State of the Union: NP Practice in Pennsylvania

State of the Union: NP Practice in Pennsylvania Lori Martin Plank, PhD, CRNP, FAANP Barbara Todd, DNP, ACNP, FAANP Susan Schrand, MSN, CRNP Federal Legislative Update 2014 Lori Martin Plank, PhD, CRNP, FAANP PA State Representative for AANP November, 2014 Legislative Branch House of Representatives 233 Republicans 199 Democrats Senate 55 Democrats 45 Republicans 1

2014 Midterm Elections 36 Senate seats 21 Democrats and 15 Republicans All 435 Members of the U.S. House 22 House Members are retiring and 5 others are running for a different office 8of these Members sit on committees of jurisdiction for health care issues Possible Outcome Republicans must win at least 6 seats to take control of the Senate and are likely to remain in control of the House AANP s Federal Policy Agenda Retire ALL federal barriers to nurse practitioner practice Home Health NPs can provide face to face assessments of patient needs, but current law requires that a physician document the encounter. Please Cosponsor H.R. 2504/S. 1332, the Home Health Care Planning Improvement Act of 2013. Durable Medical Equipment Current law requires physician documentation when ordering certain types of DME, causing increased cost and unnecessary delays. CMS has delayed the implementation of this law but legislative action must occur to remove this barrier. Please Cosponsor H.R. 3833 which would authorize NPs to document evaluations for certain DME. AANP s Federal Policy Agenda Veterans Health Administration VHA is updating their nursing handbook which would include allowing all APRNs to practice to their full scope throughout the VHA system. Urge Congress to support VHA s move forward in recognizing NPs to practice to their full scope throughout the VA system. Alignment of Medicaid to Medicare Primary Care Reimbursement Rates Under the current program, expiring on 12/31/14, only NPs under the direct supervision of a physician are eligible to participate in program. Any extension of the program must make ALL NPs eligible to participate. Please Cosponsor S. 2694, the Ensuring Access to Primary Care for Women and Children Act 2

Emerging Issues Primary Care Educating Members of Congress on the number of NPs that are primary care providers Ensuring that policy makers understand the importance of NPs being eligible for increases or additional reimbursements made to health care providers providing primary care ICD 10 As we approach the new implementation date of 10/1/15, ensuring that while testing occurs, nurse practitioners are eligible to be part of the testing group and their concerns regarding the use of ICD 10 are heard Provider Non Discrimination Section 2706 of the ACA AANP Successes Health Policy Conference: over 200 AANP members attended AANP Senior Leadership and Staff engage with senior administration officials at the White House on a regular basis House and Senate briefings held informing Members of Congress and their staffs on NPs Home Health Bill has more cosponsors than ever before DME regulation delayed Over 24,000 messages sent to policymakers in 2014 AANP activist database now has over 68,000 contacts Federal regulations relaxed regarding physician supervision in a number of settings AANP selected to represent the nursing community at a New Democratic Caucus meeting We Need Your Help Communicate with Members of Congress Meet with them in their District/State office Invite them to your practice Let them see you at work Attend a town hall meeting and ask them a question Send them a letter District work periods provide great opportunities to get to know your Member of Congress or their staff Elected officials need to hear from, meet, and interact with NPs 3

Save the Date AANP 2015 Health Policy Conference March 29 31, 2015 Hyatt Regency Washington on Capitol Hill ~ Washington, D.C. Don t Miss This Exciting Opportunity! Presentations by leading health policy authorities Up to the minute health policy updates Network with NP leaders from across the country Visit with elected officials during NP Hill Day Please visit www.aanp.org Your Federal Government Affairs Team MaryAnne Sapio, VP Federal Government Affairs Debra Swan, Associate VP Federal Government Affairs Jan Towers, Sr. Policy Consultant Clark Princell, Director PAC and Grassroots CMS Graduate Nurse Education Demonstration Project : Hospital University of Pennsylvania Barbara A. Todd, DNP, ACNP BC, FAANP Director, GNE Network of Greater Philadelphia Director, Advanced Practice Hospital University of Pennsylvania 4

National Projections for Primary Care With the Affordable Care Act, by 2015, it is estimated that a total of 25 million Americans who are newly insured will be seeking care, further straining an already overburdened primary care system. 86 Million more who have improved coverage are also likely to obtain primary care at higher rates than before. Federal and state policymakers will need to ensure there are sufficient resources and support for the primary care workforce to provide needed services to these individuals. Realizing Health Reform s Potential January 2011, The Commonwealth Fund. Melinda Abrams, Rachel Nuzum, Stephanie Mika, and Georgette Lawlor Purpose of Demonstration HUP one in five nationwide hospitals selected to receive federal funding from the Centers for Medicare and Medicaid Services (CMS) for participation in the GNE Demonstration (July 2012) Funding $200M over 4 years to the five selected sites: CMS authority for up to $50M/year (2012 2016) GNE Demonstration payment for reasonable costs for qualified clinical training for Advanced Practice Registered Nurses (APRNs) Purpose: Provide Medicare beneficiaries with improved access to health care provider services by significantly increasing the number of APRNs educated in the Greater Philadelphia Region Create an efficient partnership collaborative, replicatable, networking model between hospitals, regional nursing schools and clinical partners Allows monitoring, collection and information exchange ( best practices, etc.) through coordinated communication between regional health care systems, nursing programs, and clinical partners CMS 5 Demonstration Hospitals Selected Hospital of the University of Pennsylvania, (Philadelphia, PA ) Duke University Hospital (Durham, N.C.) Scottsdale Healthcare Medical Center (Scottsdale, Arizona) Rush University Medical Center (Chicago, Ill.) Memorial Hermann Texas Medical Center Hospital (Houston, Texas) 5

