Presentation on theme: "Reimbursement The Impact of Health Care Reform and Federal Issues"— Presentation transcript:
1Reimbursement The Impact of Health Care Reform and Federal Issues October 20, 2013Maryland Association of Nurse AnesthetistsReimbursement The Impact of Health Care Reform and Federal IssuesChristine S. Zambricki DNAP, CRNA, FAAN
2Our Agenda Context Economic, health policy and political contexts Federal health programsCRNA IssuesLegislative and regulatory issuesAffordable Care ActAdvocacy programs
4Economic Factors Shaping Health Going UpGoing DownElderly as a share of the populationWorkers to retiree ratioPer-capita health spending, more slowlyU.S. health compared with industrialized worldU.S. debt, >$16.7 TU.S. deficits annuallyEconomic growthPublic coveragePrivate coverage
8Health spending in the U.S. www.cms.gov $2.7 T in 2011, up 3.9% in 2011, about 18% of U.S. economy, average $8,680 per personThree years in a row of stable growthEconomic downturnDemandSupplyTechnology
9Political Forces shaping the 113th Congress 58.7% of vote eligible citizens, 10% latino, 13% black, 19% young voters65.9M to 60.9M votes, 51-47%,Continuing divided governmentHouseSenate114th Congress?Latino expected to increase by 40% by 2030, black voter turnout higher than white for the first time and young voters to age 29 increased from 18%
10Political Forces shaping the 113th Congress Considerable change beneath the surface12 new Senators of 100, 67 new Representatives of Most of Congress is new since 2006New leaders in some key health positionsFreshman class
12IOM: The Future of Nursing The Need to Transform PracticeKey Message #1: Nurses should practice to the full extent of their education and training.The Need to Transform EducationKey Message #2: Nurses should achieve higher levels of education and training through improved education system that promotes seamless academic progression.
13IOM: The Future of Nursing The Need to Transform LeadershipKey Message #3: Nurses should be full partners, with physicians and other health professionals, in redesigning health careThe Need for Better Data on the Health Care WorkforceKey Message #4: Effective workforce planning and policy making require better data collection and an improved information infrastructure
15Medicare & CRNAs Part A: Hospital insurance Part B: Physician services Conditions of participationPhysician supervisionPass-through programPart B: Physician servicesAnesthesia paymentMedical DirectionMedical SupervisionTeaching rulesReimbursement for other servicesParts C & D: Managed care, prescription drugs
16Part A for CRNAs Conditions of participation & of coverage Anesthesia servicesASC surgical servicesReasonable cost pass-throughCertain qualifying rural and critical access hospitals<800 cases or lessCRNA services as a hospital service, no Part B
17New England Assy of Nurse Anesthetists: Federal Issues & Advocacy SupervisionIt is a Medicare requirement, a portion of a regulation, 42 CFR §482.52(a)(4)Anesthesia must be administered only by … (4) A certified registered nurse anesthetist (CRNA), as defined in (b) of this chapter, who, unless exempted in accordance with paragraph (c)of this section, is under the supervision of the operating practitioner or of an anesthesiologist who is immediately available if needed ….
18Historical Context Part of the Medicare conditions for participation 1997: Proposed to be repealed1/2001: Repealed in a final rule2/2001: Suspended11/2001: Finalized as an opt-out process11/2001 to today: 17 states have opted out2013: No rule regarding supervision but good CMS precedents
20Part B for CRNAs Anesthesia payment Payment for other services Medical directionPain careTeaching rulesPayment for other services
21Fee-for-service (Base + time) x ($CF) = anesthesia fee (Relative value) x ($CF) = physician feePays for a thingDoes not necessarily pay forQualityThe right thingCare coordinationOptimal efficiency
22Medicare anesthesia payment (Base + time units) x (anesthesia CF)Rules determined by:Statutes enacted by CongressRegulations adopted by Medicare agency (CMS)Sub-regulatory policy adopted by MedicareMedicare Administrative Contractor that operates Medicare in each state, regionally
23Most common anesthesia services QZ, CRNA non-medically directed (NOT AA!)QX, CRNA medically directed by an anesthesiologistQK, anesthesiologist medically directing 2, 3 or 4 concurrent CRNA casesAA, personally performed by an anesthesiologist
24TEFRA medical direction rules Anesthesiologist performs all seven tasks in each of up to four concurrent cases provided by a CRNAFee split 50/50 between CRNA and medically directing anesthesiologistA payment model not a standard of careEncourages higher-cost anesthesia delivery without demonstrated quality improvement
