AANA Federal Government Affairs
HOTLINE
Number 2008-10 -- Week of Monday, May 12, 2008
 
In This Issue:
 

*  Have You Taken CRNAdvocacy Action on the Teaching Rules?
*  Senate Package to Delay Medicare Part B Reimbursement Cut Cost $18 Billion
*  Expect Bonus Payments for PQRI Program in July: CMS Offers New Ways to
      Participate in the PQRI Program
*  The NPI:  The Number CRNAs Need May 23rd!
*  Nursing Research: Economic Downturn Helps Address Shortage
*  Follow-Up: AANA Mid-Year Assembly
*  Amendments

 
 
 
>> Have You Taken CRNAdvocacy Action on the Teaching Rules?
 
Congress needs to hear from CRNAs today, so that legislators will cosponsor
an AANA-backed equitable Medicare anesthesia payment teaching rules reform
in the House, and urge the Medicare-writing Senate Finance Committee to
include equitable teaching rules provisions in its measure under development
to reverse coming Medicare payment cuts. 
 
If you've already taken action this past week, thank you!  If not, take a
look in your email inbox for a CRNAdvocacy reminder that AANA President
Wanda Wilson, CRNA, PhD, has sent all AANA members and student associate
members for whom we have email addresses.   Your call or letter to Congress
could be the one that makes the difference for CRNA education!
 
 

 
>> Senate Package to Delay Medicare Part B Reimbursement Cuts Could Cost $18 Billion
 
On Wednesday (May 7th), Senate Finance Committee
<http://www.senate.gov/~finance>  Chairman Max Baucus (D-MT) said a Medicare
package that would delay for 18 months a 10.6% cut to physician fees would
cost between $15 billion and $18 billion over five years, prompting
committee members to begin discussions on how to offset those costs (CQ
Today, 5/7).  Senators Olympia Snowe (R-ME) and Kent Conrad (D-ND) said that
committee members continue to examine reducing payments to private insurers
that administer Medicare Advantage (MA) plans as a potential offset for the
bill (CongressDaily, 5/7).  MA plans, on average, are paid an estimated 113%
of what traditional Medicare pays per patient (CQ Today, 5/7).  Last year,
when Congress passed a six-month delay for the Medicare fee cuts,
Republicans, "particularly from rural areas where the plans are popular,
objected to cuts to the MA program (CongressDaily, 5/7).  House Ways and
Means Health Subcommittee Chairman Pete Stark (D-CA) said he expects Baucus
to cut indirect medical education payments under MA that are given to
insurers that provide coverage in areas with teaching hospitals.  Baucus
said no decisions were made, but he did not rule out cutting IME payments.
"There are lots of different options on the table." 
 
Visit the Senate Finance Committee, http://www.senate.gov/~finance
 
Visit the House Ways & Means Subcommittee on Health,
http://waysandmeans.house.gov/committees.asp?formmode=detail

 
 
 
>> Expect Bonus Payments for PQRI Program in July: CMS Offers New Ways to
Participate in the PQRI Program
 
If you participated in CMS' Physician Quality Reporting Initiative (PQRI) in
2007, you can expect to receive your bonus payments by mid-July 2008,
announced CMS in a recent nationwide conference call.  Along with the bonus
payments, these providers will also be able to access their performance data
for the 2007 PQRI program.  Because of provisions that AANA was successful
in enacting in the PQRI enabling legislation, CRNAs are eligible to develop
and report Medicare Part B PQRI measures similarly to physicians. 
It's not too late to report measures for 2008.  Providers, who did not start
reporting in January 2008, can begin reporting measures to CMS beginning
July 1, 2008.  The reporting period for both the year-long and six-month
reporting period ends on December 31, 2008.  CRNAs can currently report on
at least the following three measures; (#20, 21 and 22) administration of
the antibiotic prophylaxis in a surgical patient, (#76) prevention of
catheter-related bloodstream infections (CRSBI) - catheter insertion
protocol- maximum sterile barrier technique; and (#75) prevention of
ventilator-associated pneumonia - head elevation of 45 degrees.  CRNAs may
also report additional measures from the list, such as #128 universal weight
screening, #129 universal influenza vaccine screening, and #130 universal
documentation and verification of current medications in the medical record.
 
