Post on 11-Sep-2016
transcript
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You may recall a previous article about medical homes
in this space. Well, it has been a busy few months,
and we want to update you on ACNP’s efforts to
ensure that nurse practitioners (NPs) can fully partici-
pate in any medical home demonstration project
(MHDP) the federal government undertakes. The
Medicare Improvement for Patients and Providers Act
of 2008 (Public Law [P.L.] 110-275), more commonly
referred to as “the Medicare bill,” became law on July
15, 2008, when Congress overrode the president’s
veto. The bill was debated for months and went
through many changes and more than a few votes
before becoming law. This bill contains an expansion of
the Medicare MHDP created by the earlier Medicare
Improvement and Extension Act of 2006 (P.L. 109-432).
The purpose of both the original and expansion
MHDP is to test the idea of providing Medicare bene-
ficiaries with a medical home and to give physicians a
bonus payment for such services. The original lan-
guage did not include any providers other than physi-
cians as medical home providers. Earlier this year,
when Congress started its attempts to expand the
project, ACNP learned that Congress was still using
physician-only language. ACNP, along with other key
NP advocates and organizations, immediately starting
educating lawmakers about including NPs as
providers in the demonstrations and worked with
other NP associations to have NPs added to the legis-
lation as an eligible provider for medical homes.
Generally, Hill offices are very supportive, but the pol-
itics of the bill and pushback from the physician organ-
izations were too much to overcome. There is, how-
ever, still a possibility of NP inclusion in the MHDP
because of the way the final language is written and
because some of our Senate friends have taken up
the challenge.
The Medicare Improvement for Patients and
Providers Act provides the secretary of Health and
Human Services with authority to expand the duration
and the scope of the MHDP, to the extent that any of
the following conditions are met:
• The expansion of the project is expected to
improve the quality of patient care without
increasing spending under the Medicare pro-
gram and/or
• The expansion of the project is expected to
reduce spending under the Medicare program.
We believe that NPs clearly can improve the quality
of patient care without increasing spending under the
Medicare programs, and NP participation may even
reduce spending. The fact that the secretary has dis-
cretion over how to expand the demonstration means
we have an opportunity to influence this decision.
To help influence the secretary’s decision on this
point, Sens Bingaman (D-NM), Harkin (D-IA), Collins
(R-ME), and Murkowski (R-AK) inserted a colloquy into
the official congressional record stating their support
for and urging the secretary to include NPs in the
demonstration. Sen Harkin has also agreed to circu-
late a letter for signature by colleagues urging the sec-
retary to include NPs. We will be calling on you to help
us make sure your senators are engaged in this next
important step! Stay tuned!
Check ACNP’s website, www.acnpweb.org, to
download both the full colloquy by the 4 senators and
the Dear Colleague letter from Harkin.
HHS Secretary Has Discretion toAdd NPs to Medical Home Demos
Jodie Curtis, Government Relations Director, Drinker Biddle & Reath LLP
The Senate passed S.901, the Health Centers reautho-
rization package, on July 22, 2008. The bill reconfirms the
core principles of the current federal Health Centers pro-
gram, while putting the funding for the program on track
to reach the goals of the ACCESS for All America plan.
The plan aims to reach 30 million patients by 2015. The
Senate-passed bill now heads to a conference commit-
tee with the House-passed version (H.R. 1343) to iron
out the remaining differences.
Sen Orin Hatch (R-UT), a co-sponsor of the leg-
islation with Sen Ted Kennedy (D-MA), said that
since 2001, additional funding provided under the
bill has allowed health centers in more than 750
communities nationwide to provide care to about
4 million new patients. Hatch said, “These centers
provide affordable and quality care to at-risk
Americans who otherwise might have to do
without.”
The National Association of Community Health
Centers (NACHC) says the Senate passage of S.901 is a
true testament to the success of the program and the
power of grassroots advocacy.
Senate Passes Legislation to Reauthorize Funding for Community Health Centers
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Congresswoman Allyson Schwartz (D-PA)
introduced the Home Health Care Planning
Improvement Act of 2008 (HR 6826) on
August 1, 2008, with 39 bipartisan cospon-
sors. This is the long-awaited companion bill
to Sen Susan Collins’ (R-ME) bill, S.1678,
introduced on June 21, 2007. Both bills
would allow NPs, CNSs, CNMs, and PAs to
be able to order home care services and
supplies for Medicare patients without
delay. The current Medicare law states that
only physicians may order home health care.
In a statement forwarded to Rep
Schwartz’ office to accompany her press
release, ACNP President Julie Stanik-Hutt
said, “We commend Rep Schwartz for intro-
ducing this important legislation. This bill
will enhance patient access to critical, cost
saving home health services and will
improve patient safety by assuring that the
provider of record, whether a nurse practi-
tioner or a physician, is clearly identified as
the prescriber of home care services. In this
way, both patients and home health care
providers will know who to contact should
they have questions or information to share
regarding the patient.”