25What are the TEFRA rules? Performs a pre-anesthetic examination and evaluation;Prescribes the anesthesia plan;Personally participates in the most demanding procedures in the anesthesia plan, including induction and emergence;Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;Monitors the course of anesthesia administration at frequent intervals;Remains physically present and available for immediate diagnosis and treatment of emergencies; andProvides indicated-post-anesthesia care.MCM Ch 12 Sec 50GMCM Ch 12 Sec 50G
26Medical Direction Undermined [DO NOT READ THIS BRACKETED STATEMENT. THESE SLIDES WERE PREPARED BY AANA FGA AND COMMS, 3/14-15, 2012, for the use of American Association of Nurse Anesthetists members making presentations.]As you may have read from President Malina’s message the other day, lapses in anesthesiologist supervision of CRNAs are common even when an anesthesiologist is medically directing as few as two CRNAs, according to an important new study published in the March issue of the journal Anesthesiology. The study, titled “Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics,” looks at over 15,000 anesthesia records in one leading U.S. hospital and raises critical issues about propriety and compliance in the most common and costly model of anesthesia delivery at a time when quality and cost-effectiveness are white-hot healthcare issues at every level.Anesthesiology 2012; 116:
27Of the anesthetics you personally administer, how often is an anesthesiologist involved in the following activities?Anesthesiologists are present with full-time CRNAs most commonly for pre-anesthetic assessment and emergencies. Anesthesiologists are least often present for emergence from anesthesia.Yet, is patient safety at issue here? No. The AANA has long held that medical direction ratios have nothing to do with quality of care, and everything to do with reimbursement systems—inefficient, unsustainable systems that make healthcare cost too much and divert millions upon millions of scarce healthcare dollars from real patient needs. Recent landmark studies on anesthesia safety and cost-effectiveness published in the journals Health Affairs and Nursing Economic$ have confirmed the safety and cost-effectiveness of CRNAs, and the Institute of Medicine in The Future of Nursing emphasizes APRN safety in arguing for nurses to practice to their full scope.AANA 2011 member survey, unpublished.2011-20809
28Anesthesiologist Supervision Often Lapses Now, this study in Anesthesiology confirms anesthesiologist supervision of CRNAs is more honored in the breach than in the observance. This graph is drawn directly from the study itself.Anesthesiology 2012; 116:
29Part B Medical Direction vs Part A Supervision By an anesthesiologistBy operating practitioner, or by an anesthesiologist who is immediately available if neededSeven services required in order to claim medical direction reimbursement (50% of a fee, up to 4 concurrent cases (TEFRA rules)Required as a condition of participation for your hospital, or a condition of coverage in your CAH or ASCOpt-out does not applyOpt-out does apply; 17 states have opted-out
30Part B Medical Supervision MDA supervises 5 or more CRNAsMDA bills 3 base units + 1 base unitCRNA bills QX (50%)MAY NOT BE USED FOR FAILED MEDICAL DIRECTIONFailed medical direction: CRNA bills QZ and MDA bills “0” per CMS
31AANA action on CRNA reimbursement Anesthesia payment panelsSummit on Anesthesia ReimbursementMember education on Business of AnesthesiaBuilding relationships with key payer leadersComment on changes impacting CRNA reimbursementDevelopment and support of State Reimbursement Director
32PQRSReporting program that uses incentive payments and payment adjustments to promote reporting of quality info by eligible professionals (EPs)CRNAs are EPsReport on 50% of Medicare patients by the end of 2013, get a .5% incentive paymentIn 2015, not reporting results in a 1.5% "adjustment" (meaning reduction).If not reporting, 1.5% cut in your Medicare payments in 2015, which will go to 2% in 2016.CMS proposed rules: 9 measures, registries only
33PQRSCMS cannot accept data codes for reprocessing on a claim that has already been submitted. Providers have until Dec services to add the appropriate code to the claim.There are also registry options.Additional options for avoiding the negative adjustment: reporting one data code for one Medicare patient for one measure in CY13 would help avoid the ding in CY15. If they want a bump in CY15 they have to report 50% plus one.CMS calculate administrative claims for incentives – deadline October 15. (Requires an Individual Access to CMS (IACs) Account). It can take more than a day to calculate.