For 2008, CMS has developed new ways for eligible providers (EPs) such as
CRNAs to participate in its Physician Quality Reporting Initiative (PQRI)
program.  According to CMS staff, CMS hopes that these additional options
will provide eligible providers with multiple opportunities to successfully
participate in the PQRI.
 
In 2007, EPs had only one option for reporting quality measures to CMS.
Providers had to submit individual measures on the CMS1500 claims processing
form.  One new option for 2008, allows providers to report measures
according to "measure groups."  Currently, there are four measure groups;
Diabetes, End Stage Renal Disease (ESRD), Chronic Kidney Disease, and
Preventative Care.  Each measure group is comprised of measures that are
typically reported by separately primary care providers when caring for
patients with these diseases.  A measure group generally only has to be
reported once, when the patient presents and is diagnosed, for each patient
thereby reducing the total number of times the provider would have to report
measures for one patient.  While CRNAs are not likely to report the current
measure groups based on the nature of CRNA practice, it is foreseeable that
more measure groups could be developed that might include anesthesia related
services.
 
Additionally, in 2008, CMS began accepting data directly from provider
registries.  Provider groups such as the Society for Thoracic Surgeons can
now submit the quality data they collect directly from their registries to
CMS.  Before this change, thoracic surgeons had to report the same measures
twice; first, to their registry then second, to CMS using the claims based
process. 
 
For more information about how to participate in the PQRI please go to CMS'
PQRI website, http://www.cms.hhs.gov/PQRI/
 
 
 

>> The NPI:  The Number CRNAs Need May 23rd!
 
For over a year CRNAs have been required to include their National Provider
Identifier (NPI) on all Medicare claims in the primary provider fields.
However, the Centers for Medicare & Medicaid Services (CMS) continues to be
concerned about the low percentage of claims being submitted with an NPI
alone in the primary provider identifier fields.
 
According to the Medicare agency, if your claims are being successfully
processed with NPI/legacy pairs, and most are, now is the time for CRNAs to
begin sending a small batch of claims with NPI alone.  If the claim is
processed and you are paid, you should continue to increase the volume of
claims sent with only your NPI.  Please keep in mind that if the Medicare
NPI Crosswalk cannot match your NPI to your Medicare legacy number, the
claim with an NPI-only will be rejected. If the claims are rejected, go into
your NPPES record and validate that the information you are sending on the
claim is consistent with the information in NPPES.  If it is different, make
the updates in NPPES and resend a small batch of claims 3-4 days later. If
your claims are still rejected you may need to update your Medicare
enrollment information to correct this problem. 
 
For more information on the NPI,
http://www.cms.hhs.gov/NationalProvIdentStand/
To apply for your NPI, https://nppes.cms.hhs.gov/NPPES/Welcome.do
 
 

 
>> Nursing Research: Economic Downturn Helps Address Shortage
 
On Wednesday (May 7th), the Wall Street Journal examined how the "ailing
economy" has prompted many nurses to work additional shifts, delay
retirement or return to the work force from retirement, all of which have
helped "ease the nursing shortage."  The research did not specifically
examine the vacancy rate for CRNAs.
 
The nursing shortage began in the 1990s as older nurses began to retire and
fewer younger nurses replaced them, and the shortage became worse as aging
baby boomers increased demand for healthcare.  By 2001, the U.S. had
vacancies in 126,000 nursing positions, according to the American Hospital
Association. According to the Journal, the "renewed interest in nursing," a
"familiar pattern during economic slowdowns," has helped hospitals, which in
recent years have increased wages and offered signing bonuses to attract
nurses, as well as implemented measures to allow older nurses to continue to
work.  However, experts expect the nursing shortage to continue to increase
in the future as demand exceeds the number of nurses who enter the
profession.  Jane Llewellyn, vice president of clinical nursing affairs at
Rush University Medical Center in Chicago, said, "We are seeing a temporary
lessening of the nursing shortage," but, "as soon as the economy turns up,
we'll see them staying home again" (Dougherty, Wall Street Journal, 5/7).
 