Hospital University of Pennsylvania Owned and operated by the University of Pennsylvania Among the top 10 ranked hospitals in the country Magnet designated hospital for nursing excellence Part of University of Pennsylvania Health System 4 major hospitals 14 hospital affiliates Numerous primary care affiliates Largest employer in the region Employer of > 500 APRNs HUP GNE School of Nursing Partners GNE Network of Greater Philadelphia University of Pennsylvania Drexel University Thomas Jefferson University Villanova University Temple University Widener University LaSalle University Neumann University Gwynedd Mercy University SON NP CNS CRNA CNM APRN Programs University of Pennsylvania Thomas Jefferson Drexel Villanova LaSalle Widener Temple Gwynedd Neumann 6

Demonstration Clinical Footprint Community Healthcare Partnerships across the state with over 800 clinical training Partnerships including: Hospital and university based partners Community Clinics Federally Qualified Health Centers Nurse Managed Centers 19 Geographic Clinical Training Footprint Geographic Clinical Training Footprint 7

Goals and Projected Outcomes Demonstration Year 1 and 2 (NPs) Increase in graduates from baseline Increase in enrollment from baseline Increase in clinical training from baseline Best Practice Partnership with National Nurse Center Consortium (NNCC) Partnership with City Health Centers MATCH for pediatric placements Pipeline strategy to meet workforce demands Early Challenges Incremental Payment Methodology Contracts Primary care definition Increasing clinical training capacity Preceptor Recognition Sustainability after 2016 8

Priorities DY 3 and DY 4 Building the case for a national roll out Stakeholder engagement Targeted focus on UPHS APRN workforce Preceptor development Piloting preceptor models Developing new and innovative preceptor models that will be sustainable post demonstration Care for Pennsylvania: Achieving Full Practice Authority Susan Schrand, MSN, CRNP, NP C CEO, PA Coalition of Nurse Practitioners RWJF 2013 Executive Nurse Fellow November 8, 2014 9

PCNP works every day to represent to advocate for NPs Successful Track Record PA Prescriptive Authority 20 years in the making Handicap Placard Signatory Authority Single Board Oversight Passage of Act 48 home health, DME, PT, RT, and Dietary referrals, TANF forms, Methadone assessments Teacher s Physical Form Signatory Authority Death Certificate Signatory Authority Progress in 2014 In 2014, PCNP was charged to get over half of the members of the PA Senate to sign on in support of Full Practice Authority. Other victories: Ensured that NPs are included among those who can prescribe and establish protocol in schools for epinephrine injections. Ensured that NPs were included to lead medical homes, and on statewide medical home advisory council What happened this year? Why didn t SB1063 pass into law? Unfortunately, this year in Harrisburg was one of the most gridlocked in memory. Lawmakers were focused on several key bills, like pensions and liquor, that did not pass. 10

Top Goal in 2015: Full Practice Authority 2015 Campaign: Care for Pennsylvania Full Practice Authority refers to a change in state law that would allow Nurse Practitioners to practice to the full extent of our training and licensing. Formally known as independent practice or autonomous practice Exclusive licensure authority to evaluate patients, diagnose, order and interpret tests, initiate and manage treatments including RX The Case for Full Practice Authority 11

The Time is Now Over 500,000 Pennsylvanians are about to gain insurance coverage through the Medicaid expansion called Healthy PA. More insurance for more people is great news. But patients will only be able to get care if there are enough health care professionals to see them. Only 1 out of every 3 physicians offices is accepting new Medicaid patients in PA, according to a recent study by the University of Pennsylvania. PA needs to catch up 19 states plus Washington, DC now give Nurse Practitioners Full Practice Authority. Connecticut and Minnesota joined this list this year. Source: AANP NP Care is on the Rise Health Affairs, June 2013 12

Experts overwhelmingly agree: NPs Improve Patient Care Over 100 studies have shown that NP led care leads to positive patient health outcomes as good or better than physician led care. Non partisan experts, Republicans and Democrats have all come to the same conclusion. PA patients face a primary care shortage The US Department of Health & Human services projects a primary care physician shortage of 20,400 by the year 2020. HHS says Nurse Practitioners could help to cut that shortage by more than half. 22% of Pennsylvanians including 55 of 67 counties reside in designated shortage or medically underserved areas. The AARP has endorsed Full Practice Authority Decades of evidence demonstrate that APRNs provide the same high quality of health care as physicians. This high quality of care is evident whether or not APRNs are supervised by physicians. PA AARP Reducing barriers to full APRN practice is supported by leaders in policy and science. PA AARP Other supporting organizations include: Bucks County Women s Advocacy Coalition National Nursing Centers Consortium 13

