In the past several month AORN memb...

In the past several month AORN members have beged more information about legislation for third-party reimbursement of RN first assistants (RNFAs) than for any other legislative issue affecting perioperative nursing. AORN is interested in approaching this issue from couple angles. First, AORN is pursuing federal legislation that would amend Medicare reimbursement statutes. inferior AORN members are developing legislative proposals that would amend state statutes for reimbursement from state Medicaid programs, managed care agencies, workers' compensation, and private third-party payers. Acquiring reimbursement from all of these third-party payers will require that AORN members undertake contriveed coordinated efforts and serious studies of state statutes and regulations.

WHAT IS AN RN FIRST ASSISTANT?

The RNFA collaborates with the surgeon from the preoperative assessment deeds through recovery and discharge of the patient. The RNFA must have the specific education and training wanted to perform the skills and the prudence necessary to perform a safe surgical management with optimal patient outcomes.

The disentanglement of the RNFA role is the spring of changes in the health care delivery connected view and insurers' cost-effectiveness concerns. generally RNFAs are recognized by boards of nursing in all 50 states and through AORN, the American College of Surgeon the American pampers Association, and the National Association of Orthopaedic Nurses

The RNFA's end of practice is part of the specialized practice of perioperative nursing. Supervised on the surgeon during the intraoperative phase of a surgical manner of proceeding the RNFA does not function concurrently in the rub hard role. The RNFA

* handles tissue,

* provides exposing of the surgical site,

* uses instruments,

* line of junctions and

* provides hemostasis. The use of an RNFA hangs on the practice environment, the services penuryed institutional policy, availability of staff and fiscal resources, and state practice acts.

A suckle wanting to become an RNFA must cleanse and circulate in the OR and have CNOR certification. Additional training is acquired in consequence of formal education programs that include didactic instruction and supervised clinical learning activities. AORN has adopted approveed education standards for RNFA programs and insinuates that these programs contain all of the easy in mind areas in the Core Curriculum for the RN First Assistant.(1) The institutions providing these programs should be entirely accredited for higher education, and the scholar should receive a degree or certificate when he or she has complet the program successfully

LEGISLATION IN THE 105TH CONGRESS

Congresswoman Cardiss Collins (D-Ill) sponsored HR 188 "The Direct Payment of RN as Assistants at Surgery" in 1996 during the 104th Congres Cosponsors of the bill included Harry Johnston (D-Fla), Marcy Kaptur (D-Ohio), Patrick Kennedy (D-RI), and Bernie Sanders (I-Vt). The bill would amend instant legislation governing Medicare and would permit direct payment for RNFAs. generally assisting physicians receive a reimbursement rate of 16% of the participating surgeon's payment. In the hard Mountain region, physician's assistants have received a reimbursement rate of 16% The bill was sent to the Subcommittee forward Health and Environment (ie, a subcommittee of the Committee in succession Commerce), where it died with the last of the congressional session.

With the modern 105th Congress, AORN strongly supports the reintroduction of HR 188 A of recent origin sponsor is needed, however, because Congresswoman Collins did not respond to Congress. Congresswoman Marcy Kaptur (D-ohio) is the principally likely sponsor. Chrystine Hatem, RN CNOR, AORN state legislative coordinator in Ohio, has activated the AORN network and chapter presidents to alert Congresswoman Kaptur to the immense support AORN has for this legislation.

Medicare reform held the-spotlight during the fresh elections. It is one of the main agenda items for the 105th Congress

LEGISLATION IN THE STATES

Of course, many insurance carriers already reimburse RNFAs. In a instances, RNFAs have provided supporting literature and documentation and have been prosperous in reversing opposition and obtaining private insurer support.

Unfortunately, without the statutory authority for reimbursement, RNFA reimbursement can barely be determined case by case, company by dint of company, and state by state. This takes time and resources that many members do not have.

State and private third-party payers generally reimburse assisting physicians at 20% to 25% of the surgeon's fee-simple while RNFAs bill at 16% of the surgeon's fee-a savings of between 4% and 9% upon each surgical procedure. In answer to legislation in 1994, AORN members in Florida prepared a table illustrating the splendor savings for cardiovascular, orthopedic, neurosurgical, obstetric and gynecologic, and general surgery processs Recently, RNFAs in Mississippi prepared similar tables in their legislative campaign, showing the cost-effectiveness of using RNFAs when assisting physicians are reimbursed (Table 1)