Open Payments Expansion Will Capture APRNs’ 2021 Transactions

  

As a result of effective advocacy by nurses, federal policymakers are gradually moving the needle to expand access to advanced practice registered nurses (APRNs). As so often is the case, added opportunities for APRNs can some with more oversight or potentially greater scrutiny. A case in point is Open Payments, which will shed sunlight on APRN relationships with drug and device manufacturers, due to upcoming implementation of a provision in the federal opioid response.

It has been two years since passage of the landmark legislation, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or the SUPPORT Act. The SUPPORT Act unequivocally recognized APRNs as a key part of the nation’s response to the opioid epidemic. Specifically, Congress permanently enabled nurse practitioners (NPs) to obtain the necessary waiver to prescribe buprenorphine as treatment for opioid use disorders (OUDs). For certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists, this same authority is provided with a five-year sunset, ending in 2023. ANA is not done working with Congress to get permanent authority of all APRNs to prescribe Medication-Assisted Treatment (MAT).

Congress first expanded APRN authority to treat OUDs, on a temporary basis, in the Comprehensive Addiction and Recovery Act of 2016 (CARA). Elevating APRNs in the opioid crisis response has given patients with OUDs increased access to MAT. Medication-Assisted Therapy is a widely endorsed, evidence-based approach combining buprenorphine use with counseling and behavioral therapy. Allowing APRNs to prescribe buprenorphine has been especially beneficial in areas of the country experiencing shortages of healthcare providers. According to one analysis of CARA, the number of NPs prescribing buprenorphine increased by 79 percent, and rural counties had a higher proportion of advanced practice prescribers, including NPs, compared to urban counties.

At the same time, the SUPPORT Act included a provision that expands Open Payments to include information about drug industry payments to APRNs. That provision is set to be implemented over the next two years.

The Open Payments program is not new. Open Payments comes under the Physician Payment Sunshine Act, which Congress enacted as part of the Affordable Care Act in 2010. Open Payments allows anyone on the internet to look up their physicians (or teaching hospital), and soon other qualified health care providers, and find out about money or gifts their providers have received from sources such as drug companies, device manufacturers, and research sponsors. Open Payments was created out of the desire for transparency in certain health industry transactions, and out of concern that patient care decisions might be influenced by money from outside interests.

The Open Payments searchable database is maintained by the Centers for Medicare and Medicaid Services (CMS). As shown in the screenshot below, members of the public can visit the site and search providers by name and other information such as zip code.

A search reveals how much money a provider received in a given year, who made the payments, the types and nature of payment, and how receiving these payments compares to activity of other providers. The nature and types of payment include general payments, research-related payments, and food and beverage.

In addition to keeping and displaying the data, CMS conducts the process of collecting and vetting Open Payments information. Here’s how the process works, step by step:

  1. For each calendar year, manufacturers and other reporting entities transmit data on individual transactions (valued at around $11 or more) to CMS during an open reporting period in the following year, no later than March 31.
  2. After manufacturers and other entities report for the previous year, CMS prepares the data for disclosure to recipients identified by reporters.
  3. Recipients then have a window of time each Spring to review and verify information about them and ask for corrections if appropriate.
  4. Information for the previous year goes live on the Open Payments website each June.

For APRNs, step 3 will be important in 2022 and beyond, to ensure that reports of payments in the previous year are accurate. However, there are key steps that can be taken in 2021 to prepare. First, visit OpenPayments. Get to know the database and learn more about how to participate in the program. On the Open Payments site, there is a section titled Program Expansion and Newly Covered Recipients. Providers can also sign up for information and notifications.

To summarize, payments in 2021 from manufacturers to APRNs will be subject to reporting. In early 2022, the information will be entered in Open Payments. Affected providers will have a limited opportunity to review what is reported about them. The database will be updated with 2021 data in June 2022. This sequence will recur annually.

Nurses Key to COVID-19 Response, Addressing Maternal Health in Rural Communities

  

Today, November 19, we celebrate National Rural Health Day and acknowledge the nurses that are critical to ensuring access to health care services in rural communities across the nation. This year we focus on rural health and the role you play as clinicians in rural communities, in the midst of the ongoing COVID-19 pandemic, at a time where the number of cases and hospitalizations are steadily increasing. As we begin the holiday season, the Centers for Disease Control and Infection (CDC) continues to issue guidance and recommendations for mitigation efforts necessary to curb the spread of the virus.

ANA continues to recognize and advocate on behalf of all nurses on the frontlines of the pandemic response, as well as providing resources and support. The association knows the role of the nurse is especially critical in our rural communities that struggle with continued or exacerbated spread of the virus. This is particularly concerning as the CDC has detailed how people living in rural areas are at higher risk of contracting and/or facing complications from COVID-19. Because of this increased risk, the CDC has provided several resources and information for rural communities to respond to the COVID-19 pandemic.

In addition to releasing rural-focused data and resources, CDC also recently released data detailing how pregnant women face an increased risk of severe illness if they contract the virus, as well. The agency is working with state and external partners to collect information on COVID-19 cases in pregnant women and it continues to monitor the impact. The increased risk of COVID-19 to pregnant women is troubling given the underlying issue of existing high rates of maternal mortality in the United States, with rates more likely to be greater in rural areas.

