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AORN Board of Directors meets with American Nurses' Association Washington, DC, staff
AORN JOURNAL
DECEMBER 1986, VOL. 44, NO 6
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7
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Legislation AORN Board of Directors meets with American Nurses’ Association Washington, DC, staff One View of Major Issues Facing the 100th Congress
T
he AORN Board of Directors, executive director, associate executive director, and chairman of the Legislative Committee met with the staff of the American Nurses’ Association (ANA), Washington, DC, at their office on Oct 13 and 14. The purpose of the meeting was to update the Board of the Association about the operations of the ANA Washington, DC, ofice. The meeting was a part of the contract agreement between ANA and AORN that was initiated in August. The underlying theme of the presentations over the two days was that of budget cuts and their effects on the nursing profession and health care policy. “Money is being cut and therefore, length of stay and labor are being cut by hospitals,” said Tom Nickels, JD, director of congressional and agency relations. Irene Gibson, RN, senior analyst, Health Care Financing Administration (HCFA), described the finalization of the Medicare/Medicaid conditions of participation for hospitals that appeared in the June 17 issue of the Federal Register. Those conditions contain the change in terminology regarding RN circulators and state that “LPNs and surgical technologists may assist in circulatory duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies.” Because operating supervisors must be experienced, Gibson said she believes the OR supervisors will evaluate the experience of technicians and LPNs before assigning them to circulate. She also emphasized that the conditions of participation are minimal standards for hospitals.
S
heila Burke, RN, chief of staff for Senate Majority Leader Robert Dole, presented her view of the major issues that will face the 100th Congress. First of those was institutional services, including what changes need to be made to the diagnosis related group (DRG) system for case severity, recalibrating averages, reimbursement to urban versus rural institutions, indigent care financing, and quality of care including discharge planning and how to finance out-of-hospital care. Competition among health care providers is another issue that will face the next Congress, according to Burke, as well as Medicare payments to physicians, the issue of what the minimum amount of employee health care benefits should be-especially benefits for retirees-and priorities for education, home health care financing, and research.
Payment Reform
T
he Medicare system pays for between 50% and 60%of all health care costs in this country, according to Mike Hash, an employee of Health Policy Alternatives, a Washington, DC, consulting firm, and former lobbyist for the American Hospital Association. Congress will be looking at payment reform in its next session. Physician payments under Medicare Part B are doubling every five years, and represent 20%of Medicare outlays, said Hash. A capitated system of payment is appealing to members of Congress because the government would pay a set amount 1021
AORN J O U R N A L
DECEMBER 1986, VOL. 44, NO 6
for each beneficiary and then would not have to be concerned about who picks up the cost of overruns. New procedures that must be set up in the Medicare system include patient protocols, practitioner standards, and institutional standards. Peer review organizations (PROs) will look at whether a procedure should be done on an inpatient or an outpatient basis, if the procedure should be done, and will review records for qualifications of the practitioner. “PROs are the best defense against accusations about quality of care,” said Hash, adding that nurses should play a part in the peer review process. “Nurses should be reviewing nursing practice.”
The Selective Service Issue
A
lthough the portion of a bill that includes a requirement for selective serviceregistration of health care professionals was not included in the final bill, the shortage of RNs in the military nurse corps will again be an issue for the next Congress. The Department of Defense (DOD) predicts a shortfall of 31,800 from the 58,000 members of the total nurse corps required for wartime readiness. Several nursing organizations will meet with the DOD to help plan how the DOD can increase recruitment efforts, according to Donna Richardson, senior staff specialist on the congressionaland agency relations staff at ANA. The nursing specialties in shortest supply are critical care, surgery, orthopedics, and nurse anesthetists.
ANA Political Action Committee
T
he ANA Political Action Committee (ANAPAC) was described by Joanne Symons, director of political education. The committee has been in existence for five years, and its pu’poses are to “influence elections in a visible way and provide funds.” There are 43 state nursing aSSOciation political action committees af€iliated with ANA and 360 Congressional district coordinators. Five of the nine members of the ANA-PAC board are members of the ANA board of directors; the other four are ANA general members.