Visit the American Hospital Association,
http://www.aha.org/aha_app/index.jsp
 
 

 
>> Follow-Up:  AANA Mid-Year Assembly
 
During the AANA Mid-Year Assembly (MYA) (April 13th - 16th), more than 600
CRNAs and student nurse anesthetists  came to Washington, DC, to educate
Members of Congress on Nurse Anesthesia issues.  Now's the time to follow-up
strong, to ensure legislators and their staffs have the best possible
impression of CRNAs and our agenda on Capitol Hill.
 
The messages CRNAs brought to Congress:
 
*  Reverse the coming Medicare payment cuts on CRNA and physician
      services, estimated to be 10.6% come July 2008 and another 5% in January
      2009;
*  Restore funding for nursing and nurse anesthesia education, which
      was cut by the Administration's 2009 budget proposal; and,
*  Reform Medicare anesthesia payment teaching rules for both CRNAs and
      anesthesiologists equally, not favoring one provider over another.
 
 
Following up is crucial to our advocacy activities the rest of the year.
 
*  Did you complete your lobby visit report form for every visit? An
      online lobby report form is available to you by clicking
      <http://www.zoomerang.com/Survey/survey.zgi?p=WEB227K5HGV8GT> this link


Please fill out a form for every visit you made.  
 
*  Have you evaluated AANA Mid-Year Assembly '08?  Though AANA Meetings
      & Programs takes your evaluation of every AANA Mid-Year Assembly activity,
      AANA DC would like your views on what Meetings & Programs staff can't
      evaluate - such as the degree you thought the whole program prepared you for
      your meetings on Capitol Hill, and your perspective on our new "two-track"
      Sunday educational program.  Please click
      <http://www.zoomerang.com/Survey/survey-intro.zgi?p=WEB227QAQN24NC> this
      link to complete and submit your evaluation.  
 
*  The Mid-Year Assembly slide deck and background and advocacy
      materials are all available online at www.aana.com/federalissues.aspx. 
 
 
 

>> Amendments
 
*  The House and Senate will be in session this week.  Both the House
      and the Senate will be in session this week with the House considering
      Neighborhood Stabilization Act of 2008 (HR 5818).  Meanwhile, the Senate
      will continue work on the Flood Insurance Reform and Modernization Act of
      2007 (S 2284).
 
*  CMS is posting a new educational presentation about its Physician
      Quality Reporting Initiative (PQRI) pay-for-performance program, in which
      CRNAs can participate.  Its slide presentation for an April 30 program is
      posted at http://www.ampev1.com/customers/palmetto/043008.pdf.  For more
      information about CMS' PQRI program, see http:// HYPERLINK
      "http://www.cms.hhs.gov/pqri" www.cms.hhs.gov/pqri. 
  
*  Stay Informed about the Nevada Hepatitis Outbreak.  An outbreak of
      hepatitis has been linked to an outpatient center near Las Vegas, NV, with
      AANA President Wanda Wilson CRNA PhD most recently testifying before a
      Nevada state legislative joint committee on healthcare to describe the
      profession's action plan to promote infection control and safe practice.
      The AANA is closely monitoring and acting upon the situation.  More details
      are available for AANA members on the AANA Website (http://www.aana.com).
 
*  Where are the major U.S. Presidential candidates on healthcare
      issues?  The Kaiser Family Foundation has combed their websites, statements
      and speeches and posted it all on www.health08.org.   
 
* Make a statement to back CRNA-PAC!  The AANA's CRNA-PAC is a
      separate fund, supported by AANA members' voluntary contributions, that
      builds AANA and CRNAs' strength in Washington by supporting legislators
      friendly and influential to CRNAs' federal policy issues. For more
      information, see www.aana.com/crnapac.aspx, or email info@aanadc.com if you
      have any questions.
 
*  AANA DC has Moved.  As of December 1st, 2007, our new street address
      is 25 Massachusetts Ave., NW, Suite 550, Washington, DC 20001.  Our
      telephone, fax number, and email addresses remain the same. 
 
*  For up-to-date Congressional floor & committee schedule information,
      see http://thomas.loc.gov/.
 
 
 
 
 
>> For More Information
 
The AANA Federal Government Affairs Hotline is published for the nurse
anesthetist members of AANA each week Congress is in session by the AANA
Office of Federal Government Affairs, Washington DC, 202-484-8400,
info@aanadc.com, Frank Purcell, Senior Director.  C 2008 American
Association of Nurse Anesthetists.