- Email: [email protected]
AORN contracts with American Nurses' Association for help on legislative issues; direct reimbursement for nurses; vaccine-related injuries
AORN JOURNAL
OCTOBER 1986, VOL. 44, NO 4
Leg islation AORN contracts with American Nurses’ Association for help on legislative issues; direct reimbursement for nurses; vaccine-related injuries AORN has signed a contract with the American Nurses’ Association (ANA) division of governmental affairs in Washington, DC for consulting services on legislative issues. The purpose of the agreement is for ANA to assist AORN in broadening legislativeand political activities in Washington, DC, and to “raise the stature and visibility of AORN in this area,” according to the contract proposal. The contract went into effect in August. One aspect of the agreement calls for testimony presented by ANA to be sent to Clifford Jordan, AORN executive director, and to Alicia Arvidson, AORN president. Staff members in the governmental affairs office will also be available to respond to telephone calls from Headquarters regarding legislative issues. The ANA office in Washington, DC, opened in 1951 with one staff member who served as a full-time lobbyist. The division is now composed of 11 professional staff members. Their mission is to: mediate the relations of the nursing profession to the federal government, influence national health policy, legislation,and regulations, and educate nurses to participate in local, state, national, and political processes. AORN staff members will work closest with ANA congressional and agency relations personnel, a division of the governmental affairs office. Thomas P. Nickels, JD, was recently promoted to director of congressional and agency relations after serving as ANA director of legislativeaffairs. He has been with ANA for six years, and before that served as a legislative assistant to a
congressman.Kathy Michels, RN, JD, senior staff specialist, will be our contact person. Gloria Hope, RN, PhD, is the director of the division of governmental affairs, a recent promotion from director of congressional and agency relations, where she served for two years. Before joining the ANA staff in Washington, DC, Dr Hope was with the Veterans Administration (VA). She retired in 1982 as deputy director of the VA Nursing Service, and worked for the VA at several VA medical centers as associate chief, nursing service for education. She was also an education specialist and chief, education and training division, for the VA. The Washington, DC, staff will “basically be the eyes and ears for you [AORN],” said Nickels. He explained their functions as follows. First, when an issue arises that is of interest to nursing, the congressional and agency relations staff investigates where the issue is substantively, what the history of the issue is, and determines what proposals have been made. The second step is to determine the politics of the issue, who is pushing the issue and who is working to prevent it, and who has some interest in the issue that could possibly be influenced. The staff then works together to determine why the issue has become an issue, and then identifies legislators who might be influenced. If the issue is a regulatory affair, the staff member assigned to that agency speaks with a representative of that agency in person. When ANA wants to present testimony before a congressional committee, the staff must then “try to get a seat at the table,” said Nickels. There are usually more organizationsthat want to present 639
AORN JOURNAL
testimony than there are seats at the table, so ANA must lobby to get a seat. To get a seat, “you have to be the most aggressive, know the people, and be articulate,” Nickels said. In determining ANA legislative priorities, the committee on legislation presents recommendations for issues to the ANA board of directors. The committee is composed of the ANA president and two members of the ANA board. The input on long-term policy recommendations comes from the ANA cabinets, councils, and staff, state nurses associations, the Nursing Organization Liaison Forum, and consultants. The board considers the recommendations of the committee, and then communicates its actions to the house of delegates. Although not in order of priority, the following are the top legislativepriorities for ANA, according to Nickels: reimbursement under Medicare for nurses who provide community health care, opposition to budget cuts that will affect health care, opposition to the ddimg of health professionals, which is expected to continue to be an issue, efforts toward implementation and continued funding of the National Center for Nursing Research, maintenance and protection of the Medicare program, and ensuring quality patient care under the Medicare program. The political education section of the division of governmental affairs administers the ANA political action committee (ANA-PAC), and works to involve nurses in politics through seminars to organize efforts. The ANA ofice in Washington, DC also assists state nurses associations on federal issues, and is available to give advice to the state associations. They also hold a meeting once each month to update representatives of various nursing organizations on legislative issues. Nickels stressed that the practice of every nurse is affected by legislative activities in Washington, DC. The issue of direct reimbursement for nurses and nurse midwives continues, in spite of 640
OCTOBER 1986, VOL. 44, NO 4
