assembly, the Board approved by mail changing the second legislative priority to read: "Third-party Medicare reimbursement for certified RNFA's and state third-party reimbursement for RNFAs." (4) Some members question why the focus is on CRNFA reimbursement rather than reimbursement for every practicing RNFA. The rationale for the focus on CRNFA reimbursement at the national level is multifaceted. For a national bill to be sponsored and successful, multiple variables are analyzed. One key variable that will stop a bill in its tracks is financial implications. This was demonstrated with the proposal for a national health care system, which has not received serious congressional consideration because of its astronomical cost.