Prior to introducing the bill, Schwartz’
office received several poignant vignettes
from NPs in Pennsylvania and others col-
lected by ACNP giving examples of home
care service delays due to difficulties in
finding a physician to sign an order. Please
stay tuned! This is yet another issue on
which national NP organizations are collabo-
rating. Watch for Action Alerts from ACNP
and others, as advocacy is needed from
grassroots NPs!
For full language of this bill, see http://
thomas.loc.gov.
Finally! House Version of Home Health Care
Planning Improvement Act Introduced
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At 10-year intervals, the Office of Management
Bureau of Labor Statistics (BLS) collects data on the
current labor environment based on the Standard
Occupational Classification (SOC) Principles. The
SOC, a national system for categorizing and analyzing
occupations in the public, private, and military sec-
tors, will be updated for 2010. Thus far, the only nurs-
ing information collected has been for RNs. In July
2006, nine advanced practice nursing associations
sent a joint letter to the BLS requesting that nurse
practitioners (NPs), nurse anesthetists (NAs), nurse
midwives (NMs), and clinical nurse specialists (CNSs)
be included in future collection of SOC data. The May
16, 2008, Federal Register notice included an
announcement by the Office of Management and
Budget with updates to the Standard Occupational
Classification – Revision for 2010. The proposed revi-
sion includes newly created categories for NPs, NAs,
and NMs, as requested by the advanced practice
associations; CNSs are not included.
Nurse Practitioners Includedin 2010 SOC Recommendations
Incentives for E-Prescribing in Final Mediicare Legislation
Simmy Randhawa, MS, MBA, RN, CPN, and Angela
Martin, APRN, MSN, both DNP students from George
Washington University, attended ACNP’s Advanced
Public Policy Institute for Health Professionals (PPI) in
March 2008. Here are their key observations and actions.
Simmy said one of the most valuable lessons learned
at the PPI was to focus on tangible things she could actu-
ally accomplish. Using Robert Wood Johnson
Foundation materials for the “Cover the Uninsured
Week,” Simmy set up a booth to assist staff at the
Children’s National Medical Center who were uninsured
and offered educational materials about health insurance
options and availability in both English and Spanish. She
said, “I have been truly enlightened since attending the
PPI. I know I will continue to take a proactive role in learn-
ing more about what I can do as an individual to help
influence and advocate for others.”
Angela, an APRN in private practice and a small busi-
ness owner, focused on learning what was needed to
pass a bill that would make health insurance more afford-
able and accessible for small businesses and the self-
employed. She said, “The major difference in this course
and earlier experiences was the depth and breadth of the
knowledge obtained. I really enjoyed the PPI provided by
ACNP. It was comprehensive and global in its perspec-
tive and highly motivating for taking action.”
Mark your calendar for the next Public Policy Institute
February 18 – 20, 2009!
1555-4144/08/$ see front matter © 2008 American College of Nurse Practitionersdoi: 10.1016/j.nurpra.2008.08.011
DNP Students Learn Advocacy Skills at ACNP’s Public Policy Institute
DNP Students Learn Advocacy Skills at ACNP’s Public Policy Institute
The Medicare Improvements for Patients and
Providers Act of 2008 (P.L. 110-275), passed in July
2008, includes incentives to encourage prescribers to
adopt electronic prescribing technology. This new leg-
islation will provide positive Medicare payment incen-
tives of up to 2% for practitioners who use qualified e-
prescribing systems in 2009 through 2013 and a reduc-
tion in payments of up to 2% to providers who fail to
e-prescribe by 2012.
Is your practice ready to begin e-prescribing on
January 1, 2009? The Center for Improving Medication
Management has provided a useful assessment at
www.GetRxConnected.com that will assist you in your
practice. After completing the brief E-Prescribing
Readiness Assessment, you will receive a report that
lets you know whether your practice’s electronic med-
ical record (EMR)/e-prescribing technology is certified
for a direct electronic connection with pharmacies and
the steps you should take to establish your connection.
Your practice may be using an EMR system but may
not have set up an electronic connection to pharma-
cies yet. Taking the readiness assessment would be
useful in seeing what is needed for establishing an e-
prescribing process in the practice.
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Nashville Convention Center Nashville, Tennessee October 29 – November 2, 2008
Take Advantage of:■ Dynamic keynotes
■ More than 120 CE sessions in a variety of subject areas
■ Over 100 exhibitors
■ Hands on educational and clinical workshops
■ And more!
AMERICAN COLLEGE
OF NURSEPRACTITIONERS
Nashville Convention Center
COLLEGEOF NURSE
PRACTITIONERS 2008 National Clinical
Conference
www.acnpconference.com
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