President Reagan’s veto of the Federal Employees Benefits Improvement Act of 1985 in January. That act would have allowed direct a w e s to the services of nurses and nurse midwives without the supervision of or referral from a physician, and would have allowed direct reimbursement to those nurses. The House of Representatives has now passed a new resolution (HR 4825), the Federal Employees Health Care Freedom of Choice Act of 1986, which would allow nurses to be reimbursed for services they are licensed to perform that are covered under federal employee health benefits plans. Speaking in favor of the bill to the House, Congressman Benjamin Gilman (R-NY), said, “Direct reimbursement for nurse practitioners, for example, will allow nurses who are qualified health care providers to be viewed as credible and economic participants in our changing health care system, eligible in their own right to be reimbursed for providing health care services,” according to the Aug 11 issue of Capital Update. The issue will be considered by the Senate next, where no action on the issue has taken place since the veto. The nation’s first mandatory no-fault compensation bill for vaccine-related injuries was passed in North Carolina, at least partly due to the lobbying efforts of the physicians in that state. The law passed both houses on July 11, and does not require the signature of the governor. North Carolina pediatricians last year were “shaken by the spectacle of one of their most respected colleagues agreeing to a $1.1 million malpractice settlement in a vaccine case,” according to the Aug 1 issue of American Medical News. The no-fault law takes effect Oct 1. Under the new law, families who allege that their children suffered injuries as a result of statemandated vaccines (diphtheria, pertussis, tetanus [DPT]; measles-mumps-rubella; and polio) must present their claims to the state industrial commission. The commission will determine whether the alleged injuries are vaccine-related and how much compensation will be allowed. Free medical, social, and educational services
AORN JOURNAL
for the child may be awarded to the family from the state department of human resources, as well as a maximum of $300,000 compensation for additional care, pain and suffering,loss of earnings, or attorney fees. Families will not be allowed to pursue their cases through the court system until they have received a decision from the commission; they can then appeal the decision of the commission through the courts. If the state attorney general finds that the provider who administered the vaccine or the manufacturer that produced the vaccine was negligent, the state may sue the provider and manufacturer; however, damages cannot exceed the amount the commission awarded to the family. The belief that vaccine manufacturers would lower prices because liability costs would decrease under the new law was a key element in passage of the bill. One DPT manufacturing company announced in May that it would raise the price of a vial of DPT vaccine from $64 to $17 1 because it was unable to obtain liability insurance; $120 of that cost per vial was to be set aside to pay for self-insurance. At a July 25 meeting of the US House energy and commerce subcommittee on health, Malinda Carter, member of the ANA board of directors, testified on the vaccine liability and compensation issue. Carter spoke in support of subcommittee chairman Henry Waxman’s (D-Calif) bill that would establish an administrativesystem to handle the grievances of vaccine injury victims, according to the Aug 11 issue of Capital Update. The bill would also contain compensation schedules for vaccine-related injuries, but it would not deny access to the court system. The ANA endorses the National Childhood Vaccine Injury Act (HR 5184), according to Carter. “A balance must be drawn between the concerns of the parents whose children have suffered as a result of participating in immunization programs, and those of the pharmaceutical manufacturers who, through no fault of their own, cannot guarantee that their products will be 100% reaction-free,” said Carter. The bill is set up to be no-fault, as is the North Carolina law. J COMBS DEBORAH ASSOCIATE EDITOR 642
OCTOBER 1986, VOL. 44, NO 4
Best Bypass Surgeries at High-Volume Hospitals Patients who underwent coronary artery bypass surgery had a higher rate of survival at hospitals that performed a large volume of bypass surgeries, according to a study by the Institute for Health Policy Studies, University of California, San Francisco. The researchers found that in California, hospitals that performed more than 200 bypass surgeries each year not only had the best survival rates but were also the most cost-effective. They estimated that in California alone, about 30 lives and more than $16 million could be saved each year if all the bypass surgeries were performed in high-volume hospitals. The study was commissioned by Blue Shield and the US Department of Health and Human Services. It was reported in the June 20 issue of Modern Healthcare.
Enrollment Up in Health Maintenance Organizations Enrollment in health maintenance organizations (HMOs) increased by nearly 26%in 1985. As a result, 21 million people belong to an HMO, according to statistics from Interstudy, a research firm in Excelsior, Minn. The 26%enrollment jump was the largest single-year increase since Interstudy began compiling annual HMO statistics in 1981. Other statistics included: a 42%increase in HMOs bringing the total to 244 plans (which includes Medicaid and Medicare HMOs for the first time, according to Interstudy), a 5.4%decrease in the number of not-forprofit HMOs, a 6.6%increase in federally qualified plans bringing the total to 273, and that not-for-profit plans now have 65%of the HMO enrollment. The statistics were reported in the June 20 issue of Modern Healthcare.