It s good for Medicaid and Medicare patients A recent Nursing Outlook study found states like PA without Full Practice Authority have nearly 50% more potentially avoidable hospitalizations. For every 1,000 personyears among Medicare Medicaid beneficiaries. It boosts care in rural areas Rural Pennsylvanians have about half the access to primary care physicians per capita compared to others. NPs are twice as likely as MDs to practice in rural areas. Why is this Political? FPA requires state lawmakers have to change state licensure laws Image from: www.kesherisrael.org 14

What is PCNP doing to make Full Practice Authority a reality? Two pronged approach Communications talking to news media, key influencers and the general public Lobbying to talk directly to lawmakers In 2015, PCNP will be working in the House too, not just the Senate. After successfully recruiting 26 Senate supporters, we re going to adapt the campaign to correspond with the regional groups. How could any lawmaker oppose something that improves health care? Though we ve been around for decades, Nurse Practitioners are a relatively new for many lawmakers. Some people still don t understand where we fit in the health care system. Some people are simply comfortable with the status quo and wary of change. Who Opposes Full Practice Authority? Medical trade groups 15

What are they saying about it? They say NPs aren t adequately trained. That s false. Over 100 studies have compared NP led care favorably to physician led care and disproven this claim. They say NPs won t practice in rural areas. That s false. Where are my NPs from rural counties? NPs are twice as likely as MDs to practice in rural communities. They say Full Practice Authority would threaten teambased care. That s false. Team based care is alive and well in the 19 states that already have FPA. What you need to do PCNP has your back. Any way you want to engage your community lawmakers, newspapers, organizations we will help you do it. Visit www.pacnp.org and click on the Contact Us link above the stethoscope. Tell us that you re interested in helping. Talk to your regional group leaders and volunteer to be a campaign liaison. Visit www.pacnp.org and click on the Contact Us link above the stethoscope. Tell us that you re interested in helping Think of potential coalition partners. Social Media Engage PCNP on social media. Take out your smartphone and go to facebook.com/pacoalitionofnps and like PCNP Go to @PCNP_News and follow PCNP on Twitter 16

We want to highlight the important role of every NP. Video project Go next door and sit down with Keegan to take a short, testimonial video. We re going to compile these online to send a clear message: NPs are a key part of our communities. Lobbying PCNP will help prepare you to talk with your lawmaker, either in person in your district, in Harrisburg during Lobby Day, on the phone or via letter. Follow lawmakers on social media VOTE! Who you vote for is secret. Whether or not you vote is public record. What Motivates You? 17

PCNP Organizational Update Sept 2014 Board Retreat Rapid growth, need for improved structure Strategic planning to occur in 2015 2015 Conference will incorporate a General Membership Meeting to continue building communication PCNP is committed to building Nurse Leaders, as recommended by the 2010 IOM Future of Nursing. Thank you for your attention! Have a fantastic conference! References Slide 8: Rhodes, K., Kenney, G., Friedman, A., Saloner, B., Lawson, C., Chearo, D., Wissoker, D., & Polsky, D. (2014). Primary Care Access for New Patients on the Eve of Health Care Reform. JAMA Intern Med. 174 (6): 861 869 Slide 10: Kuo Y F., Loresto F., Rounds L. and Goodwin J. (2013). States with the least restrictive regulations experienced the largest increase in patients seen by Nurse practitioners. Health Affairs, pages 1236 1243. Slide 14: Oliver, G.M., Pennington, L., Revelle, S., & Rantz, M. (2014) Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, pages 1 8. Slide 15: Pennsylvania Rural Health Care Association Issues Brief. (2010). Retreived November 3, 2014. http://www.baltichealthcapitalcentre.eu/assets/knowledge center/rura remote areas health/paruralhealth StatusCheck5.pdf AANP 2009 2010 National Sample Survey. Retrieved September 6, 2010, from http://aanp.org/nr/rdonlyres/0952e2ef CE8F 4B26 AC0019041F1B8E59/0/OnlineReport_General2.pdf. Office of Technology Assessment: Nurse practitioners, physician assistants and certified nurse midwives: a policy analysis, health technology case study. OTA Publication. No.37 [OTA HCT 37]. U.S. Government Printing Office,Washington, DC, 1986; (a) p.8. Office of Technology Assessment: Health care in rural America. Publication No. OTA H 434, U.S. Government Printing Office, Washington DC, 1991. GAO Primary Care Report, 2008. General Accounting Office Senate Testimony. Retrieved September 6, 2010, from http://www.gao.gov/new.items/d08472t.pdf. Slide 20: AANP Clinical Outcomes: The Yardstick of Educational Effectiveness. Retrieved November 3, 2014. http://www.aanp.org/images/documents/publications/clinicaloutcomesyardstick.pdf 18