35Provider Nondiscrimination Part of the Affordable Care Act (Sec. 1206)Promotes consumer choice and cost savings, by prohibiting health plans from discriminating against qualified healthcare providers by licensureTakes effect 2014, subject to notice-and-comment rulemakingAttempts to amend to weaken or strike it
36New England Assy of Nurse Anesthetists: Federal Issues & Advocacy
37ASA on nondiscrimination New England Assy of Nurse Anesthetists: Federal Issues & AdvocacyASA on nondiscrimination“(T)he Senate bill also includes gratuitous so-called “non-discrimination" language (Sec. 2706). The intentionally vague language, inserted by supporters of paraprofessionals, seeks to prevent health insurers from "discriminating" against non-physician providers in deciding who may participate in their plans. Its practical implications are to open the doors to various disruptive tactics within the insurance marketplace by paraprofessionals, putting Federal law on a collision course with each state’s scope of practice law.”
38Non-discriminationThe Obama Administration will not issue regulations interpreting the AANA-backed provider nondiscrimination provision of the Affordable Care Act before it takes effect Jan. 1, 2014FAQ document issued by Medicare, IRS-Treasury and the Department of LaborNon-grandfathered group health plans and health insurance issuers offering group or individual coverage are expected to implement the provision starting on January 1, 2014, using a good faith, reasonable interpretation of the law.
39Non-discriminationRep. Andy Harris (R-MD), the only anesthesiologist in Congress, introduced HR 2817, on July 24 with the backing of the American Society of Anesthesiologists (ASA).“We are deeply concerned that for certain covered services in a number of states, this new part of the Public Health Service Act will be interpreted to provide that all health professional groups be considered as if their education, skills and training were equal even if their state-based medical and healthcare professional licenses or certifications are very different…. This ACA [Affordable Care Act] provision disrupts over a century and a half of dynamic state-based licensure and certification, interjecting the federal government into interpreting the limits of scope of practice and procedure.” The letter was co-signed by medical societies representing dermatologists, family practice physicians, otolaryngologists, ophthalmologists, OB/GYNs and plastic surgeons.Rep. Harris’ legislation was referred to the House Energy and Commerce Committee where he does not serve, and has no cosponsors and no Senate companion bill at this date.
40AANA supports direct reimbursement to CRNAs providing pain management services
41CRNA direct reimbursement for chronic pain management Medicare has paid CRNAs directly for chronic pain management servicesThe AMA and the ASA oppose CRNAs providing chronic pain managementTwo Medicare contractors stopped paying CRNAs directly for chronic pain management servicesThese two contractors required that a physician bill for the CRNA chronic pain management services. This is called “incident-to” billing.The Medicare agency has latitude in the Social Security Act, Medicare regulations and the Medicare claims processing manual to authorize direct reimbursement for CRNA chronic pain management servicesThe AMA adopted an ASA resolution to oppose CRNAs providing chronic pain management services and to influence public perception negatively about CRNA education and trainingThis year two Medicare Administrative Contractors (MACs) issued bulletins stopping direct reimbursement to CRNAs for chronic pain management, requiring that a physician bill for the CRNA services and then pay the CRNA - this is called “incident – to” billing
43NAFA 5/2011 - Health Reform and CRNAs Physician ResistanceAmerican Medical AssociationConsistently issued resolutions, petitions, and position papers opposing scope of practiceAMA Citizens Petition to HCFA (2000)AMA Scope of Practice Partnership (2006)AMA Resolution “Independent Practice of Medicine by Nurse Practitioners” (2006)AMA Scope of Practice Data Series (2009)Health Care Truth and Transparency Act (2011)CMS and CSA sued the State of California (2010)SOPP designed to obstruct scope of practice expansion by nurses and others led by a full time legislative attorney. Developed evidence to discredit access to care arguments.Health Care Truth and Transparency Act ensures that patients receive accurate health care information by prohibiting misleading and deceptive advertising and representation of health care professionals credentials and training
44Political RealityOppositionInstitute of Medicine Report
47What Does the Pain Care Rule Say Medicare will cover services within CRNA scope of practice in a state“The primary responsibility for establishing the scope of services CRNAs are sufficiently trained and, thus, should be authorized to furnish, resides with the states.”
