AACN Responds to AMA Petition on NP and CNS Medicare Reimbursement
AACN has joined nine other professional nursing associations in responding to an American Medical Association (AMA) petition regarding Medicare Part B reimbursement for nurse practitioners (NPs) and clinical nurse specialists (CNSs).
The AMA petition contends that the Health Care Financing Administration (HCFA) has failed to ensure compliance with provisions of the Social Security Act requiring NPs and CNSs to work in collaboration with a physician and in accordance with each state’s legally authorized practice requirements.
The AMA requested the following actions by the HCFA to rectify its approach to enforcing Medicare’s collaboration and scope of practice requirements:
• Implement a system to ensure that Medicare payment to NPs and CNSs are made only in connection with those services furnished in collaboration with a physician and within their state law’s scope of practice requirements.
• Limit distribution and renewal of Medicare billing numbers only to NPs and CNSs who comply with the collaboration and state law scope of practice requirements.
• Issue detailed instructions to Medicare carriers regarding implementation of a system to ensure compliance with the collaboration and state law scope of practice requirements.
• Conduct an immediate “baseline” audit and follow up with periodic audits to ensure that Medicare payments to NPs and CNSs are limited to services furnished in collaboration with a physician and within their state law scope of practice requirements.
In their letter to (HCFA), the organizations point out that clear guidelines already exist and that scope of practice and requirements for collaboration are already a matter of law. Specifically, the letter responds that:
• Federal rules already provide clear guidelines on collaboration.
• Scope of practice and requirements for collaboration are a matter of state law.
• Mechanisms already exist for ensuring compliance with Medicare requirements.
• The AMA petition suggests only theoretical problems.
• Problems that do occur can be responded to cooperatively.
The other associations signing the letter are the American Academy of Nurse Practitioners, American College of Nurse Midwives, American College of Nurse Practitioners, American Nurses Association, American Organization of Nurse Executives, American Psychiatric Nurses Association, Association of Women’s Health, Obstetric and Neonatal Nurses, National Association of Nurse Practitioner Faculties, National Association of Nurse Practitioners in Women’s Health and the National Association of Pediatric Nurse Practitioners.
The full text of the letter can be accessed from the “Public Policy Update” area of the AACN Web site at
Celebrating Critical Care Across the Country
|ICU staff at Baylor Medical Center proudly promoted their contributions. Pictured (from left) are Elizabeth Smith, Annette Cox, Amber Brown, Boramy Pehn, Joanne Minuete and Grace Nelson.||
Awards and photos, as well as a plaque saluting CCRN-certified nurses, were part of the displays at the Critical Care Awareness Fair at St. Francis Health and Hospital Centers.|
National Critical Care Awareness and Recognition Month in May 2000 was celebrated in myriad ways across the country.
For example, at Baylor Medical Center at Garland In Texas, the staff of the 19-bed combined ICU used the occasion to expose community members as well as colleagues in other healthcare disciplines to the work of the critical care staff.
Hosted by the Shared Governance Council, the observance focused on the national theme of “Knowledge, Experience, Compassion: The Power of Critical Care.”
This theme was displayed prominently at the Critical Care Day Fair, visited by more than 300 people. Each staff member wore a button promoting critical care awareness.
The ICU nurses created poster displays on a variety of topics, including diabetes, asthma, smoking cessation, heart attacks and stroke. They also presented a history of critical care nursing and information about pulmonary artery (PA) catheters and mechanical ventilators. One display simulated an open-heart surgery patient recovering in the ICU and was complete with a ventilator, pacemaker, PA catheter, arterial line, foley catheter and chest tubes.
The area chapter of the American Heart Association donated brochures on topics such as risk factors for heart attack, exercise importance and risk factors for stroke, as well as booklets with recipes for low-fat, low-cholesterol meals. In addition, several pharmaceutical companies donated door prizes for the event and displayed patient information on medications available for the treatment of conditions such as hypertension and hypercholesterolemia.
The Shared Governance Council, which gives the nurses the opportunity to make decisions relevant to their unit, was piloted in the ICU for one year prior to its adoption by the other nursing departments.
At the same time, critical care nurses at St. Francis Health and Hospital Centers, Beech Grove, Ind., presented posters and displays highlighting who they are and what they do.
The Critical Care Awareness Fair was situated in the west lobby, where all visitors to the facility could stop to view the information. The nurses also created prizes that were raffled at the fair.
In addition to displays related to each of the ICU areas, posters celebrating the achievements of the CCRNs on the staff were presented. Award plaques, a slide show of critical care nurses in action and staff photos were also displayed. Information about various
professional associations, including AACN, provided information on how nurses could be involved in a more global network.
