Capitol Beat

The value of nurses continues to be seen at the federal level. Paralleling the Administrations’ December report, that recognized the role registered nurses and advance practice registered nurses (APRNs) play in patient care, the Medicare Payment Advisory Commission (MedPAC), also made recommendations to show the value of nurses. At the most recent MedPAC meeting in January, the 17 commission members, including two nurses, unanimously voted to recommend that “The Congress should require APRNs and Physician Assistants (PAs) to bill the Medicare program directly, eliminating ‘incident to’ billing for services they provide.” The goal of this recommendation is to reduce costs in the Medicare program as well as improve Medicare’s data on who furnishes care to beneficiaries. Currently, APRNs and PAs are paid 85 percent of the rate that physicians receive under the physician fee schedule when they bill Medicare directly for the same services. Therefore, practices may be reimbursed less overall, but accurate data can be collected to show the value of nursing.

The second recommendation from the Commission reads that, “The Secretary [of Health and Human Services] should refine Medicare’s specialty designations for APRNs and PAs.” Medicare has limited information on the specialties of practice for these clinicians and therefore cannot target resources appropriately to areas of concern, such as primary care.

It is important to note that nothing in either of the recommendations would determine what services clinicians can perform, which is up to state statutes and the physicians with whom they practice. MedPAC can only make recommendations to Congress for consideration to changes to the Medicare system.

These recommendations closely parallel the Administration’s Reforming America’s Healthcare System Through Choice and Competition Report that endorses broader state and federal scope-of-practice (SOP) statutes for all health care providers, including APRNs, that allow them to practice to the top of their license and full skill set. The report also advises eliminating “collaborative practice” and supervision requirements which can impede access to care and limit the ability of providers to diagnose and treat myriad health care issues, especially in underserved populations and in rural areas where patients rely on APRNs for timely care and lifesaving treatment.

Individual states will have to determine SOP statutes, but if all APRNs who bill Medicare are designating their areas of practice as well as services provided, increased data will be available to better determine patient outcomes and highlight quality nursing services. Moreover, better data will be available for services provided by communities to allow for more informed choices at the local and state level.

ANA continues to participate in discussions regarding APRN SOP and has provided comment to MedPAC and the Administration on issues, such as expansion of telehealth services to Medicare beneficiaries, that can affect nurses and the care they provide to patients across the country.

After a postponement following the partial government shutdown, President Trump’s State of the Union address to the newly elected 116^th Congress included outlining his vision to end the HIV/AIDS epidemic by the end of the next decade and pledging $500 million over 10 years to fight childhood cancer, the leading disease-related cause of death in American children.

The President also touted recent declines in prescription drug prices and promised additional reductions, while maintaining that he supported coverage for pre-existing conditions. It is politically feasible that the Democratic-controlled House and Republican-controlled Senate could find common ground with the President on both the HIV/AIDS and childhood cancer efforts.

Lowering prescription drug prices is something both President Trump and House Speaker Nancy Pelosi listed as a priority when they gave their respective news conferences post-Election Day. However, lawmakers from both parties have spent years trying to address this issue, with limited success. It remains to be seen whether the Democratic House and Republican Senate can come together in collaboration with the White House to craft an effective piece of legislation in the face of what is likely to be intense lobbying from pharmaceutical companies and other health industry stakeholders.

In the official Democratic response former Georgia gubernatorial candidate and state representative Stacey Abrams called on leaders in Washington to tackle the ongoing issue of gun violence prevention and criticized Republican Attorneys General who have joined a Texas court case that would invalidate the entire Affordable Care Act (ACA). She urged elected officials to back efforts that would expand access and lower the cost of health care. Abrams also joined the President in pointing out that prescription drugs are too expensive for too many families, and that policy solutions are badly needed to address this.

While health care is unlikely to dominate the start of this Congress to the extent that it dominated the start of the previous Congress, lawmakers on both sides of the aisle still believe that voters sent them to Washington to take tangible steps toward improving the American health care system. Despite the challenges of divided government, the prominence of health policy in the SOTU and the Democratic rebuttal emphatically shows that your vote truly matters when it comes to policy decisions regarding the nation’s health care system.