48Where They Stood For CRNA Pain Care AARP American Hospital Association and select State Hospital AssociationsNational Rural Health AssociationNursing AssociationsOpposed to CRNA Pain CareAMA“ASA Rebukes CMS Rule for Jeopardizing Patient Safety and Quality Health Care”Source: Comments at and
50IPRCCHHS charged IPRCC to create a comprehensive population health level strategy for pain prevention, treatment, management, and research.Structure includes 5 Working PanelsProfessional Education and TrainingMargaret Faut- Callahan, PhD, CRNA, FAANPublic Health: Care, Prevention, and DisparitiesJackie Rowles, CRNA, MS
52VHA Nursing Handbook Update APRNs as LIPs – Cathy Rick, CNOIOM “Future of Nursing”Consistent with current anesthesia handbookDear Colleague Letter: The Honorable Eric Shinseki. Secretary of Veterans AffairsASA CampaignOver 40 nursing groups co-signed letter to Shinseki this weekMet with Interim CNO – Christine Engstrom
53ASA message and response ASA said CRNA LIPs would be “required” to function without physician oversight. In response, the AANA-AVANA letter stated that “the truth is that neither the VHA draft Nursing Handbook nor the term ‘Licensed Independent Practitioner’ suggest that CRNAs and other APRNs would be ‘required’ to function without physician involvement should the VHA designate APRNs as LIP.”ASA said the Nursing Handbook would result in “effectively eliminating physician-nurse team-based coordinated care. In response, the AANA-AVANA letter stated, “The ASA statement is false. While the VA Anesthesia Handbook supports care provided in teams, it does not require anesthesiologist supervision of CRNAs. Consistent with the Anesthesia Handbook, several VHAs are staffed solely by CRNAs working without anesthesiologist supervision…. Overall care of the patient remains a collaborative effort among physicians, APRNs, nurses and other healthcare professionals, as it should.”ASA cited its long-discredited “Silber” study as justification for concluding “anesthesia care is improved with the involvement of a physician anesthesiologist in a team.” In response, the AANA-AVANA letter stated that “This ASA statement misrepresents the findings of a claims-data based study, the results of which have not been replicated and have been disregarded by Medicare.”
54Anesthesia Payment Teaching Rules What Medicare pays for services when education of anesthesia students or residents is involvedWhen it’s 1:1, payment is as though qualified provider (CRNA, anesthesiologist, or medically directed CRNA) is delivering the service74 FR 61738, /25/2009.74 FR 61738, /25/2009.
55Teaching Rules: 1 to 2CRNA uses QZ modifier, present during pre- and post-anesthesia care and during concurrent casesAnesthesiologist uses AA + GC modifier, present during critical or key portions, immediately available
56Teaching rules: Medically directed Medically directed CRNA gets 50% of a fee in one SRNA case, and discontinuous time in each of two concurrent SRNA cases
57Teaching Rules inequity issue: MD with resident vs MD with SRNA
58Medicaid and CHIPFederal-state program for indigent pregnant women or women with children, and for indigent seniors in post-acute nursing home settingsCovered services vary by stateAffordable Care Act expansion of Medicaid
59Private coverage Insurance Self-administered plans By type: Fee for servicePreferred provider organizationHealth maintenance organizationHigh deductible health plan
61Reimbursement of CRNA services PastPresent and FutureFee-for-serviceFFS, ACOs, bundled global & capitated systemsPeriodic SGR cutsWill they fix SGR?50/50 public/privateTrend toward more public as share of retirees growsSmall share MedicaidMedicaid expansion
62The Affordable Care Act of 2010 Expansion of coverageMedicaid expansion, subsidies in exchangesInsurance reformsState-based exchanges for marketing coverageNondiscrimination, consumer protectionsDelivery system reformsAccountable Care OrganizationsInnovation CenterIndependent Payment Advisory BoardFinancing
65Graduate Nursing Education Part of ACA, funded through GMEFour-year, up to $200MM total to expand education of APRNs in five hospitalsDuke (Durham)Memorial-Hermann Texas Medical Center (Houston)Penn (Philadelphia)Rush (Chicago)Scottsdale Healthcare Medical Center (Scottsdale)Evaluation
66Coverage Provisions Medicaid Expansion Exchanges Increase eligibility for MedicaidAdditional federal funding for new participantsExchangesA regulated means to market health plans
67Supreme Health Reform Decision Is requiring a person to purchase health coverage or pay a penalty constitutional?Is expanding Medicaid, a state-run program with some federal funds, constitutional?