Hey, Mom, the White House Called!
“Bread, cheese and diet Coke” might be typical of a message board in many homes. However, the message and number left on the board at the Thornby residence was not.
I don’t know about you, but I usually do not get calls from the White House. In fact, I have never had a call from the White House—until now. Imagine my surprise when my 17-year-old daughter Sarah greeted me with: “Hey, Mom, the White House called.”
Why would the White House call me? The fact is the White House was not calling me, but all of you as members of AACN. I just happen to be representing you this year as your president. In that capacity, I was invited to participate in a conference call, along with representatives of other specialty nursing and state nursing associations.
The call was facilitated by the Office for Women at the White House to discuss issues of concern to the nursing community. Barbara Wooley, special assistant to the president on women’s affairs, and Beverly Malone, deputy assistant secretary for health at the Department of Health and Human Services, updated us on current legislative issues important to nursing. Those invited to participate in the call then commented on a variety of issues, including regulation of nurse practitioners; the nursing shortage, as well as the shortage of nursing faculty; bachelor of science in nursing preparation; access to healthcare; and the provision of sufficient nursing staff in schools, home health and nursing homes.
I was able to specifically address the serious concerns expressed by our members, both male and female, regarding workplace issues that diminish their ability to provide the care our most vulnerable and critically ill patients need. I pointed out that nurses help ensure safe passage of patients through the healthcare system and emphasized that the nursing shortage is more than a concern for nursing; it is a crisis for our country.
President Clinton created the White House Office for Women’s Initiatives and Outreach in June 1995 to better serve and listen to his constituents. The office serves as a liaison between the White House and women’s organizations by listening to women’s concerns and proposals to present to the president and others in the administration. Both internally and externally, the office advocates for issues that are important to women. In addition, the office schedules events and speeches for White House officials and presidential appointees and promotes roundtable discussions to amplify the president’s pro-woman, pro-family agenda.
Wooley serves as the administration’s “eyes and ears” on women’s issues. She strives to make sure that nurses are prominent in healthcare discussions and visible to the administration.
Accomplishments, policy statements, links to women-focused sites and e-mail contacts can be found on the office’s Web site at www.whitehouse.gov/women.
This White House call was an exceptional opportunity to speak on your behalf. More importantly, it demonstrated the influential position AACN enjoys within the nursing and critical care community. Being part of an organization that is invited to the table on important issues or that is a leader in the discussions is an important value of your membership. The same was true when I attended the American Nurses Association convention, where AACN is an organizational affiliate. ANA and other specialty organizations see AACN as a leader and look for opportunities to join with us as a voice on common issues.
AACN has positioned itself to have an influence and is making waves. We hope all of you will join with us, and encourage your colleagues to do so as well, to make AACN even stronger as the undisputed leader in critical care.
Public Policy Update
Healthcare Issues Rank High With Voters
A recent survey conducted by the Washington Post, the Kaiser Family Foundation and Harvard University found that healthcare
ranks highest among the issues voters say are important to them.
The study also found that the voters surveyed view Democrats as best able to deal with these issues. Of respondents who considered healthcare a voting issue, 55% said Gore would do a better job on the issues, compared to 30% percent that favored Bush.
The survey, which was conducted between July 5 and 18, 2000, involved a nationally representative sample of registered voters, as well as an over-sample of “health care or Medicare-oriented” registered voters. The survey was designed to provide a more in-depth look at the attitudes of issue-oriented voters as compared to registered voters in general.
Survey findings showed that 42% of registered voters viewed healthcare or Medicare as one of the two most important issues that will decide their presidential vote, with 16% citing Medicare and 26% citing healthcare. However, the term healthcare covered multiple issues.
Asked to identify the most important healthcare issues, 20% of respondents said making Medicare “financially sound”; 19% said increasing the number of insured Americans; 15% said protecting patients rights in health plans; 14% said helping people age 65 and older pay for medicines; 11% said regulating the costs of medicine; and 11% said helping families with the cost of caring for elderly or disabled family members.
Survey respondents favored Clinton-Gore Medicare prescription coverage proposals by a margin of 57% to 36% over the Bush-congressional GOP approach of delivering prescription benefits through private plans. Eight out of 10 voters wanted a patient’s bill of rights to sue health plans and seven out of 10 wanted federal action to cover more of the uninsured, though only 38% would be willing to pay more taxes to fund a major government effort to cover the uninsured.
The full survey can be found at
Nursing Home Quality Protection Act
In July 2000, Rep. Henry Waxman (R-Calif.) introduced H.R. 4949, the Nursing Home Quality Protection Act. The bill would establish stricter sanctions on nursing homes that violate health and safety standards; provide more funding for nursing homes to hire additional staff to provide better care for residents; and require the federal government to post detailed information about nursing homes on the Internet, so that the public has the information they need when considering nursing homes for placement of family members.