OCTOBER 1986, VOL. 44, NO 4
Leg islation AORN contracts with American Nurses’ Association for help on legislative issues; direct reimbursement for nurses; vaccine-related injuries AORN has signed a contract with the American Nurses’ Association (ANA) division of governmental affairs in Washington, DC for consulting services on legislative issues. The purpose of the agreement is for ANA to assist AORN in broadening legislativeand political activities in Washington, DC, and to “raise the stature and visibility of AORN in this area,” according to the contract proposal. The contract went into effect in August. One aspect of the agreement calls for testimony presented by ANA to be sent to Clifford Jordan, AORN executive director, and to Alicia Arvidson, AORN president. Staff members in the governmental affairs office will also be available to respond to telephone calls from Headquarters regarding legislative issues. The ANA office in Washington, DC, opened in 1951 with one staff member who served as a full-time lobbyist. The division is now composed of 11 professional staff members. Their mission is to: mediate the relations of the nursing profession to the federal government, influence national health policy, legislation,and regulations, and educate nurses to participate in local, state, national, and political processes. AORN staff members will work closest with ANA congressional and agency relations personnel, a division of the governmental affairs office. Thomas P. Nickels, JD, was recently promoted to director of congressional and agency relations after serving as ANA director of legislativeaffairs. He has been with ANA for six years, and before that served as a legislative assistant to a
congressman.Kathy Michels, RN, JD, senior staff specialist, will be our contact person. Gloria Hope, RN, PhD, is the director of the division of governmental affairs, a recent promotion from director of congressional and agency relations, where she served for two years. Before joining the ANA staff in Washington, DC, Dr Hope was with the Veterans Administration (VA). She retired in 1982 as deputy director of the VA Nursing Service, and worked for the VA at several VA medical centers as associate chief, nursing service for education. She was also an education specialist and chief, education and training division, for the VA. The Washington, DC, staff will “basically be the eyes and ears for you [AORN],” said Nickels. He explained their functions as follows. First, when an issue arises that is of interest to nursing, the congressional and agency relations staff investigates where the issue is substantively, what the history of the issue is, and determines what proposals have been made. The second step is to determine the politics of the issue, who is pushing the issue and who is working to prevent it, and who has some interest in the issue that could possibly be influenced. The staff then works together to determine why the issue has become an issue, and then identifies legislators who might be influenced. If the issue is a regulatory affair, the staff member assigned to that agency speaks with a representative of that agency in person. When ANA wants to present testimony before a congressional committee, the staff must then “try to get a seat at the table,” said Nickels. There are usually more organizationsthat want to present 639
AORN JOURNAL
testimony than there are seats at the table, so ANA must lobby to get a seat. To get a seat, “you have to be the most aggressive, know the people, and be articulate,” Nickels said. In determining ANA legislative priorities, the committee on legislation presents recommendations for issues to the ANA board of directors. The committee is composed of the ANA president and two members of the ANA board. The input on long-term policy recommendations comes from the ANA cabinets, councils, and staff, state nurses associations, the Nursing Organization Liaison Forum, and consultants. The board considers the recommendations of the committee, and then communicates its actions to the house of delegates. Although not in order of priority, the following are the top legislativepriorities for ANA, according to Nickels: reimbursement under Medicare for nurses who provide community health care, opposition to budget cuts that will affect health care, opposition to the ddimg of health professionals, which is expected to continue to be an issue, efforts toward implementation and continued funding of the National Center for Nursing Research, maintenance and protection of the Medicare program, and ensuring quality patient care under the Medicare program. The political education section of the division of governmental affairs administers the ANA political action committee (ANA-PAC), and works to involve nurses in politics through seminars to organize efforts. The ANA ofice in Washington, DC also assists state nurses associations on federal issues, and is available to give advice to the state associations. They also hold a meeting once each month to update representatives of various nursing organizations on legislative issues. Nickels stressed that the practice of every nurse is affected by legislative activities in Washington, DC. The issue of direct reimbursement for nurses and nurse midwives continues, in spite of 640
OCTOBER 1986, VOL. 44, NO 4
