2010
Invitational Leadership Meeting
Legislative
and Practice Issues Summary and Planning
|
Current
Policy Concerns, Challenges
and Opportunities |
Patient
and
NP Practice Impact |
Next
Steps for Attendees and
AANP Support |
|
Inconsistent,
Limited and/or Restricted Access to Insurance Credentialing ,
Contracting and Reimbursement |
BENEFITS
TO CHANGES: *Increases
care access *Improves
patient choice *Facilitates
transparency and outcomes tracking of NP provided services |
MSRA
for resources and support AANP
has linked with the initial MSRA from Ohio to provide added support and
advocacy for insurance related issues. The November 2010 MSRA meeting
summary will be available shortly. Contact your regional director to
learn more. NP
EDUCATION on topic:
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Medicare
Requirements on home health, nursing home care, DME |
BENEFITS
TO CHANGES: *Increased
access *Eliminates
unnecessary delays in care, system redundancies and costs *Utilizes
the healthcare workforce more effectively. |
AANP
will continue to address and advocate
for these issues on the Hill and with key stakeholders
(including partnerships with other nursing associations) CONNECT
WITH YOUR FEDERAL LEGISLATORS NOW
to let them know how this issue impacts patients. H.R.
4993 / S. 2814 Home
Health Care Planning Improvement Act of 2010 Would
update the Social Security Act to Adds APN and PA language to list of
authorized providers to order home health (potential to
move by end of year…need grassroots to drive the need to add this on to
a larger bill package.)
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Hospital
Bylaws: Limitations
on joining hospital staff, Admission
Barriers, Bylaws that
limit the skills NPs can provide (increasing issues for utilization
of Acute Care NPs) |
BENEFITS
TO CHANGES: *Utilizes
the healthcare workforce more effectively *Address
mismatch between the “can” and “may” of care delivery in the in-patient
setting |
Shared
strategies from meeting: 1.
Seek
to use “APRN” language instead of “midlevel provider” in bylaws to
clarify the statutory differences between NP and PA physician oversight
where grouped professional classifications are care barriers. 2.
Seek
out bylaw language from institutions that have effective bylaws to use
as examples 3.
Discuss
liability concerns with hospital risk management (for situations where
an NP is the only provider of a service in the facility and bylaws
limit the ability of the NP to provide emergent/life-saving care
without physician oversight) |
|
Medicaid
Provider Pool: Participation
restrictions on managed-care plans Some states
continue to limit to FNP and PNP—and not full NP population of providers |
BENEFITS TO
CHANGES: *Increases
care access/decrease utilization of higher cost care settings *Improves
patient choice *Facilitates
transparency and outcomes tracking of NP provided services |
Shared
strategies from meeting: 1.
Meet
with State Medicaid agency to discuss updates 2.
Address
the concern that added NPs would be added costs—“adding NPs would not
add costs because it would not increase the number of patients in the
Medicaid program. Added providers would increase access to primary care
services, and could reduce the use of higher cost urgent care and
emergency room visits for care that could be given in these NP
settings” (Shared by Gwen Wetzel, Region 8 Director at another meeting,
but excellent insight to use in any state.) 3.
Continue
to work to address issue with the MSRA (managed care) |
|
Statutory
autonomy: Plans and
actions to seek legislative and regulatory changes |
BENEFITS TO
CHANGES: *Increases
care access *Improves
patient choice *Update
statute and regulation for effective workforce utilization *Increase
the transparency and accountability of NPs |
Shared
strategies from meeting: 1.
Use
the NCSBN Model Nurse Practice Act as a language template (would aid in
decreasing the variability of care provided and regulatory practices
between states—See last page) 2.
Leverage
recent publications and reports that support updating practice acts and
rules to reflect NP preparation Utilize
AANP State Government Affairs for strategic and support planning |
|
Workforce
Study Commissions: State and
Federal level studies looking to indentify NP workforce—numbers,
locations, and practice patterns to plan for future development |
*Need
accurate numbers of NPs to gauge pipeline *Provides
opportunity to share how both adequate numbers AND utilization of NPs
at the top of their education and skill are needed to address care
needs. *Studies
are being used to help influence and guide state policy development |
Shared
strategies from meeting: 1.
Work
on getting NPs to these policy tables. May of the attendees (or their
represented associations are currently engaged) 2.
Partner
with AANP for NP practice data when serving on these commissions 3.
Ensure
that all ARPN roles have voice at table given the diversity of practice
needs 4.
Emphasize
the need to have NPs (and other care providers) practicing at the top
of their license to meet care needs |
|
Global
Signature/signature recognition: Several
states looking to address signature recognition on multiple forms (AKA:
“treating the paperwork” that completes the care NPs are already able
to provide.) |
BENEFITS TO
CHANGES: *Facilitates
transparency in care *
Streamlines care process for patients *
Eliminates redundancies in care due to paperwork requirements *
Reduces care delays by allowing paperwork to be competed at the point
of care |
Excellent
updates have occurred in the last few legislative sessions in this
area. Some items and states continue to need updates. Shared
strategies from meeting: 1.
Keep
at it…it is worth it! 2.
Global
Signature language has been successful in a few states (Here’s one
example from Maine on global signature language http://mainelegislature.org/legis/bills/bills_124th/chappdfs/PUBLIC259.pdf
) 3.
Others
have had to go item by item in a “laundry list” bill (Here’s one
example from Colorado’s “signature bill”
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Healthcare
(Medical) Homes/ACO |
Emerging
models of care and reimbursement |
Shared
strategies from meeting: 1.
Seek
opportunities for NP leaders to shape the Healthcare Home and ACO
policies on state and organizational levels. To find healthcare home
pilots in your area visit, http://www.pcpcc.net/pcpcc-pilot-projects 2.
Monitor
and engage in legislation related to these models to ensure that NPs
will be full participants 3.
AANP
will continue to participate at the national level with organizations
that influence and develop policy in these areas |
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BOM rules
limit practice (examples: pain management and dermatologic care) |
CONCERNS: Would
limit patient access to services and unnecessarily restrict practice |
Shared
strategies from meeting: 1.
Monitor
BOM rules and respond to proposals that would interfere with
appropriate care delivery 2.
Continue
dialog with regulators on the overlapping scopes of practice/skills of
both disciplines in caring for patients 3.
AANP
to continue to monitor state-level trends and share with state
representatives and group members |
|
Several
states looking at transitions to NCSBN language, planning updates to
licensure and regulation of NP practice, and modernizing policies for
effective NP utilization in care delivery. |
BENEFITS
TO CHANGES: *Clarity
of role *Increased
avenues to care *Improved
patient choice *Effective
and efficient workforce utilization |
Shared
strategies from meeting:
|