08.01.13
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NURSE TALK RADIO: Victory for Northern Calif. Sutter RNs

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By Pattie Lockard
Executive Producer
Nurse Talk Radio

Joanne Jung on the Health Benefits Victory for Nurses

Victory for Nurses in Northern California!…AND a victory for nurses across the country!

Recently, a federal administrative law judge with the National Labor Relations Board handed nurses a victory, finding Sutter Hospitals in the San Francisco Bay Area engaged in illegal “unfair labor practices” when it unilaterally cut paid sick leave and eliminated all paid healthcare coverage for RNs who work less than 30 hours per week, affecting hundreds of nurses and their families.

The judge ordered the hospital chain to “rescind its unilateral changes and…make whole employees for any losses they have suffered…plus interest.” Sutter had maintained it projected expenses related to the implementation of the Affordable Care Act, but would not “show their homework” to the judge. Why? Because there was no certainty or reason for their projected increases. Joanne Jung, a spokeswoman for the California Nurses Association/National Nurses United joins us to discuss the topic.

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07.31.13
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What if patients determined an adverse event?

NurseERNext fall, patients will be able to report adverse events in a limited time.  They’ll be able to initiate an investigation with the Agency for Healthcare Research and Quality if they feel they were given the wrong medication or suffered a negative patient outcome.  The report will then go to the RAND Corporation and the ECRI Institute, which investigates medical errors.

While originally supportive of the idea, the American Hospital Association touted the empowerment of patients when the idea was originally proposed last year.  Original story is here.

Now that the program is about to begin comes the warning that patients don’t have the background to assess what’s an adverse event and may merely complain when they’re not satisfied.  Another objection is the time it would add to facilities and physicians to answer questions by investigators about these reports.  The agency says it would only add 28 hours in administrative time.  Response is here and here.

In Minnesota, there is no such avenue for consumer complaints, but healthcare professionals can report an adverse event after it’s happened to the Office of Health Facilities.  This office however, while tasked with protecting vulnerable patients, is limited in its power.  It can’t, for example, investigate incidents where a lack of nurse staffing resulted in a “near-miss” or a fear of an adverse event.

As hospitals continue to cite industry studies that cite excellence in healthcare, there are few places to create a more realistic view of the quality of care patients receive.  Consumers need to join nurses at the Minnesota legislature and on-line forums to detail cases where they or their loved ones received poor quality care.

Patients’ voices should be heard.  Patients should join the chorus of nurses who cry for minimum standards of care to ensure that nurses have the time to provide safe care to patients.  Nurses have been clamoring for safe staffing levels for decades, but they’ve nearly always been rebuffed by administrators who cry out for lower costs instead.

07.30.13
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ANA Recommendation: Include APRNs

The American Nurses Association (ANA) has recommended to a federal agency that health insurers seeking to offer plans on state health insurance exchanges must include a certain number of advanced practice registered nurses (APRNs) in each plan’s network of health care providers for the plans to qualify.

“Findings from several decades of research consistently demonstrate that APRNs provide safe, quality care with comparable patient outcomes to physicians and even higher patient satisfaction rates,” said ANA President Karen A. Daley, PhD, RN, FAAN. ”As many more millions of uninsured or underinsured seek primary care services through these exchanges, they will need access to qualified primary care providers. That will not happen if private insurers continue to exclude or restrict APRNs from their provider networks.”

In comments submitted to the Centers for Medicare & Medicaid Services (CMS) on a proposed rule governing the exchanges, ANA proposed that each health insurance plan in a particular state include at least a minimum number of APRNs in its provider network to qualify for the exchange. That minimum would be set equal to 10 percent of the number of APRNs who independently bill Medicare Part B in that state. About 100,000 APRNs nationwide are qualified and enrolled as independent Medicare providers and bill Medicare for services provided to Medicare patients under their own National Provider Identifier. More than 250,000 APRNs – nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists – are licensed nationally.

“This standard is easy to monitor and enforce, and easy to understand and meet for health insurance plans that are serious about addressing the real burden of patient access to primary care,” Daley said. “Recruiting and credentialing APRNs in these plans has to be a top priority.”

For Connecticut, which ranks as the median of the 50 states in APRN participation in Medicare Part B, ANA’s recommendation would require exchange plans to include 178 APRNs in their networks. Under ANA’s proposal, the required minimums per plan would range from a low of 16 APRNs in Hawaii to a high of 654 in Florida, according to CMS data from 2011.

Many private insurers traditionally have focused on forming networks of physicians and have not placed the same priority on credentialing other health care professions, including APRNs. This lack of inclusion in provider networks, combined with other barriers to practice such as restrictions in some state regulations, prevent many APRNs from offering the full range of services for which they are educated and licensed to provide. Consequently, APRNs are restricted from contributing to their fullest capabilities to alleviating the nation’s shortage of primary care providers, especially for certain patient populations such as the elderly, lower-income groups, and rural residents.

The exchanges, a key provision of the Affordable Care Act, will be online marketplaces where individuals and small businesses can compare and buy among a range of health insurance plans that cover at least a minimum baseline of essential services, but vary in cost and other factors. The exchanges are designed to enhance competition, improve choice of affordable health insurance to individuals, and give small businesses the same purchasing clout as large businesses. Exchanges are scheduled to start open enrollments October 1, for insurance that becomes effective January 1, 2014.

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ANA is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.