68Medicaid expansion in the ACA For beneficiaries up to age 65 up to 138% FPL (FPL = $15,415 for an individual in 2012)Starts in 2014, feds pay 100% of expansion, declining to 90% by 2020 and years thereafterSupreme Court: Unconstitutional to take away a state’s Medicaid for refusing to expand itMississippi is rejecting Medicaid expansion (Gov. Bryant, 11/7/12)Source:
69Exchanges (Marketplaces) and Essential Health Benefits Exchanges are for marketing health coverage in a stateState-based exchange (As of Oct. 1 working well)Federally facilitated exchange (disaster so far)Combination ( jury is out)Essential Health Benefits link to benchmarks of small business plans in a state
70Delivery System Reforms Accountable Care OrganizationsCenter for Medicare & Medicaid InnovationIndependent Payment Advisory Board (IPAB)
71Implementation Timeline NAFA 5/ Health Reform and CRNAsImplementation Timeline2011: Various pilot projects and advisory panels launch, Title 8 reauthorization, beginning of Medicaid expansion implementation2012: Graduate Nursing Education2012: Supremes decide constitutionality2013: Finalization of plans2014: Provider nondiscrimination, state based exchanges take effect
73Budget SequestrationSequestration is $1.2 trillion in automatic spending cuts due to go into effect over the next 10 years$85 billion 3/1/12Half by dollar value from national securityMedicare, -2%Other health and research, -8%National security, -9%Exempts Medicaid, Veterans benefits, most student aidAgency flexibility in apportionment?
74Pew: Increase, decrease or same? Aid to world’s needy212848Aid to needy in U.S.274424Health care383422Medicare364611Education602910Social Security41Veterans benefits536Pew Research Center, 2/13-18/2013.Pew Research Center, 2/13-18/2013.
75AANA supports permanent repeal and replacement of the SGR formula with a payment system that accurately reflects the cost of providing anesthesia care.
76Briefing: SGRThe Sustainable Growth Rate (SGR) is a Medicare Part B payment formula for CRNA and physician servicesSGR is based on the economyReduced payment has been threatened since 2002Every year Congress defers rather than repeals the SGR cuts2012 CRNA payment will decrease by 26.2% in MARCHThe Sustainable Growth Rate (SGR) is a formula used to calculate physician (and CRNA) payments for Medicare patientsSGR is based on the national economy but health care costs have risen faster than the GDPFor every year beginning in 2002 the SGR formula has called for substantial reductions in physician (CRNA) payment ratesThe Center for Medicare and Medicaid Services (CMS) projects that the 2012 physician (CRNA) fee schedule conversion factor will decrease 29.5 percent.
77What’s a 26.2% Medicare Cut?If a CRNA performs unit 100% Medicare cases, that yields $236,700 in feesMinus 30% = $165,690Difference of -$71,010 if 26.2% cuts hit 3/1/2012Congress continues struggling with paying for relief from 26.2% Medicare Part B payment cuts scheduled for March 1. The AANA and CRNAs have weighed-in and continue to, but the outlook for long-term relief is dim and short-term relief appears more likely.Approximately $365.00/weekBut what are these huge Medicare cuts anyway?Say a CRNA performs unit cases, that are all on Medicare patients, that are all paid 100% to the CRNA as nonmedically directed services including the patient’s copay.On the bottom of this page, you can see the effects of what AANA has already done for CRNAs. For the year beginning January 2008, Medicare would have paid about $243 for each of those cases, for a total of $218,700 for the year. But Medicare at that time was predicting total payment cuts of 15% for CRNA and physician services by January Had those cuts taken effect, Medicare would have paid not $243 but $207 for each case, totalling $186,300. That would have been a reduction of more than $32,000 in Medicare anesthesia payment from one year to the next.But AANA was at work. And instead of a cut, CRNAs got an increase, so that those same cases this year pay $236,700.However, if Medicare cuts payments 20% in 2010, that’ll mean a reduction in anesthesia payments approaching $50,000. The actual Medicare cuts coming April 1, 2010, unless Congress acts equal 21.2%.If you’re employed by a hospital, or a group, or in independent business, the question is the same: If those cuts hit, where will that money come from? We have got to keep working together to win in Washington to reverse these extreme cuts.
78What’s new with SGREnergy and Commerce plan to replace SGR with a quality-based plan that would update payments by .5 – 1 % each year.Update Medicare payment rates by 0.5 percent until 2019, until performance-based payment methods: the Quality Update Incentive Program and the Alternative Payment Model, which could increase doctors’ payments by as much as 1 percent.The CBO scored the SGR reform bill $175.5 billion over 10 years.Freezing SGR payments will cost $139.9 billion. $36 billion comes from the cost of replacing that system with a quality-based payment plan.
