Legislative Update
WARN Legislative Update
May 2011
By Judy Klaver
"Giffords's office looks to expand brain-injury coverage"
By Jason Millman
Source: http://thehill.com/blogs/healthwatch/health-reform-implementation/154675-giffords-office-looks-to-expand-brain-injury-coverage.
The contents of this site are © 2011 Capitol Hill Publishing Corp., a subsidiary of News Communications, Inc.
The office of the Arizona congresswoman who was shot in the head is spearheading an effort to require more insurers to cover traumatic brain injury (TBI).
Staffers for Rep. Gabrielle Giffords (D-Ariz.) are trying to gain support for making TBI coverage part of the “essential health benefit” package that all insurers must offer by 2014 in order to participate in new state-run health exchanges created by the healthcare reform law.
The staffers and advocates say most Americans lack the same level of care that Gifford’s has received since she was shot in the head at point-blank range during a January tragedy that killed six people and wounded 11 others.
“We want everybody to get the care our buddy Gabby is getting,” said Rep. Bill Pascrell (D-N.J.) during a Thursday press conference.
Pascrell, along with Giffords’s office, is circulating a letter to all members of Congress asking them to support requiring TBI coverage on the new health insurance exchanges.
The scope of the essential health benefits package, which will be determined by the Department of Health and Human Services, will play a huge role in the final cost of the Democrats’ 2010 healthcare law.
The nonpartisan Congressional Budget Office expects 8 million individuals to join the exchanges in 2014, and it projects that number to grow to 24 million in 2018. Enrollment can grow even higher if more employers decide to drop insurance coverage and instead pay penalties.
Pascrell, who co-founded the Congressional Brain Injury Task Force more than a decade ago, said he is sensitive to the cost of the essential benefits package, but TBI is a priority for him.
“I hope we’re not going to question the money that is necessary,” he said.
Advocates say expanding TBI coverage can wind up saving money in the long run by helping injury victims stay out of long-term care facilities and allowing them to reenter the workforce after their recovery.
RN Safe Staffing Act Reintroduced in U.S. House of Representatives
ANA-supported Safe Staffing legislation was reintroduced in the House of Representatives on March 2.
Representatives Lois Capps (D-CA) and Steven LaTourette (R-OH) dropped the Registered Nurse Safe Staffing Act (H.R. 876), which would hold hospitals accountable for the development of valid, reliable unit-by-unit nurse staffing plans. These plans would be established by direct care registered nurses (RNs) in coordination with nursing leadership and based on each unit’s unique characteristics and needs. ANA needs your help to educate
members of Congress and build support for this important legislation!
Insufficient nurse staffing is among the top concerns for nurses today. Accordingly, securing appropriate staffing to protect nurses and patients remains a lead priority for ANA. ANA supports the establishment of nurse-patient ratios to address the current crisis, but feels strongly that these ratios must be set, not by legislators, but in the workplace, in direct coordination with nurses themselves, and based on unit-by-unit circumstances and needs.
This approach, based on ANA’s Principles for Nurse Staffing, treats direct-care nurses as more than just a number in a ratio. The RN Safe Staffing Act recognizes nurses as professionals and requires that they play an integral part of staffing plan development and decision-making by giving them a say in the care that they provide.
The Registered Nurse Safe Staffing Act would require Medicare participating hospitals, through a committee comprised of at least 55% direct care nurses or their representatives, establish and publicly report unit-by-unit staffing plans. These plans must: establish adjustable minimum numbers of RNs; include input from direct care RNs or their exclusive representatives; be based upon patient numbers and the variable intensity of care needed; take into account the level of education, training and experience of the RNs providing care; take into account the staffing levels and services provided by other health care personnel associated with nursing care; consider staffing levels recommended by specialty nursing organizations; take into account unit and facility level staffing, quality and patient outcome data and national comparisons as available; take into account other factors impacting the delivery of care, including unit geography and available technology; ensure that RNs are not forced to work in units where they are not trained or experienced.
While ANA respects all attempts to address staffing, we have real concerns about the establishment and legislation of fixed nurse to patient ratio numbers in federal or state legislation. Such legislated numerical ratios seem to offer a concrete solution, and may appear to be a good fit for some workplaces, however, so many other variables—factors including intensity of patient care needed, level of experience of nursing staff, layout of
the unit, level of ancillary support—are key to establishing the “right” nurse-patient ratio for any one unit.