The staff of ANA-PAC researches the voting records of all candidates, and endorses those who are interested in health care issues and have been helpful to nursing. Those candidates who are endorsed receive financial assistance for their campaigns from ANA-PAC. Staff members also visit individual states to assist in grass-roots campaign efforts.
Other Updates
J
ane Pinsky, senior staff specialist on the congressional and agency relations staff, discussed pay equity. She said only the states of Arkansas, Delaware, and Utah have not yet done studies on pay equity, and predicted an average increase in salaries for nurses of between 8%and 14% in states where pay equity is implemented. Prospective Payment Assessment Commission (ProPAC) staff representative Robin Burman explained the function of the commission in overseeing the prospective payment system and reporting to Congress. Seventeen commissioners serve for three-year staggered terms; one commissioner is Carolyne K. Davis, RN, PhD, former administrator of HCFA. Kathy Michels, RN, JD, assistant director of congressional and agency relations for ANA, said fiscalyear 1987 appropriations for nursing programs had been set. Funding for nursing education totals $53.3 million, an increase of $1.1 d o n over fiscal year 1986. Nursing research was appropriated $19 million, an increase of $2.3 million over last fiscal year. At least $2 million of the $19 million must be spent on national research service awards. Michels is the AORN contact in the ANA Washington, DC, office. She will assist in increasing the visibility of AORN and broadening its legislative activities in Washington, DC. She will keep AORN staff members apprised of the status of current issues of interest to AORN. She holds a BSN from the University of Wisconsin-Oshkosh, and a Juris Doctor from the University of Wisconsin-Madison. Before joining the ANA staff in 1984, Michels was a nurse attorney and legislative liaison for the Wisconsin Nurses’ Association, Madison. DEBORAH J. COMBS EDITOR ASSOCIATE 1023
DECEMBER 1986, VOL. 44, NO 6
T
7
. *
Legislation AORN Board of Directors meets with American Nurses’ Association Washington, DC, staff One View of Major Issues Facing the 100th Congress
T
he AORN Board of Directors, executive director, associate executive director, and chairman of the Legislative Committee met with the staff of the American Nurses’ Association (ANA), Washington, DC, at their office on Oct 13 and 14. The purpose of the meeting was to update the Board of the Association about the operations of the ANA Washington, DC, ofice. The meeting was a part of the contract agreement between ANA and AORN that was initiated in August. The underlying theme of the presentations over the two days was that of budget cuts and their effects on the nursing profession and health care policy. “Money is being cut and therefore, length of stay and labor are being cut by hospitals,” said Tom Nickels, JD, director of congressional and agency relations. Irene Gibson, RN, senior analyst, Health Care Financing Administration (HCFA), described the finalization of the Medicare/Medicaid conditions of participation for hospitals that appeared in the June 17 issue of the Federal Register. Those conditions contain the change in terminology regarding RN circulators and state that “LPNs and surgical technologists may assist in circulatory duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies.” Because operating supervisors must be experienced, Gibson said she believes the OR supervisors will evaluate the experience of technicians and LPNs before assigning them to circulate. She also emphasized that the conditions of participation are minimal standards for hospitals.
S
heila Burke, RN, chief of staff for Senate Majority Leader Robert Dole, presented her view of the major issues that will face the 100th Congress. First of those was institutional services, including what changes need to be made to the diagnosis related group (DRG) system for case severity, recalibrating averages, reimbursement to urban versus rural institutions, indigent care financing, and quality of care including discharge planning and how to finance out-of-hospital care. Competition among health care providers is another issue that will face the next Congress, according to Burke, as well as Medicare payments to physicians, the issue of what the minimum amount of employee health care benefits should be-especially benefits for retirees-and priorities for education, home health care financing, and research.
