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IOM Update: Advocacy for RNFA Reimbursement

Publish Date: May 24, 2012

New York State’s Future of Nursing Action Coalition, a non-partisan entity designated by the Robert Wood Johnson Foundation to take a state leadership role in implementing the recommendations of the IOM’s report, The Future of Nursing: Leading Change, Advancing Health, has written a letter to United States Senator Charles Schumer identifying Medicare’s continued refusal to recognize first assistant services provided by registered nurse first assistants (RNFAs) as eligible for reimbursement is a scope of practice barrier. The letter advises that recognition and resolution of this barrier is wholly consistent with the recommendations in the Future of Nursing report.

The March 19, 2012 letter is an important accomplishment for nursing because it calls attention to a public policy issue affecting not only nursing, but health care delivery as a whole. RNFAs are experienced operating room nurses who are well-qualified to practice as first assistants at surgery. RNFAs are needed to provide first assistant services across the country, especially in light of the shortage of physicians and residents available to first assist and the health care reform climate which requires the most cost-effective quality care in today’s operating rooms.

The IOM’s Future of Nursing report calls for more nurse involvement in the reform of our health care systems. One direct result of the report has been the formation of state Action Coalitions to implement the recommendations in the report at the state, local and regional level. The state Action Coalitions are charged with convening nurses and non-nurses across a state to implement the four key messages in the report:

  1. Nurses should practice to the full extent of their education and training (scope of practice)
  2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression
  3. Nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States
  4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

State Action Coalitions bring together diverse groups of stakeholders, such as provider and payer groups, employers, consumer groups, and educators. New York State’s Action Coalition was formalized in October 2010 and includes statewide nursing organizations, state agencies, academic institutions, and health care systems. The coalition agreed with AORN State Legislative Coordinator for New York, Marlene Craden, RN BSN CNOR CRNFA, that the lack of reimbursement for RNFA services acts as a scope of practice barrier for RNFA practice. At Craden’s request, the coalition memorialized this concern in a letter to Senator Charles Schumer, one of Craden’s representatives in the U.S. Senate.

“I asked for the letter on behalf of all RNFAs in hopes that the coalition could shed a new light on an old issue – RNFAs not being reimbursed by Medicare for their services,” says Craden. “Not only does Medicare not pay, but many third party payers do not reimburse for RNFA services unless a state law requires it. My hope is that other state action coalitions will follow suit and formally identify this lack of reimbursement as exactly the type of scope of practice barrier the IOM report seeks to eliminate, both at the federal and state level. The IOM Future of Nursing report is well-known and respected by legislators and staff. Multiple letters of this type from state action coalitions, if brought to the attention of various legislators, could serve to influence initiatives to change both Medicare and state insurance laws.”

AORN has been urging its members to become involved in their state’s Action Coalition since publication of the Future of Nursing report. As perioperative nursing experts, AORN members are uniquely poised to have a voice in shaping the future of health care in our country. This letter from the New York State Action Coalition is a perfect example of how AORN member engagement in a state Action Coalition can result in positive advancements for nursing practice and patient safety. AORN members are encouraged to pursue similar action with their state Action Coalition. Members and RNFAs should contact AORN’s director of government affairs Amy Hader for advocacy support and assistance with a template letter. More information on the Future of Nursing report and its impact on perioperative nursing is available from AORN.

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