Presentation Transcript

1. HCIAC Summit Developing and Maintaining Win/Win Relationships with Health Care Corporate Partners The AORN Experience May 5, 2011
2. AORN Overview AORN is a non-profit professional nursing organization promoting safe surgical practices and optimal patient outcomes 40,000+ perioperative registered nurses Based on scientific evidence, we define nursing practices for surgical patients through our Recommended Practices For our corporate partners, we provide meaningful venues for access to perioperative nurses/directors to promote optimal outcomes & patient safety.
3. Overview of the Presentation Changing environment related to decision-making Changing regulatory environment How AORN has responded to these changes
4. Health Care Reform Changing Environment Affordable Care Act Don Berwick – “triple aim” Improving experience of care Improving health of populations Reducing per capita costs of health care Key elements from a surgical perspective (Top 25) Accountable care organizations Value-based purchasing Bundled payments Readmissions Continued emphasis on hospital-acquired conditions Net effect: changing relationship of our constituencies with our corporate partners
5. Changes in OR decision-making Surgeon – important decision maker – but not the sole decision maker
6. Changes in OR decision-making More technology – e.g., hybrid ORs, navigation systems, robotics, etc.
7. Changes in OR decision-making More players/teams in the OR
8. Changes in OR decision-making Ironically – more technology and team interaction – yet more difficult access for the Health Care Industry Representative
9. Changes in OR decision-making How decisions are made…the Value Analysis Committee Typically all the key and multidisciplinary stakeholders involved (and as a result – nursing has a greater voice again) Providing in-depth analysis and clinical review of product/device Team members empowered at enlightened facilities Balance between productivity, quality, outcomes and costs Reducing variation
10. Another big change in how we interact…the regulatory environment OIG Guidelines AdvaMed & PhRMA Codes Accreditation Guidelines For us, it’s the ANCC (American Nurses Credential Center) HCIR Credentialing Interestingly, no statutes or regulations Quasi-regulatory (Joint Commission experience)
11. Regulatory Environment - Historical FDA’s Draft Policy Statement on Industry-Supported and Educational Activities – 21 C.F.R. 202 (1)(2)(1994) ACCME acts with stronger Standards for Commercial Support - distinguishing between promotion and education 2003 – OIG Compliance Program Guidelines for Pharmaceutical Manufacturers (also Medical Device) Justification – government is largest purchaser of healthcare services including medical devices and pharmaceuticals Relies primarily on Anti-kickback Statute, as well as False Claims Act, Stark I and Stark II Key question: was there a tangible benefit provided to a healthcare professional with an intent to induce or reward referrals? Directly from OIG Guidelines: Anti-kickback Statute “prohibits some practices that are common in other business sectors”
12. Regulatory - AdvaMed Code of Ethics (Actually – a voluntary industry code) 3rd Party Education Conferences Grants to conference sponsor (accredited provider) acceptable Must be bona fide educational activities Sponsor controls content and faculty Must follow standards of the accrediting body (e.g., ACCME, ANCC, etc.) – for ANCC – no industry dissemination of education Meals and refreshments okay Must be all attendees, must be modest, and secondary to education Strict Prohibition on Recreation and Entertainment None, regardless of value and whether secondary to educational venue Theatre, sporting events, golf, skiing, hunting, etc. Prohibition on Gifts – Education Items Exception No non-educational branded items (e.g., mugs w/logos) No cookies, wine, gift baskets, etc. But items that benefit patients or serve a genuine educational function okay, provided that gift is less than $100 All Three - big impact on our partnerships/activities at our Annual Congress
13. Regulatory - Nursing Education & HCIR Involvement AORN very active in this area Key question – should the same level of scrutiny and rules of the ACCME be applied to the ANCC? AORN believes not… Often, nurses are typically not in a position to influence or induce a referral Federal legislation* (including the Physician Sunshine Payment Act**) does not contemplate nurses Previously industry-sponsored nurse education took place in the hospital – not in resort locations Nurses are key (e.g., AORN & WHO Checklists) for supplies & equipment – yet might unintentionally limit available education Could there be a potential unintended impact – compromising patient safety and optimal outcomes? Note: Some companies bypassing ANCC issue by using State of California accreditation (refer to AdvaMed Code)
14. Potential Proposed Language to ANCC Recognizing the critical need for nurses to continue receiving continuing education and the difficulty of obtaining funding for this purpose, a qualified commercial interest representatives may present Continuing Education Programs to [Registered Nurses] provided that the qualified commercial interest representative discloses the name of his or her commercial interest affiliate and the nature of the his or her relationship with the commercial interest affiliate in writing to the participants of the Continuing Education Program prior to the commencement of the program. “Industry Representative” means an employee, consultant, agent or representative employed or engaged by an Affiliate that has a nursing or medical degree . “Continuing Education Program” means a program designed to provide further relevant education to a [registered nurse] that is prepared by an ANCC Accredited Provider that meets all ANCC requirements for continuing education. “Qualified Commercial Interest Affiliate” means an individual, partnership, company or other entity that offers products and services to healthcare providers. “ANCC Accredited Provider” means an organization that has been accredited by ANCC to plan, develop and implement continuing education programs    http://www.sages.org/video/details.php?id=102288
15. Regulatory? - The HCIR Credentialing Business Model Credentialing Companies Value $ Medical Device, Products and Equipment Companies (Payer) Health Care Facilities (Customer) =
16. Regulatory – CredentialingThe Problems from AORN’s Perspective Incongruence of needs between targeted and the paying customer Result – misalignment No standardization – no incentive for hospitals (and other facilities) to do so Added time/$ for corporate partners No reciprocity – multiple approaches and fees Not always the case, but costs will likely be shifted to the final consumer – the patient Intrusive requirements Hospital defers to the credentialing organization Requirements often go beyond what hospital requires of its employees (flu shot example)
17. Step 1: Standardized Criteria AdvaMed, AORN, AACN and others partnered to publish a consensus statement on credentialing Elements include: Health Vaccinations Product and/or general liability insurance Pertinent to independent representatives Background verification Attestation or hospital-sponsored background check? For example, OIG exclusion Drug screens – laws significantly vary from state to state Health care facility orientation/procedures Training documentation – OR Protocol, OSHA, HIPAA, product training, etc.
18. Step 2: Reciprocal Arrangements AdvaMed and AORN – consent from HCA, MedStar and Mayo to conduct pilot for universal access with the following: Standardized criteria as agreed by the organizations Single source normalizing of processes – regardless of the credentialing company used Goal - measureable results Was anything compromised? Was anything improved?
19. Remaining Questions - Credentialing Frankly, individual facilities administering their own credentialing policies/procedures are worse than the credentialing market Could state legislation make a difference? Attempts in Indiana (S.B. 199) and Louisiana Can AHA, CMS & Joint Commission be drawn back into the discussion? Attempts made, but unsuccessful results And if they do come back into the discussion – will the result be positive?
20. AORN Response/Strategic Advocacy Continuing education – ANCC Credentialing – AdvaMed, legislative efforts Regulatory advocacy – e.g., OSHA, FDA
21. AORN Response/Strategic Conduit to our audience Choice. Support. Outcomes. - supported by AdvaMed Navigating regulatory/accreditation maze Combining continuing education with hands-on workshops Care Fusion, Ethicon Endo, Advanced Sterilization Products “Interactive exhibits” (worked with ANCC) Continuing education on the exhibit floor – AORN Congress
22. AORN Response/Strategic Conduit to our audience Market Research – AORN Works (for-profit subsidiary) AORN Foundation Research Education grants Scholarship Strategic Account Management Three entities – single voice

23. QUESTIONS/COMMENTS?