Staffing, care coordination and barriers to practice were among the issues discussed when American Nurses Association (ANA) leaders met with Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner, MHA, BSN, RN, and other top officials.
At the Jan. 30 meeting, ANA President Karen A. Daley, PhD, RN, FAAN, and senior association staff reviewed ANA’s efforts on implementation of the Affordable Care Act (ACA). Further, they addressed with CMS ongoing opportunities for nursing to contribute to health care transformation, as well as rules that inhibit nurses from making full contributions.
“Meeting face to face with Administrator Tavenner and other CMS leaders was a great opportunity to talk about our shared interests in moving health care reform forward, as well as nurses’ critical role in that process,” Daley said. “We hope we can continue to work closely with CMS to break down the barriers nurses often face, while opening up more opportunities for them to provide the services and care patients need.”
Tavenner and CMS also expressed a commitment to ongoing collaboration.
“As a nurse myself, I understand how important nurses are to realizing the health care system we have envisioned for all Americans,” Tavenner said. “I look forward to continued meaningful discussions with ANA to make sure nurses in all roles and in all settings are recognized as central to our health care system, and their contributions are carried through in federal regulations.”
ANA leaders spoke about the significant, ongoing work within the association supporting nurses’ key roles in care coordination, particularly ANA’s newest policy document, Framework for Measuring Nurses’ Contributions to Care Coordination. The latest in a series of three policy documents, it provides a dynamic roadmap that can be used to identify prioritized measures of care coordination. ANA also briefed CMS on its efforts to develop a pressure ulcer incidence “eMeasure” that collects data through the electronic health record. This eMeasure is an exemplar for the development, testing and implementation process that can be replicated to develop other measures, particularly in care coordination.
ANA leaders noted the ongoing need for measure development support and the association’s desire to collaborate on efforts to fill significant measure gaps.
Another topic addressed was the lack of nursing measures within Hospital Compare, the CMS public reporting database. In particular, ANA spoke to the value of adding structural measures that reflect nurse staffing, such as nursing hours per patient day and skill mix. This reflects the considerable research that clearly demonstrates the link between patient outcomes and nurse staffing and the need to provide consumers access to this important information. Many hospitals already collect this important data, so adding this requirement will likely be a minimal burden.
Discussions also took place on the crucial issue of ongoing barriers to full and efficient APRN practice, particularly the requirement for physician co-signature or counter-signature. While acknowledging that congressional action is the principal solution to the burdensome durable medical equipment (DME) requirements, ANA noted its appreciation for the implementation delay and recommended that CMS consider adjusting the threshold amount from $1,000 to $5,000 as the trigger for the signature requirement. (DME includes products such as portable oxygen systems and blood glucose monitors.)
CMS noted that this provision was enacted at a time when fraud was particularly problematic and since then, the Administration has made significant improvements to address this problem. ANA stressed that continued efforts to remove unnecessary requirements, like co-signature or counter-signature, are needed. ANA also acknowledged efforts by CMS to use provider-neutral language in its regulations and communications.
Addressing CE inequity
ANA leaders spoke to an inequity that exists as a result of rules promulgated to implement provision §6002 of the ACA. Currently, five groups awarding continuing education are exempt from the reporting requirements of this law — all of which are for physicians. ANA asked that American Nurses Credentialing Center be added as an exempted certification group.
ANA will follow up with specific CMS leadership on each of these important efforts.
In addition to Daley, ANA enterprise Chief Executive Officer Marla J. Weston, PhD, RN, FAAN; ANA Executive Director Debbie Hatmaker, PhD, RN, FAAN; and ANA Senior Director for Programs Cheryl Peterson, MSN, RN, were present at the meeting.
Other CMS leaders were Jonathan Blum, principal deputy administrator and director of the Center for Medicare, and Patrick Conway, MD, deputy administrator for Innovation and Quality and CMS chief medical officer.