The conclusion of the year is an su...

The conclusion of the year is an superior time to take stock of AORN's progres and examine the legislative challenges of the time to come Based on recommendations from the national Legislative Committee (NLC) AORN has narrowed its public policy interests to four issues that guide the efforts of its control Affairs Department:

* keeping the RN in the OR, which specifically belongs to the Health Care Financing Administration (HCFA) propos method change to remove prescriptive staffing language for surgical services in hospitals and ambulatory surgery center that obtain reimbursement from Medicare or Medicaid;

* RN first assistant (RNFA) third-party reimbursement at the state on a level and Medicare reimbursement for certified RNFAs (CRNFAs) at the federal level;

* supervision of and delegation to assistive personnel primarily surgical technologists (STs); and

* patient and personnel health and safety in the OR, including patients' bill of rights and fume plume evacuation in the OR.

KEEPING THE RN IN THE OR

In December 1997 HCFA propos a method change to the prescriptive language for staff members in hospitals and ambulatory surgery center that are reimbursed by means of Medicare and Medicaid. According to the propos lordship change, staffing for surgical services would be the decision of hospital administrators. commonly the rule specifically states that a physician, osteopath, or promote is to supervise the OR.

AORN answer AORN's response to this propos mastership change was strong and noisy There was such an tumult by the stakeholders that HCFA had to hire additional staff members to field the answer AORN members rallied and sent a record number of literal senses before the April 20, 1999 answer deadline. AORN also issued a pres release and encouraged members to contact their local newspapers, demanding that the vicinity of an RN in the OR remains mandatory.

As oftentimes happens in public affairs issues, however, this was a case of "hurry up and wait." In 1998 and 1999 AORN leaders met twice with HCFA representatives and one time with Virginia Trotter Betts, the senior advisor upon nursing and policy at the US Department of Health and Human Services. In addition, AORN has provided solicitationed outcomes data to HCFA and has gained the support of many associations, including the American community of Surgeons. To date, no decision has been made onward the proposed rule change; however, officials assure that AORN will be notified of HCFA's decision before it is released to the public. At pres time, the exhibited date for final decisions onward the proposal is December 2000

It remains extremely important to inform Congres members of the situation and ask them to contact the HCFA administrator, Nancy-Ann M DeParle, in support of maintaining the commands as they are. As Congres members are likely to receive an answer from HCFA before others, we must educate them as before long as possible on the part perioperative nurses play in the OR.

Nurse-to-patient ratios. In October, Gov Gray Davis (D-Calif), backed through the state nurses' association, signed a bill making California the first state to require hospitals to suitable fixed nurse-to-patient ratios, in an effort to force higher quality care and combat cost-cutting measures. The novel law prohibits hospital administrators from assigning assistive personnel to perform certain medical proceedings including assisting in invasive surgery administering medication, and assessing patients. The law also prohibits hospitals from shifting supply with nourishments between units without adequate training.

The bill guards all licensed nurses (ie, RN and licensed practical nurses) It does not specify minimum nurse-to-patient ratios, on the contrary instead requires the State Department of Health Services to risk such standards for general, psychiatric, and special hospitals. The bill's sponsor, California Assembly member Sheila James Kuehl (D-Santa Monica), will sponsor a follow-up bill in 2000 that will delay implementing the law by the agency of a minimum of one year to provide the state time to establish the povertyed ratios. The governor also signed a bill expanding patients' access to mental health care and their rights to solicit health insurers for punitive damages and prosecute outside reviews of decisions that renounce coverage.

RNFA REIMBURSEMENT

This has been a great year for RNFA reimbursement. At the federal flush AORN members worked diligently in Florida, Georgia, Iowa, and other states to attract a sponsor to the Medicare reimbursement bill in Congres The interest in the bill is predicated forward the number of constituents who contact the appropriate Congres members and, of course, the take away from of the proposed legislation. Before a bill is introduced, it must be "scored" by means of the Congressional Budget Office, which evaluates the proposal and analyzes its weight on the budget. AORN's federal lobbyists intimateed that AORN obtain an independent outlay analysis of the proposed bill and that a favorable sumptuousness analysis would help AORN immovable a sponsor.

Consequently AORN contracted with Muse and Associates, Washington, DC--whose caster Don Muse, previously worked at the Congressional packet Office--to perform the cost analysis of RNFAs being reimbursed for assisting during surgery In March 1999 Muse and Associates determined the outlay of RNFA reimbursement for a five-year period to be well in exces of $500 million. To be seriously considered and viable through Congress, a proposal should be les than $500 million.