President Reagan’s veto of the Federal Employees Benefits Improvement Act of 1985 in January. That act would have allowed direct a w e s to the services of nurses and nurse midwives without the supervision of or referral from a physician, and would have allowed direct reimbursement to those nurses. The House of Representatives has now passed a new resolution (HR 4825), the Federal Employees Health Care Freedom of Choice Act of 1986, which would allow nurses to be reimbursed for services they are licensed to perform that are covered under federal employee health benefits plans. Speaking in favor of the bill to the House, Congressman Benjamin Gilman (R-NY), said, “Direct reimbursement for nurse practitioners, for example, will allow nurses who are qualified health care providers to be viewed as credible and economic participants in our changing health care system, eligible in their own right to be reimbursed for providing health care services,” according to the Aug 11 issue of Capital Update. The issue will be considered by the Senate next, where no action on the issue has taken place since the veto. The nation’s first mandatory no-fault compensation bill for vaccine-related injuries was passed in North Carolina, at least partly due to the lobbying efforts of the physicians in that state. The law passed both houses on July 11, and does not require the signature of the governor. North Carolina pediatricians last year were “shaken by the spectacle of one of their most respected colleagues agreeing to a $1.1 million malpractice settlement in a vaccine case,” according to the Aug 1 issue of American Medical News. The no-fault law takes effect Oct 1. Under the new law, families who allege that their children suffered injuries as a result of statemandated vaccines (diphtheria, pertussis, tetanus [DPT]; measles-mumps-rubella; and polio) must present their claims to the state industrial commission. The commission will determine whether the alleged injuries are vaccine-related and how much compensation will be allowed. Free medical, social, and educational services
AORN JOURNAL
for the child may be awarded to the family from the state department of human resources, as well as a maximum of $300,000 compensation for additional care, pain and suffering,loss of earnings, or attorney fees. Families will not be allowed to pursue their cases through the court system until they have received a decision from the commission; they can then appeal the decision of the commission through the courts. If the state attorney general finds that the provider who administered the vaccine or the manufacturer that produced the vaccine was negligent, the state may sue the provider and manufacturer; however, damages cannot exceed the amount the commission awarded to the family. The belief that vaccine manufacturers would lower prices because liability costs would decrease under the new law was a key element in passage of the bill. One DPT manufacturing company announced in May that it would raise the price of a vial of DPT vaccine from $64 to $17 1 because it was unable to obtain liability insurance; $120 of that cost per vial was to be set aside to pay for self-insurance. At a July 25 meeting of the US House energy and commerce subcommittee on health, Malinda Carter, member of the ANA board of directors, testified on the vaccine liability and compensation issue. Carter spoke in support of subcommittee chairman Henry Waxman’s (D-Calif) bill that would establish an administrativesystem to handle the grievances of vaccine injury victims, according to the Aug 11 issue of Capital Update. The bill would also contain compensation schedules for vaccine-related injuries, but it would not deny access to the court system. The ANA endorses the National Childhood Vaccine Injury Act (HR 5184), according to Carter. “A balance must be drawn between the concerns of the parents whose children have suffered as a result of participating in immunization programs, and those of the pharmaceutical manufacturers who, through no fault of their own, cannot guarantee that their products will be 100% reaction-free,” said Carter. The bill is set up to be no-fault, as is the North Carolina law. J COMBS DEBORAH ASSOCIATE EDITOR 642
OCTOBER 1986, VOL. 44, NO 4
Best Bypass Surgeries at High-Volume Hospitals Patients who underwent coronary artery bypass surgery had a higher rate of survival at hospitals that performed a large volume of bypass surgeries, according to a study by the Institute for Health Policy Studies, University of California, San Francisco. The researchers found that in California, hospitals that performed more than 200 bypass surgeries each year not only had the best survival rates but were also the most cost-effective. They estimated that in California alone, about 30 lives and more than $16 million could be saved each year if all the bypass surgeries were performed in high-volume hospitals. The study was commissioned by Blue Shield and the US Department of Health and Human Services. It was reported in the June 20 issue of Modern Healthcare.
Enrollment Up in Health Maintenance Organizations Enrollment in health maintenance organizations (HMOs) increased by nearly 26%in 1985. As a result, 21 million people belong to an HMO, according to statistics from Interstudy, a research firm in Excelsior, Minn. The 26%enrollment jump was the largest single-year increase since Interstudy began compiling annual HMO statistics in 1981. Other statistics included: a 42%increase in HMOs bringing the total to 244 plans (which includes Medicaid and Medicare HMOs for the first time, according to Interstudy), a 5.4%decrease in the number of not-forprofit HMOs, a 6.6%increase in federally qualified plans bringing the total to 273, and that not-for-profit plans now have 65%of the HMO enrollment. The statistics were reported in the June 20 issue of Modern Healthcare.