Regardless of the approach taken, no staffing system or ratio can protect patients and nurses without transparency and enforcement. The RN Safe Staffing Act requires public reporting of staffing information– hospitals would be required to post daily the number of licensed and unlicensed staff providing direct patient care on each unit and each shift, while specifically noting the number of RNs, and data must also be reported the Secretary of Health and Human Services (HHS) for publication on the Department’s Hospital Compare Website. The bill also requires collection and public reporting of quality data related to nursing services.
The bill affords whistle-blower protections for RNs and others who may file a complaint regarding staffing, allowing for refusal of assignment and establishing procedures for receiving and investigating complaints.
Hospitals would be held accountable under the RN Safe Staffing Act through enforcement mechanisms including civil monetary penalties that can be imposed by the Secretary of Health and Human Services for each knowing staffing violation, as well as penalties for failure to collect and publicly report staffing and nursing- sensitive indicator data.
We need your help to build support for the RN Safe Staffing Act! Get more staffing information on ANA’s safe staffing website, http://www.safestaffingsaveslives.org/ or jump straight into action by writing your members of Congress or sharing your story through our Take Action page.
National Quality Forum (NQF) Endorses 21 Measures for Nursing Homes
Washington, DC – To improve the quality of care in nursing homes for the 1.4 million Americans who currently reside in facilities across the country, the National Quality Forum (NQF) has endorsed 21 measures to be used to care for both long-term residents and short-stay patients. The NQF-endorsed measures will be used in the Centers for Medicare & Medicaid Services’ Nursing Home Compare, an online database for consumers to compare the care provided in more than 17,000 nursing homes across the country.
In 2004, NQF endorsed an initial set of measures for publicly reporting care in nursing homes. With the completion of the current project, the 17 measures that were previously endorsed will be retired and, in some instances, replaced by the newly endorsed measures. These measures were recently retired in the transition to CMS’ updated data collection instrument, the Minimum Data Set 3.0 (MDS 3.0).
“Choosing where to go for long- or short-term care in a nursing home is an incredibly important decision,” said Janet Corrigan, NQF president and CEO. “Patients and their families need reliable information on the quality of care being provided in skilled nursing facilities so they can make informed decisions about the place they will receive care on a daily basis. The quality data derived from these measures will provide important information about infection rates, patient care experiences, and the general health of residents in nursing homes across the country.”
The 21 NQF-endorsed nursing home measures assess patient outcomes and the patient’s own experience of care for both long-term residents and short-stay patients. The measures address falls, infections, pressure ulcers, and the general health of residents and patients. Examples of endorsed measures include:
• percentage of patients who received influenza and pneumococcal vaccinations;
• percentage of residents with urinary tract infections;
• percentage of residents who need increased help with activities of daily living; and
• patient experience of care surveys for both long-term residents and short-stay patients.
NQF’s Steering Committee on Nursing Homes was co-chaired by David Gifford, MD, MPH, Director, Rhode Island Department of Health, and Christine Mueller, PhD, RN, FAAN, Associate Professor and Chair, University of Minnesota School of Nursing.
“These measures will help consumers better understand and compare quality of care when selecting nursing homes and will help them to monitor care once they or a family member is in a nursing home,” said Dr. Gifford. “Nursing homes can also use these measures to benchmark how they are doing compared to others in addressing important nursing home quality of care issues.”
Physical therapy or nursing rehabilitation/restorative care for long-stay patients with new balance problem (RAND)
Percent of residents experiencing one or more falls with major injury (long stay) (CMS)
The percentage of residents on a scheduled pain medication regimen on admission who report a
decrease in pain intensity or frequency (short stay) (CMS)
Percent of residents who self-report moderate to severe pain (short stay) (CMS)
Percent of residents who self-report moderate to severe pain (long stay) (CMS)
Percent of residents with pressure ulcers that are new or worsened (short stay) (CMS)
Percent of high-risk residents with pressure ulcers (long stay) (CMS)
Percent of residents assessed and appropriately given the seasonal influenza vaccine during the flu season (short stay) (CMS)
Percent of residents assessed and appropriately given the seasonal influenza vaccine (long stay)(CMS)
Percent of residents assessed and appropriately given the pneumococcal vaccine (short stay) (CMS)
Percent of residents assessed and appropriately given the pneumococcal vaccine (long stay) (CMS)
Percent of residents with a urinary tract infection (long stay) (CMS)
Percent of low-risk residents who lose control of their bowels or bladder (long stay) (CMS)
Percent of residents who have/had a catheter inserted and left in their bladder (long stay) (CMS)
Percent of residents who were physically restrained (long stay) (CMS)
Percent of residents whose need for help with activities of daily living has increased (long stay) (CMS)
Percent of residents who lose too much weight (long stay) (CMS)
Percent of residents who have depressive symptoms (long stay) (CMS)
Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Discharged
Resident Instrument (ARHQ)
Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Long-Stay
Resident Instrument (ARHQ)
Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Family
Member Instrument (ARHQ)
The National Quality Forum (NQF) operates under a three-part mission to improve the quality of American
healthcare by:
• building consensus on national priorities and goals for performance improvement and working in partnership
to achieve them;
• endorsing national consensus standards for measuring and publicly reporting on performance; and
• promoting the attainment of national goals through education and outreach programs.