79SGR Key Talking Points4 years ago Medicare said anesthesia services were undervaluedCRNAs do not control service volumeCRNAs provide access to care in rural AmericaCRNAs are 25% more cost effectiveQuality of CRNA care is equalAll barriers to the use of CRNAs should be eliminated4 years ago Medicare increased payment for anesthesia services by 25% 4 years ago because anesthesia services were determined to be persistently undervalued by an independent government agency (GAO 2007)CRNAs are do not control service volume as other specialties do – the intention of SGR was to affect the incentives of individual physicians (CRNAs) concerning the rate of use of servicesCRNAs as the sole anesthesia provider are 25% more cost effective than the next least costly model (Nursing Economic$ 2010)There is no difference in quality of care between CRNAs and other anesthesia providers (Health Affairs 2010)All barriers should be eliminated to the use of advanced practice registered nurses such as CRNAs (Institute of Medicine 2011)
80What Can AANA & CRNAs Do? Know the issues Participate in AANA advocacy programsMid-Year AssemblyCRNA-PACFPDs & Key ContactsCRNAdvocacy AlertsInitiatives in reimbursement – SRSState level GRC, PAC and BOD
82SRS BackgroundAANA Anesthesia and Payment Policy Coordinating Panel (APPCP) recommendation to the AANA BODAANA BOD approved September 2012Goal: reimbursement advocacy in each stateThe SRDrepository of state reimbursement informationcoordinator of state advocacy work.
83State Reimbursement Specialist program At the direction of the BoardA focal point in each state for CRNA reimbursement knowledge, and for advocacy of CRNA reimbursement interestsDevelopment of key relationshipsPrivate payors – three largest health plans in statePublic payors – Medicaid, exchanges, MACOther interests – Hospital, rural health and health plan associationsCoordinated by your AANA FGA team
84Objectives Monitor trends Serve as a resource Work with state association to establish key relationships
85SRS Position Requirements Keen interest in reimbursementWilling to enhance knowledgeRepresent with professionalism and enthusiasmWilling to disclose conflicts of interest
86Job DescriptionCoordinate and improve payment processes and reimbursement in your stateAccomplish this task by working with others based on state association’s needs and resources
87Job Description Establish key contacts with Top three health plans in your stateExchange BoardsMedical Director for Medicare Administrative ContractorMedicaid DirectorInsurance CommissionerState Hospital AssociationState Ambulatory Surgery Center AssociationState Rural Health Association
88Job DescriptionServe as a repository of information by monitoring state reimbursement activities:Medicare Local Coverage Determinations (LCDs)Medicaid payment policyCommercial insurance reimbursementAccountable care organizations (ACOs)State exchanges
89Job DescriptionAssist with state reimbursement issues as a first responderCommunication with state leadersEnter state reimbursement information into special SharePoint siteAlert the AANA to any emerging issues
90PALSVolunteers who get others to volunteer or contributeVolunteers - contributorsConstituents:Everyone who voted for the candidateVoters who voted for the wrong candidateRegistered voters who don’t voteVoting age not registered to vote
91through federal political advocacy. What is CRNA-PAC?Separate fund, 100% from CRNAs’ voluntary contributions, not duesEnsures CRNAs have access to DC, where our issues are decidedNot partisanAlways working for the profession of nurse anesthesiaCRNA-PAC’s Mission Statement: Advancing the profession of nurse anesthesiathrough federal political advocacy.
92Stats that Make Us Proud Largest federal nursing PAC in the countryTop ten PAC nationwide for healthcare professionals$1.1 million impact on the 2012 national elections with 94% of CRNA-PAC supported candidates elected to office.
932013 CRNA-PAC Highlights $1.75 million goal for 2013-2014 “CRNA-PAC Loves the 80’s” Party at Mid-Year Assembly“Remember the RatPAC” Party at Annual MeetingRefreshed Care to Be Counted website,Student-specific engagementNew Incentive Club levels
95Does This Work? A case study Problem: Present threat to CRNA pain practiceStrategy: Research. Grassroots. Local & national allies. Advocacy. Response. Comments.Outcome: Medicare rule covering all CRNA services within state scope of practice published 12/2012, effective 1/2013
96Thank You from Your AANA FGA Frank Purcell, Senior Director Federal Goverment AffairsChristine Zambricki, Senior Director Federal Affairs StrategiesKate Fry, Associate Director Political AffairsRomy Gelb-Zimmer, Associate Director Federal Regulatory and Payment PolicyRandi Gold, