Transcript Elements of Care - S3 amazonaws com

The Legislative Process
and Patient Advocacy
Presented by:
Deborah Halinski, BSN, RN, CNN, CPHQ
Objectives
• Discuss how ANNA’s Health Policy Statement impacts nephrology
practice
• Describe the Legislative Process
• Describe the healthcare provider role in patient advocacy
• Identify ways to become involved in promoting health care policy
initiatives
ANNA Health Policy Statement
• Our national organization has approximately 10,000 members
practicing in many different areas:
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Hemodialysis
Peritoneal Dialysis Therapies
Chronic Kidney Disease
Transplantation
Continuous Renal Replacement Therapies
• Membership consists of:
– RNs = 89%
– APRNs = 6%
– Others = 5%
Health Policy Statement (continued)
• ANNA’s obligation is to set and update standards of patient care,
educating practitioners, stimulate research and disseminate
findings, promote interdisciplinary communication and
cooperation and addressing issues that may impact nephrology
nursing.
• The Health Policy Statement was created to represent ANNA’s
viewpoint on public policy issues relevant to the treatment of
people with kidney disease and the practice of nephrology
nursing
• The Health Policy Statement addresses issues related to: Nursing,
Elements of Care, Transplantation, Medicare ESRD Program
Management and Managed Care & Commercial Health Plans and
the ESRD Population
Elements of ANNA Health Care Policy
• Nursing
 Assure and protect access to professional nursing care delivered by
educated, well-trained and experienced RNs for people with kidney disease
 Promote nurse’s role in health policy advocacy through educational efforts,
grassroot outreach and other activities that promote health and well-being of
those affected by kidney disease
 Include nurses in policy development at all levels of government, on all
boards, commissions, expert panels, task forces and other groups setting
policies and standards
 Support efforts to resolve nursing shortage, including measures to assure
funding to address shortage of nursing faculty
Nursing (continued)
 RNs experienced in dialytic therapy must be present to provide assessment
and supervision of patient care activities and unlicensed personnel during
dialysis treatments
 Use of Advanced Practice RNs in the management of people with kidney
disease can result in cost effective high quality care
 Advocate for policies and programs that promote and ensure health care
environments that provide humane and dignified patient-centered care
(includes dialogue, education and research on end-of-life issues and
decision making on discontinuation or withdrawal from treatment)
**Any health care provider can play a part in supporting advocacy efforts**
Elements (continued)
• Elements of Care
 Nephrology nursing is directed toward assessing and treating the health
needs of those with compromised kidney function and establish high
standards of patient care that are routinely updated
 Appropriate, quality treatment available to individuals with kidney disease or
other diseases requiring renal replacement therapies
 Supports legislative, regulatory and programmatic efforts that promote
prevention and management of chronic kidney disease
 Endorses the ESRD Prospective Payment System and other regulations from
CMS and will continue to play an active role in implementation of changes.
Also supports efforts to allow flexibility for the provision of daily or more
frequent dialysis.
 Supports legislative, regulatory and program efforts that promote disaster
preparedness
Elements (continued)
• Transplantation
 Support for educational programs for the public and health professionals
addressing the shortage of donor organs
 Support for the federally funded Organ Procurement and Transplantation
Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR)
 Include organ/tissue donation language in all legislative and regulatory
proposals related to advance directives, living wills, and durable power of
attorney
 Continued federal support of transplant activities including medical research
and coverage of immunosuppressive drug therapy and legislative initiatives to
extend immunosuppressive drug coverage for the life of the transplant organ
 Educate insurers and other payers regarding success and cost effectiveness
of organ transplantation
Elements (continued)
• Medicare ESRD Program Management
 Supports ESRD payment reforms that support delivery of care and are
consistent with the standards of professional nephrology nursing and clinical
practice guidelines/standards established by the renal community
 Patients with CKD should have access to education and support & clinical
care that may improve kidney function or delay progression of their disease
• Managed Care and Commercial Health Plans and the ESRD Population
 Involve nephrology professionals and/or utilize clinical practice guidelines in
the development of care delivery models
 Provide coverage for dialysis services for members who travel outside the
health plans coverage area
 Provide coverage for immunosuppressive agents for all transplant recipients
for the life of the transplanted organ(s)
Legislative Process
Laws Begin as Ideas
House
• Representative sponsors a bill
• Bill get assigned to a committee
and/or sub-committee for review
– “Mark-up” in sub-committee, where
considered changes are often made
• If released by the committee, bill
gets put on calendar to be voted
on, amended or debated
• If bill passes by simple majority,
218 of 435, the bill moves to the
Senate
Legislative Process (continued)
Senate
• Bill assigned to another committee and/or sub-committee for
review
• If released, goes through debate and vote.
• A simple majority of 51 of 100, passes the bill
Committees (House)
The House’s committees consider bills and issues and oversee
agencies, programs, and activities within their jurisdictions.
• Agriculture
• Rules
• Appropriations
• Science, Space and Technology
• Armed Services
• Budget
• Education and the Workforce
• Energy & Commerce
• Small Business
• Transportation and Infrastructure
• Veterans Affairs
• Ethics
• Ways and Means
• Foreign Affairs
• Intelligence
• Homeland Security
• Joint Economic Committee
• House Administration
• Joint Committee on the Library
• Judiciary
• Natural Resource
• Oversight and Government Reform
• Joint Committee on Printing
• Joint Committee on Taxation
• Select Committee on Benghazi
Committees (Senate)
•Standing
•Agriculture, Nutrition & Forestry
•Appropriations
•Armed Services
•Banking, Housing and Urban Affairs
•Budget
•Commerce, Science and Transportation
•Energy & Natural Resources
•Special, Select & Other
•Indian Affairs
•Select Committee on Ethics
•Select Committee on Intelligence
•Select Committee on Aging
•Budget
•Commerce, Science and Transportation
•Finance
•Joint
•Foreign Relations
•Joint Committee on Printing
•Health, Education, Labor & Pensions
•Joint Committee on Taxation
•Homeland Security & Government Affairs
•Joint Committee on the Library
•Judiciary
•Joint Economic Committee
•Rules and Administration
•Small Business & Entrepreneurship
•Veterans Affairs
Final Steps for a Bill
• Once passed, bill goes to a conference committee made up of
House and Senate members
• Members work out any differences between House and Senate
versions
• Resulting bill returns to House & Senate for final approval
• Government Printing Office prints revised bill in a process called
enrolling
• President has 10 days to sign or veto the enrolled bill
Healthcare Provider Role as Advocate
• Advocacy is defined as the act of pleading for, supporting
or recommending a cause.
• We spend long hours with our patients and their families
making us well suited for that role
• Our knowledge and skills in patient education allow us to
effectively translate information about medical diagnoses,
procedures and medications into language they
understand
• That knowledge and skill set, makes us perfect to
advocate for patients and our profession at community
and public levels
• We become an advocate because we believe in an issue
or see a need for change
Healthcare Provider Role as Advocate(continued)
• We can advocate as an individual or as a group speaking on
behalf of our patients or cause
• People may shy away from advocacy activities because it involves
too much time and energy. Maybe, maybe not
• Don’t have to start big, start with small project. For example:
sending an e-mail to a legislator, making a phone call
• Believing it is impossible to make a difference. Not true at all.
Comments from the nephrology community are heard by
governing bodies like CMS. For example: Five Star Program, being
re-evaluated because the renal community demonstrated flaws in
current design of that program
Healthcare Provider Role as Advocate(continued)
• Join your professional organization and/or state nurses
association
• Educate yourself, colleagues
Journal), family and friends
(consider writing an article for ANNA
• On a facility level
– Clarifying patient concerns
– Answering questions
– Supplying information the patient needs to make decisions
about care
– Supporting patients decisions
Healthcare Provider Role as Advocate(continued)
• Community involvement:
– Lobby at local and national levels
– Consulting with representatives from
groups when health legislation is being
written
– Monitoring health care legislation and its
enforcement
– Encouraging providers and payors
– Educating consumers and lawmakers
***There were 47 ANNA members in attendance
representing 25 states***
Becoming Active in Promoting Health Care
Policy Initiatives
• What can I do?
• Check with your professional organization and state nurses
association for current issues.
• Look for opportunities to become more informed of health care policy
issues. Some examples:
– ANNA Nurse in Washington Internship (NIWI) Grant (application deadline is
Nov. 15, 2015)
– ANNA Health Policy Workshop (Held every 2 years, due in 2017)
– Participate in Virtual Lobby Day (coincides with Health Policy Workshop)
– Technical Expert Panel (often look for volunteers to participate in different
issues)
Promoting Health Care Policy (continued)
• Educate policy makers
– ANNA Kidney Disease Education Awareness
– NRAA 2015 Facility Tour Toolkit
• Take the opportunity for comment periods that are open to the
public. For example:
– Conditions for Coverage
– Dialysis Facility Report
– Quality Incentive Program (QIP)
We are Not Alone…
• ANNA National President submitted comments to CMS on behalf of its
membership regarding recommendations for future updates to the
Conditions for Coverage for ESRD Facilities and for CMS-1614-P:
Medicare Program; ESRD Prospective Payment System, Quality
Incentive Program, and Durable Medical Equipment, Prosthetics,
Orthotics and Supplies.