Your Chance to Comment on Health Policy Issues
The Centers for Medicare and Medicaid Services (CMS) have released notices in the Federal Register providing opportunity for public comment on the following items.
Proposed FY2012 IRF PPS Rule Including Proposed Quality Measures.
Comments must be received by June 21, 2011. To review and comment, go to:
http://www.rehabnurse.org/uploads/files/pdf/irfpps%20federal%20register%20110505.pdf
Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates.
Comments must be received by June 20, 2011. To review and comment, go to:
http://www.rehabnurse.org/uploads/files/Inpatient_PPS110505.pdf
Summer Webcast Wed. June 29, 2011, from 1 - 2:15 p.m. Eastern Time
"A Snapshot of Evidence-based Interdisciplinary Care of the Stroke Patient"
Looking at nursing science for the stroke patient through the lens of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework presents exciting new opportunities for guiding the delivery of stroke rehabilitation care across the care continuum. Elaine Miller, PhD, RN, CRRN, FAAN, FAHA, will present an overview of this revolutionary evidence-based care which, for the first time, looks at recovery and rehabilitation of the stroke patient from a holistic perspective, including the humanistic side to healing which incorporates family, work and environmental factors.
Registration begins soon -- visit www.rehabnurse.org for updated registration information.
Wisconsin Legislative Update Wisconsin Nursing News
The Wisconsin Center for Nursing (WCN) and the Wisconsin Nursing Coalition (WNC) hosted a conference May 2, titled: "The IOM Report: Building the Future of Nursing in Wisconsin." Over 200 nurses attended this historical event, representing educators and practice members from all schools and regions of Wisconsin.
Internationally known nursing workforce expert Peter Buerhaus, PhD, RN, of Vanderbilt University presented: "The Future of Nursing: Workforce Data, Quality, Economics, & Public Policy." Ellen K. Murphy, MSN, JD, FAAN, professor emerita from the University of Wisconsin-Milwaukee, spoke on "Scope of Practice and What It Means for Wisconsin Nursing's Future."
You can access these keynote speaker presentations by going to http://wisconsinnurses.org/WCN_WNA_Conference.php.
Participants in regional breakout sessions held in the afternoon were filled with enthusiasm and energy in planning for exciting possibilities for the future of nursing in Wisconsin. The discussion and suggestions from the regional works shops is still being processes. So stay tuned for further details.
The Wisconsin Center for Nursing looks forward to bringing you more events in the future as we work together to advance this important endeavor for nursing in our state. If you are interested in participating in IOM activities in our state, call 414-801-NURS (6877).
Key messages from Dr. Buerhaus’s presentation:
• Nursing is seen as a secure job by parents for both males and females.
• Strong nursing core values are held worldwide.
• Gallop poll findings regarding the most trusted professions; Nurses have consistently rated very high on who individuals trust for their heath information and overall trust level,
• The general public trust and admire nurses they believe nurses will act in the patient self interest not their own.
• The general public respects the work nurses do.
• 88% of nurses are satisfied with their choice of nursing, one of the highest satisfaction ratings.
• 70% of the nurses in the US are working, it is the largest workforce.
• Because of the recession more nurses are working longer making it difficult at present for new graduates to find a place post graduation. But, as the economies improves we could find ourselves in an acute nursing shortage.
Past Legislative Updates
July 2011 update
December 2010 update
May 2010 update
Februrary 2010 update
Fall 2009 update