Payment Reform
T
he Medicare system pays for between 50% and 60%of all health care costs in this country, according to Mike Hash, an employee of Health Policy Alternatives, a Washington, DC, consulting firm, and former lobbyist for the American Hospital Association. Congress will be looking at payment reform in its next session. Physician payments under Medicare Part B are doubling every five years, and represent 20%of Medicare outlays, said Hash. A capitated system of payment is appealing to members of Congress because the government would pay a set amount 1021
AORN J O U R N A L
DECEMBER 1986, VOL. 44, NO 6
for each beneficiary and then would not have to be concerned about who picks up the cost of overruns. New procedures that must be set up in the Medicare system include patient protocols, practitioner standards, and institutional standards. Peer review organizations (PROs) will look at whether a procedure should be done on an inpatient or an outpatient basis, if the procedure should be done, and will review records for qualifications of the practitioner. “PROs are the best defense against accusations about quality of care,” said Hash, adding that nurses should play a part in the peer review process. “Nurses should be reviewing nursing practice.”
The Selective Service Issue
A
lthough the portion of a bill that includes a requirement for selective serviceregistration of health care professionals was not included in the final bill, the shortage of RNs in the military nurse corps will again be an issue for the next Congress. The Department of Defense (DOD) predicts a shortfall of 31,800 from the 58,000 members of the total nurse corps required for wartime readiness. Several nursing organizations will meet with the DOD to help plan how the DOD can increase recruitment efforts, according to Donna Richardson, senior staff specialist on the congressionaland agency relations staff at ANA. The nursing specialties in shortest supply are critical care, surgery, orthopedics, and nurse anesthetists.
ANA Political Action Committee
T
he ANA Political Action Committee (ANAPAC) was described by Joanne Symons, director of political education. The committee has been in existence for five years, and its pu’poses are to “influence elections in a visible way and provide funds.” There are 43 state nursing aSSOciation political action committees af€iliated with ANA and 360 Congressional district coordinators. Five of the nine members of the ANA-PAC board are members of the ANA board of directors; the other four are ANA general members.
The staff of ANA-PAC researches the voting records of all candidates, and endorses those who are interested in health care issues and have been helpful to nursing. Those candidates who are endorsed receive financial assistance for their campaigns from ANA-PAC. Staff members also visit individual states to assist in grass-roots campaign efforts.
Other Updates
J
ane Pinsky, senior staff specialist on the congressional and agency relations staff, discussed pay equity. She said only the states of Arkansas, Delaware, and Utah have not yet done studies on pay equity, and predicted an average increase in salaries for nurses of between 8%and 14% in states where pay equity is implemented. Prospective Payment Assessment Commission (ProPAC) staff representative Robin Burman explained the function of the commission in overseeing the prospective payment system and reporting to Congress. Seventeen commissioners serve for three-year staggered terms; one commissioner is Carolyne K. Davis, RN, PhD, former administrator of HCFA. Kathy Michels, RN, JD, assistant director of congressional and agency relations for ANA, said fiscalyear 1987 appropriations for nursing programs had been set. Funding for nursing education totals $53.3 million, an increase of $1.1 d o n over fiscal year 1986. Nursing research was appropriated $19 million, an increase of $2.3 million over last fiscal year. At least $2 million of the $19 million must be spent on national research service awards. Michels is the AORN contact in the ANA Washington, DC, office. She will assist in increasing the visibility of AORN and broadening its legislative activities in Washington, DC. She will keep AORN staff members apprised of the status of current issues of interest to AORN. She holds a BSN from the University of Wisconsin-Oshkosh, and a Juris Doctor from the University of Wisconsin-Madison. Before joining the ANA staff in 1984, Michels was a nurse attorney and legislative liaison for the Wisconsin Nurses’ Association, Madison. DEBORAH J. COMBS EDITOR ASSOCIATE 1023