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CMS Updates Regulation that Respiratory Orders May Come From MDs Only
CMS Updates Regulation that Respiratory Orders May Come From MDs Only provided only on, and in accordance with, the orders of a doctor of medicine or osteopathy.” CMS found the parameters for the ordering of respiratory care services to be too narrow. While doctors of medicine or osteopathy have the option of delegating this task to NPs and PAs, this delegation requires physicians to countersign all orders by NPs or PAs for respiratory care services. CMS has not found any evidence that indicates that the ordering of respiratory care services should be kept to a different, and possibly higher, standard than rehabilitation and other hospital services. Nor have they found any documented studies indicating that qualified, licensed practitioners such as NPs and PAs should be restricted from ordering these necessary services for their patients. Furthermore, CMS believes that the process of physician countersignature of orders written by qualified, licensed NPs and PAs, specifically for common hospital services such as rehabilitation and respiratory care services, is burdensome to practitioners (physicians as well as NPs and PAs) and the hospitals they serve. Many states, under their scope-of-practice laws and other regulations, already allow qualified, licensed practitioners to order rehabilitation services and respiratory care services, in addition to other common hospital services such as dietary and social work services. ACNP will continue to push for this change and keep its members informed of the progress.
Reference 1. Proposed Changes to Medicare Conditions of Participation Affecting Hospital Rehabilitation Services and Respiratory Care Services. Federal Register 75 (04 May 2010): 24050-24051.
Stay tuned to the ACNP Online Learning Center for New CE Opportunities from the 2010 National Clinical Conference!
A C N P FORUM
On January 1, 2010, a new regulation was put into effect by the Centers for Medicare and Medicaid Services (CMS). The Joint Commission (TJC) followed with support of this new regulation. This regulation, which pertains to both ambulatory and inpatient orders for respiratory therapy prescriptions/orders, is as follows: “Two Joint Commission elements of performance address respiratory care for hospitals that use Joint Commission accreditation for deemed status purposes. CMS requires a doctor of medicine or osteopathy to direct respiratory care services but does not limit the authority of a doctor of medicine or osteopathy to delegate tasks to other qualified health care personnel to the extent recognized under state law or a state’s regulatory mechanism. Therefore, nonphysician practitioners may write respiratory care orders, provided it is within the scope of their license. However, if a doctor of medicine or osteopathy delegates responsibility for writing orders to an eligible nonphysician practitioner (such as a physician assistant [PA] or nurse practitioner [NP]), the responsible doctor of medicine or osteopathy must co-sign the order.” After receiving several public requests (including requests from various hospitals, as well as from TJC) for review of this requirement, CMS proposed on May 4, 2010, to revise the existing requirements to allow these licensed practitioners (including NPs and PAs), in addition to physicians as currently allowed, to order these services as long as such privileges are authorized by the medical staff and are in accordance with both hospital policies and procedures and state laws. The current requirement for respiratory care services explicitly states that these services “must be
Visit http://bit.ly/acnponlinece for more details! 1555-4155/10/$ see front matter © 2010 American College of Nurse Practitioners DOI:10.1016/j.nurpra.2010.09.010
807
A C N P FORUM
2010 National Clinical Conference
808
lenges. Finally, President- Elect, Janet Selway, DNSc, CRNP- A/P, updated participants about the recently released IOM report, The Future of Nursing: Leading Change, Advancing Health, with insights gleaned from her participation in the events surrounding release of this significant report. In a second dynamic plenary session, Adrian Hutber, PhD, Vice President, Exercise Is Medicine, American College of Sports Medicine, challenged nurse practitioners to evaluate the potential benefit to each patient through ensuring that physical activity, combined with counseling and referral, should be an integral component of treatment plans. Dr. Hutber shared many moving examples with significant positive feedback from attendees. The ACNP 2010 State Affiliate Award was presented to the Nurse Practitioner Association of Maryland (NPAM) in recognition of their outstanding legislative achievement. The award is presented annually to a State Affiliate that has made a significant contribution to legislation, policy, or regulation that promotes nurse practitioner practice. Until October of this year, Maryland NPs were required to have an approved, written collaborative agreement in order to practice. The financial cost and approval timeframe required by the agreement delayed appointments to new NP jobs and transfers from out of state. With the help and support of several organizations, NPAM was able to repeal this burdensome and often prohibitive state collaborative agreement. Utilizing excellent communications between organizations, well-crafted testimony and lobbying, as well as perseverance, the 17-page collaborative agreement was repealed and now only an attestation to collaborate by the NP is required. Not content with their momentous achievement, NPAM is already planning on a repeal of the attestation. NPAM’s accomplishment vastly improves the regulatory environment for Maryland NPs and serves as model to other states that may be facing similar barriers to practice. Former ACNP President and NPAM member Julie Stanik-Hutt PhD, ACNP, CCNS, FAAN, received the award. The ACNP 2010 Student Scholarship Award was presented to David Free, BA, Former ACNP President