Preliminary research conducted in three states by the Health Care Financing Administration (HCFA) suggests that nursing home quality of care is seriously impaired when nursing staff levels fall below minimum ratios. The study findings include the fact that 54% of nursing homes are below the recommended minimum level of two hours of care provided by nurse aides per resident per day; 23% are below the suggested minimum level of 45 minutes of care provided by total licensed staff (RNs and LPNs) per resident per day; and 31% are below the suggested minimum level of 12 minutes of care provided by RNs per resident per day.
Phase One of the study does not provide specific recommendations for the potential establishment of a regulatory minimum ratio requirement and will be followed by a Phase Two study to gather data on more states in order to identify alternative minimum thresholds and to assess relative costs and benefits of such ratios. In addition, more research will be required to assess the feasibility of implementing minimum ratio requirements.
The complete HCFA study can be found at
Needlestick Legislation Update
California became the first state to enact needlestick legislation in 1998, followed by Texas, Maryland and Tennessee in 1999. Measures to protect healthcare workers from HIV exposure are being proposed in additional states through measures to reduce needlestick injuries. New laws in Alaska and Connecticut require health facilities to use “safe needles” whenever possible. The Connecticut law provides an exception for drugs that are prepackaged or for FDA-approved prefilled syringes, as long as proper disposal systems are in place.
In New Hampshire, lawmakers recently established a committee to study the feasibility of requiring healthcare workers to use only retractable needles. The committee is scheduled to report recommendations by Nov. 1, 2000. A new Maryland law requires state health and labor officials to adopt regulations to implement the federal blood borne pathogen standard, which governs occupational exposure to blood and other potentially infectious materials.
Study Shows Nursing Home Drug Errors Preventable
Researchers at the University of Massachusetts Medical School and Brigham and Women’s Hospital, Boston, Mass., found 546 medication-related injuries at 18 Massachusetts nursing homes over a one-year time period. According to Jerry Gurwitz, MD, a gerontologist at the university, if the results are extrapolated nationally, there are an estimated 350,000 adverse drug events yearly in nursing homes; 20,000 of them are fatal or life-threatening; and half of those are preventable. The study, which is the first to focus on medical errors in long-term care facilities also found 188 “near misses,” or errors that could have resulted in adverse effects but did not.
Gurwitz pointed to the current environment and healthcare system factors such as sicker patients receiving more medications, staffing shortages of licensed nursing positions, high turnover rates of less-skilled staff, frequent use of temporary employees and lack of quality improvement programs as contributing to the errors. Most of the problems in nursing homes were found to be related to a problem with monitoring drug treatment. Improvement in documenting patient drug data and education to train the staff in the safe use of medications are needed to reduce the incidence of medication errors.
The study was published in the August issue of the American Journal of Medicine.
CDS Is a Resource for Professional Development
Editor’s note: Following is the first in a series of articles by Career Development Services on ways AACN members can maximize their career strategies and build their portfolios.
By Rosemary Westra, RNC, MS
Manager, Continuing Education and Career Development Services
In today’s dynamic healthcare environment, professional nurses can blend their unique knowledge, skills and experience to meet new demands and to create new professional opportunities. Professional development requires an ongoing assessment and redefinition of one’s personal skills and interests, as well as familiarity with the healthcare environment. For AACN members, Career Development Services (CDS) is available to assist in these areas.
What Is CDS?
CDS is an alliance between AACN and Cross Country TravCorps, the country’s largest medical staffing company. Through this free service, AACN members can access career and professional development services. The key components of CDS are career coaching, career placement and career information.
Career Coaching—Career coaches assist critical care nurses in developing strategies to reach their career goals. Included are assistance with skills, interests and values clarification, resume development, job interviewing and job negotiation techniques.
Career Placement—Career coaches assist nurses who are interested in exploring job opportunities by providing information about the availability of travel and permanent jobs nationwide. Included are job placement, negotiation of contracts and benefits packages, licensure information and relocation assistance.
Career Information—CDS provides information such as salary surveys, state licensure requirements and projected job market trends.
How Can CDS Assist Me?
Trained career coaches are available to assess your career preferences, current capabilities, clinical background and professional skills. Using this assessment, CDS coaches assist individuals in identifying career goals and strategies to achieve their goals. Career coaches also provide information about marketplace trends, career-oriented articles and publications, and information about academic and credentialing requirements for specific career options.
How do I access CDS?
All AACN members have access to CDS by calling (888) AACN-JOB (222-6562) or by visiting the AACN Web site at www.aacn.org.
