Sending the Wrong Messages
A message from ONA's Executive Director, Susan King, MS, RN, CEN, FAAN
Several weeks ago, I attended a health care roundtable hosted by Congressman Earl Blumenauer. He periodically invites representatives from professional associations, health systems and advocacy groups to talk with him about issues we are facing, make recommendations to him, and provide feedback about his work.
Of course, one of the major topics on the minds of the participants in January’s meeting was implementation of the federal health care reform laws currently called the Affordable Care Act or the ACA. The complexities of the federal law were identified related to Oregon’s work on health care reform and many attendees identified barriers to our work here in the state. At one point Congressman Blumenauer said he wondered what messages are being sent to states and providers working to truly change our health care delivery system.
Good question. The Center for Medicare Medicaid Services’ (CMS) own documents read “Primary care for any population is critical to ensuring continuity of care, as well as to providing necessary preventive care, which improves overall health and can reduce health care costs.” So, while the statements support expansion of primary care capacity, the final rule certainly does not.
Primary care incentive payments will be given to certain physicians and to nurse practitioners who work under supervision of a physician. That would deprive Oregon NPs from receiving such additional payment despite the fact that they are a critical part of our primary care capacity. Fortunately, leadership of the Oregon Health Authority has agreed to request “flexibility” from CMS for Oregon, which has never shackled the nursing profession to medicine.
For years, ONA, the American Nurses Association (ANA), and other organizations have been attempting to secure changes in the Social Security Act related to Medicare provisions. Under a part of Medicare, clinical nurse specialists and nurse practitioners are reimbursed as providers. Under another part, neither of them can admit a patient to home health care. Despite the acknowledgement that this inconsistency is inappropriate, we have not yet been able to get this resolved. United States Congressman Walden has been a strong advocate for changing the law as have all of our other Oregon representatives and senators. We are anticipating introduction of another bill to remedy this problem as Congress begins its work and we are hoping for success this time.
So with these examples, it is clear that our policies need to be consistent with the goals of health care reform. Whether practicing under an RN license or as an RN with advanced practice education and certification, we need to send our own message that barriers to our practice have to be eliminated.