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Healthcare Policy and Patient Advocacy. Angela Mund CRNA DNP. Objectives. Discuss the history of nursing and policy Compare and contrast policy and politics Describe the policy process and areas for personal involvement Discuss the current literature as related to health policy.

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Healthcare policy and patient advocacy

Healthcare Policy and Patient Advocacy

Angela Mund CRNA DNP


Objectives
Objectives

  • Discuss the history of nursing and policy

  • Compare and contrast policy and politics

  • Describe the policy process and areas for personal involvement

  • Discuss the current literature as related to health policy


History of nursing and policy making
History of Nursing and Policy Making

  • Florence Nightingale

    • Parliament and The Crimean War

  • Lillian Wald and Lavina Dock

    • Licensure and Rights to Healthcare

      Advent of Advanced Practice Nursing


Historical aspect
Historical Aspect

  • 1970’s-Department of Health, Education, and Welfare

    • Committee to Study Extended Roles for Nurses

  • 1980’s

    • Tax Equity and Fiscal Responsibility Act of 1986

      • Medicare IG search into fraudulent billing practices

    • Cost containment, Prospective Payment System 1983

      • Bundled payments based on DRGs

      • CRNA services became practically unreimbursable

    • Consolidated Omnibus Budget Reconciliation Act of 1986



Medicare
Medicare occurring now?

  • Medicare Part A: Payments to hospitals, ASC, etc

  • Medicare Part B: payment regulations for healthcare providers who are eligible to receive direct reimbursement

    • Provisions for medical supervision

      • greater than 4 concurrent cases: MDs 3 base units plus 1 additional base unit if present for induction

    • Provisions for medical direction

      • TEFRA requirements 7 conditions of payment

      • According to HCFA not a quality of care issue but elements of an anesthetic that an MD should be present for if they want to get reimbursed


AANA continuing to follow and advocate for changes to outdated, inefficient TEFRA requirements for payment

AANA

Cost and Efficiency


Federal supervision requirements
Federal Supervision Requirements outdated, inefficient TEFRA requirements for payment

  • Medicare Part A

  • November 13th, 2001

    • After consultation with stakeholders, each state Governor can send a letter to CMS requesting exemption from federal supervision

  • 17 states have “opt’ed out”


Chronic pain management
Chronic Pain Management outdated, inefficient TEFRA requirements for payment

  • Medicare authorizes payment under Part B

  • Medicare administrative contractor refusing payment

  • Role of the Federal Trade Commission and Hospital Associations

  • Battles in Louisiana, Oklahoma, Missouri and Iowa


Is there a difference between policy and politics

Is there a difference between policy and politics? outdated, inefficient TEFRA requirements for payment


How are nurses and policy related
How are nurses and policy related outdated, inefficient TEFRA requirements for payment?

Impact of policy on nursing practice

Impact of policy on patient care

Impact of policy on national and global health

Impact of policy on politics (legislative and regulatory)


Professional responsibility
Professional Responsibility outdated, inefficient TEFRA requirements for payment

Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has.” Margaret Mead


Aana code of ethics
AANA Code of Ethics outdated, inefficient TEFRA requirements for payment

  • 6.4 The CRNA participates in research activities to improve practice, education, and public policy relative to the health needs of diverse populations, the health workforce, the organization and administration of health systems, and healthcare delivery.

  • 3.3 The CRNA participates in activities that contribute to the ongoing development of the profession and its body of knowledge


Basic policy elements
Basic Policy Elements outdated, inefficient TEFRA requirements for payment

  • Reviewing Policies includes studying formal decisions and actions

  • A policy may include a network of interacting decisions rather than a single decision

  • Policies change over time

  • Review policies that were not acted on

  • Identify policies created out of clear decision-making to develop an effective process of policy making

    Ham, et al 1992


Influencing policy
Influencing Policy outdated, inefficient TEFRA requirements for payment

  • Prepare, Prepare, Prepare

  • Speak the language of legislation and regulation

  • Understand committee structure

  • Ask the Ask!


Movement of legislation in brief
Movement of Legislation (in brief!) outdated, inefficient TEFRA requirements for payment


The political process is rarely rational linear or expeditious

The political process is rarely rational, linear, or expeditious

Just take a look at attempts for Health Care Reform!


S 252
S.252 expeditious

Title: A bill to amend title 38, United States Code, to enhance the capacity of the Department of Veterans Affairs to recruit and retain nurses and other critical health-care professionals, to improve the provision of health care veterans, and for other purposes.


Ten commandments
Ten Commandments expeditious

  • The Personal is Political

    SERENDIPITY!

  • Friends come and go but enemies can accumulate

  • Politics is the art of the possible

    MAJORITY RULES!

  • Be polite, be persistent, be persuasive

    WRITE, CALL, VISIT, WRITE, CALL VISIT…


Ten commandments1
Ten Commandments expeditious

5. Talk to strangers

6. Give early and often

7. Take credit and control

(What is the role

of the PAC?)