and Nurse Practitioner Association of BSN, RN, of Arnold, MD. The publisher of Maryland member Julie Stanik-Hutt receives the 2010 ACNP The Journal for Nurse Practitioners , State Affiliate Award on behalf of NPAM. The American College of Nurse Practitioners hosted a very successful 2010 National Clinical Conference, Nurse Practitioners: Shaping Policy, Improving Practice, October 20 – 24 in Tampa, Florida. An unprecedented number of pre-conference skill workshops including suturing techniques, coding and administration, spirometry, and brain CT & MRI interpretation kicked off five days of intense education for the attendees. Offering over 100 clinically focused concurrent sessions, conference topics such as acute care, women’s health, pain management, diabetes, mental health, and an extensive list of other clinical topics were designed for the ranges of clinical interests. Industry-sponsored symposiums provided attendees with the latest developments from leading industry innovators. Attendees availed themselves of abundant opportunities for networking with colleagues from their clinical specialty area and geographical location. After a day of dynamic, interactive skills workshops, the 2010 ACNP National Clinical Conference launched with a dynamic presentation by ACNP leadership focusing on key policy initiatives of importance to nurse practitioners. ACNP President, Marsha Siegel, EdD, FNP-C, led the discussion with an overview of organizational endeavors with emphasis on policy accomplishments. Thad Wilson, APRN, BC, FNP, PhD, Immediate Past President, guided attendees through the maze of legislative activities during the 2010 Congressional session, noting both achievements and remaining chal-
A C N P FORUM
Association of Maryland’s Public Relations Committee. Here he helped to develop recruitment and retention programs for student NPs as well as worked on the documentation that NPAM used to abolish Maryland’s collaborative agreement. Mr. Free exemplifies the student nurse practitioner who is working to improve his profession and ACNP extends a hearty congratulation for his accomplishments The city of Tampa offered many exciting restaurants and shops, featuring fantastic native distinction not found elsewhere. Dozens of runners and walkers gathered ahead of the sunrise for the second annual ACNP President Marsha Siegel and ACNP President-Elect Janet ACNP PAC Fun Run/Walk, a two-mile trip Selway display a proclamation from the City of Tampa declaring along the beautiful Bayshore Boulevard in November 8 – 14, 2010, as “Nurse Practitioner Week.” Tampa. Great memories were made while at the same time raising funding for ACNP PAC efforts during what is quickly becoming an Elsevier, graciously sponsors an annual student scholarship recognizing an individual nurse practi- ACNP Conference highlight event. ACNP would like to thank the city of Tampa for protioner student who has made an outstanding contribution to the profession through his or her studies viding such a wonderful venue and warm hospitality. The 2011 National Clinical Conference will be held and activities in the community and in the nurse practitioner field. As a student in the University of in Denver, Colorado October 5 – 9. ACNP looks forMaryland Baltimore’s Masters FNP Program, David ward to another dynamic clinical conference in the has worked tirelessly on the Nurse Practitioner beautiful city of Denver.
809
American College of Nurse Practitioners
2011 National Clinical Conference October 5–9, 2011 • Colorado Convention Center • Denver, CO
Mark Your Calendar Now! • Choose from more than 120 CE sessions, including over 60% at the intermediate or advanced level • Participate in hands-on educational and clinical workshops (additional fee required) • Earn over 30 CE credits • Network with NPs from around the country • Visit healthcare-related exhibitors
Reference 1. Proposed Changes to Medicare Conditions of Participation Affecting Hospital Rehabilitation Services and Respiratory Care Services. Federal Register 75 (04 May 2010): 24050-24051.
Stay tuned to the ACNP Online Learning Center for New CE Opportunities from the 2010 National Clinical Conference!
A C N P FORUM
On January 1, 2010, a new regulation was put into effect by the Centers for Medicare and Medicaid Services (CMS). The Joint Commission (TJC) followed with support of this new regulation. This regulation, which pertains to both ambulatory and inpatient orders for respiratory therapy prescriptions/orders, is as follows: “Two Joint Commission elements of performance address respiratory care for hospitals that use Joint Commission accreditation for deemed status purposes. CMS requires a doctor of medicine or osteopathy to direct respiratory care services but does not limit the authority of a doctor of medicine or osteopathy to delegate tasks to other qualified health care personnel to the extent recognized under state law or a state’s regulatory mechanism. Therefore, nonphysician practitioners may write respiratory care orders, provided it is within the scope of their license. However, if a doctor of medicine or osteopathy delegates responsibility for writing orders to an eligible nonphysician practitioner (such as a physician assistant [PA] or nurse practitioner [NP]), the responsible doctor of medicine or osteopathy must co-sign the order.” After receiving several public requests (including requests from various hospitals, as well as from TJC) for review of this requirement, CMS proposed on May 4, 2010, to revise the existing requirements to allow these licensed practitioners (including NPs and PAs), in addition to physicians as currently allowed, to order these services as long as such privileges are authorized by the medical staff and are in accordance with both hospital policies and procedures and state laws. The current requirement for respiratory care services explicitly states that these services “must be
Visit http://bit.ly/acnponlinece for more details! 1555-4155/10/$ see front matter © 2010 American College of Nurse Practitioners DOI:10.1016/j.nurpra.2010.09.010
807