• Other organizations providing comments:
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American Nurses Association
American Kidney Fund
American Society of Nephrology
Forum of ESRD Networks
Kidney Care Partners
National Renal Administrators Association
Renal Physicians Association
Renal Support Network
Capital Hill Visit
• June 22-23, 2015: ANNA Health
Policy Workshop
• Learned about ANNA Legislative
Initiatives and my role in the
Health Policy Workshop
• Intensive workshop on legislative
process
• Who the players are, who we
might be meeting with
• How to navigate through the
House and Senate
buildings/system
114th Congress (2015-2016)
• H.R. 1130 – Chronic Kidney Disease Improvement and Treatment Act of
2015. This act would expand and improve coordination of federal
chronic kidney disease and ESRD research efforts, remove barriers that
dis-incentivize the use of home dialysis, and ensure the economic
stability of the life-sustaining Medicare ESRD benefit.
• ANNA has urged members of Congress to cosponsor legislation to
improve federal policy related to caring for individuals with CKD by
addressing gaps in critical research, improving beneficiary access to
treatments for CKD and create economic stability for providers caring
for these individuals
• Status: referred to the Subcommittee on Health of both the House
Energy and Commerce Committee and the House Ways and Means
Committee
114th Congress (continued)
• H.R. 1342 -Home Health Care Planning Improvement Act of 2015.
As the pool of nephrologists decrease, nurse practitioners, clinical
nurse specialists and physician assistants are playing increased
roles in the delivery of primary health care services. The use of
these physician extenders is especially true in rural and medically
underserved areas. Medicare recognizes Advanced Practice
Registered Nurses (APRNs) for the care they provide in home
health settings but requires a physician’s signature to certify a
home health episode. The passing of this act would allow APRNs
to certify home health plans for Medicare patients. This legislation
would ensure that beneficiaries have timely access to the home
health care they need in states where APRNs are licensed to
provide such services.
114th Congress (continued)
• H.R. 1342 (continued)
• ANNA has urged members of Congress to pass legislation that recognizes the APRNs
role in home health care and ensures that Medicare beneficiaries have timely access to
home health care services
• Status: Referred to the Subcommittee on Health of both the House Energy and
Commerce Committee and the House Ways and Means Committee. This bill has had
some positive forward motion since June and may be considered as part of a package
of non-controversial health-care related bills in the fall.
114th Congress (continued)
• H.R. 2713 - Title VIII Nursing Workforce Reauthorization Act of
2015
• The Nursing Workforce Development Programs at the Health Resources and Services
Administration (HRSA) supported the recruitment, education, and retention of an
estimated 450,000 nurses between fiscal years 2006 and 2012. A report issued by
HRSA predicts that the percentage of unfilled nursing positions will increase 29% by
2020
• ANNA has requested a funding level of $244 million for the Nursing Workforce
Development programs at HRSA in FY 2016.
• Status: Referred to the Subcommittee on Health, may not increase funding but would
not lose any current funding
The Big Meeting Day
• ANNA members were partnered with other representatives from
their state for some congressional visits
• Armed with fact sheets, questions to ask Representatives and/or
Senators
• Appointments with Kristin Gillibrand, Chuck Schumer and Kathleen
Rice
• We did our pitch on the bills and got the following responses:
• Gillibrand,’s aides-maybe, would consider supporting
• Schumer’s aides – yes to support. Staffer advised us that Home Health
Planning Bill was in mark-up in Finance committee and hoping to get score and
any technical assistance by July. She also mentioned that the Chronic Disease
Care Bill was coming up and that it would include ESRD
• Rice – met personally with Rep. Rice. Had lots of question
regarding CKD and transplantation and concerns of nurses. Had
questions regarding the bills presented and got yes for support of 2
bills and the workforce funding
Recap
• ANNA Health Policy Statement provides a framework of many
aspects of nephrology care that impact how we practice and
provide care to our patients
• ANNA Health Policy Statement is a great resource for learning
about opportunities to get involved
• Advocacy – there is a variety of ways to become involved in
patient advocacy, some small and some big. The hardest step is
the first one
• The Legislative Process can be overwhelming but learning a little
bit about the process can help us understand the importance of
becoming involved.
Final Thoughts
I challenge each of you to do one
thing to advocate for patients and
yourselves.
I’m thankful to be a nurse
becauseI get to advocate for people
who are at their weakest
From: Career Quotes
References/Resources
• American Nephrology Nurses
Association
– www.annanurse.org/HealthPolicy
• American Nurses Association
– www.nursingworld.org
• Kidney Care Partners
– www.kidneycarepartners.com
• National Council of State
Boards of Nursing
– www.ncsbn.org
• National Kidney Foundation
– www.kidney.org
• New York State Nurses
Association
– www.nysna.org
• U.S. House of Representatives
– www.house.gov
• U.S. Senate
– www.senate.gov