Ten commandments2
Ten Commandments expeditious

8. Politics has a chit economy

9. Reputations are permanent

DEPENDABILITY

10. Don’t take it personal

BEST OFFENSE IS A GOOD DEFENSE


Tips for lobbying
Tips for Lobbying expeditious

  • Be Prepared

  • Be Precise

  • Be a professional


Tips for lobbying1
Tips for Lobbying expeditious

  • Communicate

  • Drive the Discussion

  • Cultivate Relationships

  • Lobby in person or on paper


Advocacy at
Advocacy at expeditious


Political action committees
Political Action Committees expeditious

  • Pay to Play

  • The role of the Lobbyist

  • Bipartisenship

    • How do I know who is getting my money?

  • Do PAC’s influence legislation?

  • Reporting


Healthcare pac contributions 2012 cycle
Healthcare PAC Contributions 2012 Cycle expeditious

American Association of Nurse Anesthetists came in 18th

44,000 members (including students)

The ANA came in 17th

Represents over 3 million nurses

Only other nursing PAC to make top 100

American College of Nurse Midwifes

12,000 members


Aana levels of giving to the pac
AANA Levels of Giving to the PAC expeditious

  • Presidential Club

  • Congressional Club

  • Capital Club


Open secrets

Open Secrets expeditious


How can you become involved
How can you become involved? expeditious

  • Local Politics

  • State Level

    • Committees and State Boards

  • Federal Level

    • AVANA Committees

    • AVANA Board


What are some challenges you experienced in your practice that could be impacted by changes in legislation or regulation?

How can you use the some/all of the political strategies to create influence?


Areas for involvement
Areas for Involvement that could be impacted by changes in legislation or regulation?

  • Nursing Workforce Development (Title VIII)

  • Reimbursement

  • Health Care Reform

  • Patient Access to Providers

  • Nurse Practice Acts


Barriers to involvement
Barriers to Involvement that could be impacted by changes in legislation or regulation?

Time

Money

Education

Fear

Lack of leadership/mentoring

Initial disillusionment


What components do you think would be useful
What components do you think would be useful? that could be impacted by changes in legislation or regulation?


Power that could be impacted by changes in legislation or regulation? is an inevitable part of human interaction, and those persons, including nurses, who deny this fact will be at a serious disadvantage when trying to make changeKalisch &Kalisch, 1982


Power
POWER that could be impacted by changes in legislation or regulation?

  • Numbers

    • Role of the professional organization

  • VOICE Of NURSING!

  • Expert power

  • Public Respect and Admiration

    • Use the Media


As patient advocates we cannot be spectators or sideline shoutersWe mustaffect change through discussion, debate, analysis, and research in a positive proactive mannerC. Bettin, AANA Senior Director of Commincations


Rewards of advocacy
Rewards of Advocacy shouters

  • Personal Satisfaction

  • Professional Satisfaction

  • Sense of Accomplishment

  • Sense of Control over patient outcomes


Nurses have the skills to be successful at influencing policy
Nurses have the skills to be successful at influencing policy

  • Negotiation and communication

  • Problem solvers

  • Management of challenging personalities and conflict

  • Team players– Building Coalitions


Nursing leadership from bedside to boardroom opinion leaders perceptions

Nursing Leadership from Bedside to Boardroom: Opinion Leaders Perceptions

Robert Wood Johnson Foundation Survey (2010)


Barriers to Nurses’ Ability to Contribute to Improvements in Planning Policy Development, and Management of Health Systems and Services

Question Wording: Please tell me if you think each of the following is a major barrier, a minor barrier, or not a barrier to nurses’ ability to contribute to improvements in planning policy development, and management of health systems and services?

Not Important Decision Makers

Doctors as Revenue Generators


How to Ensure That Nurses Take on More Leadership in Improving Health Status and Delivering Healthcare Services

Question Wording: What, if anything, do you think could be done to ensure that nurses take on more leadership in improving health status and delivering healthcare services in the United States today? (Open-end question; Percent shown)


What will be impact be of the iom report on the future of nursing and the aprn consensus document

What will be impact be of the IOM Report on the Future of Improving Health Status and Delivering Healthcare ServicesNursing and the APRN Consensus Document?


Recommendations of the iom report
Recommendations of the IOM Report Improving Health Status and Delivering Healthcare Services

  • Nurses should practice to the full extent of their education and training

  • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless education progression


Recommendations of the iom report1
Recommendations of the IOM Report Improving Health Status and Delivering Healthcare Services

  • Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States

  • Effective workforce planning and policy making require better data collection and an improved information infrastruture


Aprn consensus model
APRN Consensus Model Improving Health Status and Delivering Healthcare Services

  • National Council of State Boards of Nursing

  • Ensure patient safety and expand patient access to APRNs

  • Standardization

  • 4 essential elements:

    • Licensure, accreditation, certification, education (LACE)


Aprn consensus model1
APRN Consensus Model Improving Health Status and Delivering Healthcare Services

  • Services or care provided by APRNs not defined or limited by setting but rather by patient care needs

  • What does this mean for us?