A C N P FORUM
2010 National Clinical Conference
808
lenges. Finally, President- Elect, Janet Selway, DNSc, CRNP- A/P, updated participants about the recently released IOM report, The Future of Nursing: Leading Change, Advancing Health, with insights gleaned from her participation in the events surrounding release of this significant report. In a second dynamic plenary session, Adrian Hutber, PhD, Vice President, Exercise Is Medicine, American College of Sports Medicine, challenged nurse practitioners to evaluate the potential benefit to each patient through ensuring that physical activity, combined with counseling and referral, should be an integral component of treatment plans. Dr. Hutber shared many moving examples with significant positive feedback from attendees. The ACNP 2010 State Affiliate Award was presented to the Nurse Practitioner Association of Maryland (NPAM) in recognition of their outstanding legislative achievement. The award is presented annually to a State Affiliate that has made a significant contribution to legislation, policy, or regulation that promotes nurse practitioner practice. Until October of this year, Maryland NPs were required to have an approved, written collaborative agreement in order to practice. The financial cost and approval timeframe required by the agreement delayed appointments to new NP jobs and transfers from out of state. With the help and support of several organizations, NPAM was able to repeal this burdensome and often prohibitive state collaborative agreement. Utilizing excellent communications between organizations, well-crafted testimony and lobbying, as well as perseverance, the 17-page collaborative agreement was repealed and now only an attestation to collaborate by the NP is required. Not content with their momentous achievement, NPAM is already planning on a repeal of the attestation. NPAM’s accomplishment vastly improves the regulatory environment for Maryland NPs and serves as model to other states that may be facing similar barriers to practice. Former ACNP President and NPAM member Julie Stanik-Hutt PhD, ACNP, CCNS, FAAN, received the award. The ACNP 2010 Student Scholarship Award was presented to David Free, BA, Former ACNP President and Nurse Practitioner Association of BSN, RN, of Arnold, MD. The publisher of Maryland member Julie Stanik-Hutt receives the 2010 ACNP The Journal for Nurse Practitioners , State Affiliate Award on behalf of NPAM. The American College of Nurse Practitioners hosted a very successful 2010 National Clinical Conference, Nurse Practitioners: Shaping Policy, Improving Practice, October 20 – 24 in Tampa, Florida. An unprecedented number of pre-conference skill workshops including suturing techniques, coding and administration, spirometry, and brain CT & MRI interpretation kicked off five days of intense education for the attendees. Offering over 100 clinically focused concurrent sessions, conference topics such as acute care, women’s health, pain management, diabetes, mental health, and an extensive list of other clinical topics were designed for the ranges of clinical interests. Industry-sponsored symposiums provided attendees with the latest developments from leading industry innovators. Attendees availed themselves of abundant opportunities for networking with colleagues from their clinical specialty area and geographical location. After a day of dynamic, interactive skills workshops, the 2010 ACNP National Clinical Conference launched with a dynamic presentation by ACNP leadership focusing on key policy initiatives of importance to nurse practitioners. ACNP President, Marsha Siegel, EdD, FNP-C, led the discussion with an overview of organizational endeavors with emphasis on policy accomplishments. Thad Wilson, APRN, BC, FNP, PhD, Immediate Past President, guided attendees through the maze of legislative activities during the 2010 Congressional session, noting both achievements and remaining chal-
A C N P FORUM
Association of Maryland’s Public Relations Committee. Here he helped to develop recruitment and retention programs for student NPs as well as worked on the documentation that NPAM used to abolish Maryland’s collaborative agreement. Mr. Free exemplifies the student nurse practitioner who is working to improve his profession and ACNP extends a hearty congratulation for his accomplishments The city of Tampa offered many exciting restaurants and shops, featuring fantastic native distinction not found elsewhere. Dozens of runners and walkers gathered ahead of the sunrise for the second annual ACNP President Marsha Siegel and ACNP President-Elect Janet ACNP PAC Fun Run/Walk, a two-mile trip Selway display a proclamation from the City of Tampa declaring along the beautiful Bayshore Boulevard in November 8 – 14, 2010, as “Nurse Practitioner Week.” Tampa. Great memories were made while at the same time raising funding for ACNP PAC efforts during what is quickly becoming an Elsevier, graciously sponsors an annual student scholarship recognizing an individual nurse practi- ACNP Conference highlight event. ACNP would like to thank the city of Tampa for protioner student who has made an outstanding contribution to the profession through his or her studies viding such a wonderful venue and warm hospitality. The 2011 National Clinical Conference will be held and activities in the community and in the nurse practitioner field. As a student in the University of in Denver, Colorado October 5 – 9. ACNP looks forMaryland Baltimore’s Masters FNP Program, David ward to another dynamic clinical conference in the has worked tirelessly on the Nurse Practitioner beautiful city of Denver.
809
American College of Nurse Practitioners
2011 National Clinical Conference October 5–9, 2011 • Colorado Convention Center • Denver, CO
Mark Your Calendar Now! • Choose from more than 120 CE sessions, including over 60% at the intermediate or advanced level • Participate in hands-on educational and clinical workshops (additional fee required) • Earn over 30 CE credits • Network with NPs from around the country • Visit healthcare-related exhibitors