Just earlier this year, we saw the Centers for Medicare & Medicaid Services (CMS) issue a Request for Information (RFI) seeking comment from stakeholders on how to improve access to care and outcomes for women and infants in rural communities. Submissions to the RFI, part of CMS’ larger goal of improving health through the Rethinking Rural Health Initiative, will inform the agency as it develops new and refines existing programs targeting rural families. ANA used this opportunity to share with CMS how nurses in rural communities are an integral part in addressing maternal health and ensuring women have access to needed health care services before, during, and after their pregnancy.

ANA recognizes existing barriers to improving maternal health in rural areas, such as gaps in access to providers or loss of coverage. To mitigate these barriers and challenges, nurses must be engaged to expand provider capacity. This includes utilizing Certified Nurse Midwives (CNMs) for pregnancy care, Nurse Practitioners (NPs) trained in women’s health, and Registered Nurses (RNs) to providing care coordination and connecting women to needed services—all leading to better outcomes for women and infants. Across the country, nurses are leading maternity and infant care models that ensure access to care, provide quality care, and ensure better outcomes.

Innovative models and initiatives must be encouraged in strategies to address maternal health in rural areas. It is imperative that strategies strengthen and uplift the contributions of nurses in all communities. Nurses are an integral part in the health care delivery system—especially in rural communities that face barriers to accessing needed care. Innovative payment models should be developed and implemented that recognize the critical value of RNs, NPs, and CNMs and adequately compensate for services these clinicians provide. To address gaps in access to providers, states must be incentivized to allow NPs and CNMs to practice at the full extent of their education and training.

We expect to see renewed attention on discussing and addressing maternal mortality and morbidity at the federal level. For example, the Medicaid and CHIP Payment and Access Commission continues to discuss this issue at public meetings and the June 2020 Report to Congress includes a chapter examining why mortality and morbidity rates continue to rise. As policymakers seek approaches to address rural maternal health challenges and barriers, the critical role of the nurse cannot be overstated. Leveraging the education and expertise of CNMs, NPs, and RNs to expand provider capacity and lead innovative care delivery models will only result in better maternal and infant health.

ANA continues to closely monitor this issue and take advantage of opportunities to highlight the importance of the nurse in addressing maternal health and other health care challenges in rural communities. In addition to the resources linked above, the following are available to better understand current challenges in addressing rural maternal health:

• Maternal Health Care in Rural Communities
• Maternal and Obstetric Care Challenges in Rural America
• Rural Disparities, Racial Disparities, and Maternal Health Crisis Call Out for Solutions
• Left Out: Barriers to Health Equity for Rural and Underserved Communities

We want to hear from you! Share your story of #RNAction in rural health by sending a message to rnaction@ana.org.

ANA Advocacy Team Prepares for a New Administration and a New Congress

  

The ballots have been cast and we are now waiting for the electoral college to come together to cast their votes for the next President of the United States. The projected winner is Joe Biden and his transition team is already working to prepare for the start of his presidency, and Congress is currently electing their leadership for the 117th session.

Just as the President-Elect and Congress are preparing for 2021 – so is ANA’s Policy and Government Affairs team. ANA seeks to maintain a position as a leader on nursing issues with both the new Administration and Congress – and advocacy has already started. Two letters have been sent to the Biden transition team – one capturing ANA’s priorities and the other related to placing a registered nurse on the Biden COVID-19 Task Force.

We want you to know that the Policy and Government Affairs team has developed a comprehensive “100 Day Advocacy Plan” which will encompass all levels of advocacy – Administration, legislative, regulatory, grassroots and political. The plan is a coordinated approach to ensure that ANA’s policies and priorities are shared at all levels of the federal government.

We remain committed to finding opportunities for nurses to be at the table; –We will resume our outreach with career policy makers at federal agencies and seek to establish meaningful relationships with the newly appointed leaders to support a swift and seamless transition between administrations.

Last year ANA achieved several legislative victories and thanks to many of you we increased our advocacy network by over 160%. The Policy and Government Affairs team will continue this level of excellence in the next Congress, working closely with returning members as well as establishing relationships with newly elected freshman. Our team will continue to seek opportunities for nurses to testify before Congress and make your voices heard. Please know, that early on we will be asking our nurse advocates to reach out to their newly elected Congressional Members not only to congratulate them, but to offer to be a resource on health care issues.

Our Administration has changed – but our work continues. Much more needs to be done to ensure that our frontline providers have access to PPE and other resources as they continue to combat COVID-19. ANA is working with our colleagues to ensure APRNs can work to their full scope. As telehealth continues to grow as a health care delivery model – ANA will be there to support those efforts. That’s just a few of the issues we are working on!

ANA is prepared with a solid plan to support the interests of the 4.2 million registered nurses. However, we can’t do this alone. We need nurses and nurse advocates to actively engage in the process. Please sign up for alerts at RNAction.org, visit our advocacy page, and read our Capitol Beat blog for all the latest activities of ANA’s Policy and GOVA Department.