Licensed independent pracitioners
Licensed Independent Improving Health Status and Delivering Healthcare ServicesPracitioners

  • Consensus Model as Framework; IOM Recommendations

  • All APRNs must be LIPs

  • Privileges granted through Medical Staff Board

  • However…”APRNS will practice within the privileges that are granted at the local level by the Professional Standards Board?

  • Timing of Full Implementation

  • Does your facility have a CRNA on the APRN Committee?


Coalition for patients rights
Coalition for Patients Rights Improving Health Status and Delivering Healthcare Services

  • Maureen ShekletonProfessional Relations SpecialistAmerican Association of Nurse Anesthetists

  • > 35 Member organizations (diverse group)

  • State Action Coalitions

  • Offset the AMA SOPP initiative

    • Limits patients’ choice of providers

    • Attempts to define the SOP of CRNAs


Patients access to responsible care alliance parca
Patients’ Access to Responsible Care Alliance (PARCA) Improving Health Status and Delivering Healthcare Services

  • Provide Access to information for Legislators

  • Nondiscriminatory language for reimbursement in healthcare reform legislation- SUCCESS!!!


Is there an optimal time to study health policy? Improving Health Status and Delivering Healthcare Services


Model for teaching healthcare policy
Model for Teaching Healthcare Policy Improving Health Status and Delivering Healthcare Services

  • Information

  • Commitment

  • Initiative

  • Involvement

    Educators will need to demonstrate the relevancy of policy to practice

    Maynard (1990) Political Influence: a Model for Advanced Nursing Education


Health care policy for advocacy in health care dnp essential 5
Health Care Policy for Advocacy in Health Care (DNP Essential #5)

“The DNP graduate integrates practice experiences with two additional skill sets: the ability to analyze the policy process and the ability to engage in politically competent action” (AACN)


“Nurses will not be effective in politics and policy making until they value their voices, develop policy agendas that embrace their core values, and learn the skills of policy making and influencing”

  • Peters


Is there an optimal route for nurses to study health policy? making until they value their voices, develop policy agendas that embrace their core values, and learn the skills of policy making and influencing”


Lobbying in Washington DC making until they value their voices, develop policy agendas that embrace their core values, and learn the skills of policy making and influencing”


What kind of degree would be required needed

Is there a role for a nursing specialty in Health Care Policy?

What kind of degree would be required/needed?


Health policy and research
Health Policy and Research Policy?

  • Nursing Research

    • Supply the data and background information for creating policy

  • Policy Research

    • Analysis of the problem, provide alternative recommendations for future initiative


No Harm Found When Nurse Anesthetists Work Without Supervision By PhysiciansBrian Dulisse and Jerry Cromwell

Health Affairs, 29, no.8 (2010):1469-1475


Cost Effectiveness Supervision By PhysiciansAnalysis of Anesthesia Providers Paul F. Hogan Rita Furst Seifert Carol S. Moore Brian E. Simonson

NURSING ECONOMIC$/May-June 2010/Vol. 28/No. 3


Influence of Supervision Ratios by Anesthesiologists on Supervision By PhysiciansFirst-case Starts and Critical Portions of AnestheticsRichard H. Epstein, M.D., C.P.H.I, M.S.,* Franklin Dexter, M.D., Ph.D.†

Anesthesiology, V 116 • No 3 March 2012


“If nurses want to be sought out as health care resources and have their views reflected in health care policy, Nurses have to get off the porch to run with the big dogs”

-Mary Wakefield RN PhD


References
References and have their views reflected in health care policy, Nurses have to get off the porch to run with the big dogs”

Abood, S.(2007). Influencing health care in the legislative arena. Online Journal of Issues in Nursing.

Aroskar, MA. Molodow, DG & good, CM (2004). Nurses’ voices: Policy, politics and Ethics. Nursing Ethics, 11(3), 266-276.

Boswell, C., Cannon,S., & Miller J. (2005). Nurses’ political involvement: Responsibility versus Privilege. Journal of Professional Nursing, 21(1), 5-8.

Kalisch, BJ & Kalisch, PA. (1982). Politics of Nursing. Philadelphia: JB Lippincott

Peters, RM (2002). Nurse Administrators role in Health Policy: Teaching the Elephant to Dance. Nursing Administration Quarterly, 26(4), 1-8.


References1
References and have their views reflected in health care policy, Nurses have to get off the porch to run with the big dogs”

  • Twedell, D. & Webb J. (2007). The Value of the Political Action Committee: Dollars and Influence for Nurse Leaders. Nursing Administration Quarterly, 31(4), 279-283.

  • Whitehead, D. (2003). The health-promoting nurse as health policy career expert and enterpreneur. Nurse Education Today, 23(8), 585-592.


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