CDS welcomes your questions about career development. E-mail your questions to
email@example.com. Selected questions will be answered in future columns.
Next: Skills for the Millennium
Share the Benefits of AACN Membership
Share the benefits of membership in AACN with your nurse colleagues—and earn the chance to receive valuable prizes.
AACN’s new Member-Get-A-Member campaign is now under way and continues through Dec. 31, 2000.
Member recruiters in both individual and chapter categories will be entered into a prize drawing each time a new member lists them on the “referred by” line of his or her membership application. Thus, the chances of winning prizes increases with each new member recruited.
However, the rewards start up front, because recruiters will receive a free gift the first time a qualified new-member application is received.
Following are the prizes that will be awarded in the drawing:
Grand Prize (one per category)—Registration, airfare and hotel for NTI 2001, May 19 through 24
First Prize(one per category)—Three-year membership to AACN (a $211 value) or an AACN gift certificate of equal value
Second Prize (two per category)—Two-year membership to AACN (a $148 value) or an AACN gift certificate of equal value
Third Prize (three per category)—One year membership to AACN (a $78 value) or an AACN gift certificate of equal value.
For more information about this new Member-Get-A-Member campaign or to receive member recruitment materials, call (800) 899-AACN (2226), or visit the AACN Web site at
Group Discount for All Member Categories
Nurses who join AACN or renew their membership as a group of five or more receive a discount on the membership fee.
The group discount program applies to members or affiliate members, as well as to international, student and emeritus memberships.
New and renewing groups of members or affiliate members pay a $69 membership fee per year instead of the $78 annual individual fee. Groups of international members pay $92 per year instead of $104, and groups of student members or of emeritus members pay $46 instead of $52.
This group rate applies only to one-year memberships, and full payment for all members in the group must accompany applications. Membership certificates will be mailed to the individual placing the order for distribution to all members of the group.
For more information about this new program or to obtain a group membership application form, call (800) 899-AACN (2226), or visit the AACN Web site at
The Intravenous Nurses Society will present “Needlestick Safety Issues in Infusion Therapy” on Nov. 4 and 5, 2000, in Orlando, Fla. For more information, contact INS Membership Services at (800) 694-0298.
Best Practices in Critical Care Nursing
“Best Practices in Adult and Pediatric Critical Care Nursing: Innovation and Success” will be presented by Lucile Packard Children’s Hospital and Stanford Hospital & Clinics from Nov. 8 through Nov. 11, 2000 at the Mauna Lani Bay Hotel in Hawaii. For more information, call Barbara Pannoni at (650) 497-8273.
Information printed in “Currents” is provided as a service to interested readers and does not imply endorsement by AACN or AACN Certification Corporation.
Write a CE Article
AACN is seeking nurses or other healthcare professionals who are interested in submitting articles to be published as continuing education offerings in AACN News and on the AACN Web site, or for use as a monograph.
Suggested topics include domestic violence, AIDS/HIV to meet state relicensure requirements (e.g. Florida), telemetry and progressive care issues, pain management, sedation, neuromuscular blockade, case management, invasive and noninvasive monitoring and renal patient care, as well as JCAHO compliance-related articles that address competency and skill validation programs, tools or best practices.
Send abstracts to Marianne Martineau, Education Resource Specialist, AACN, 101 Columbia, Aliso Viejo, CA 92656. Additional information is available by calling (949) 362-2000, ext. 361.
Receive a Free Educational Tool When You Order From AACN
Order a product from the AACN Resource Catalog through September 2000 and receive an educational tool valued at up to $10 free, while
You can order by calling (800) 899-AACN (2226), or online in the “Bookstore” area of the AACN Web site at www.aacn.org, or by calling (800) 899-AACN (2226). Mailed orders must be postmarked by Sept. 30, 2000, to be eligible for this special offer.
Limit one coupon per order. Not redeemable for cash. Offer good only on products ordered directly from AACN.
Oct. 1 Proposals due for AACN Data-Driven Clinical Practice Grant. To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the
"Research” section of the AACN Web site at
Oct. 1 Proposals due for AACN Clinical Practice Grant. To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the “Research” section
of the AACN Web site at
Oct. 1 Proposals due for AACN-Sigma Theta Tau Critical Care Grant. To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the
"Research” section of the AACN Web site at
Nov. 1 Deadline to submit exemplars in connection with AACN Circle of Excellence awards for 2001. For more information, call (800) 899-AACN (2226) or visit
the AACN Web site at
http://www.aacn.org. Click on “Awards.”
Dec. 31 AACN’s Member-Get-A-Member campaign ends. For more information, call (800) 899-AACN (2226) or visit the AACN Web site at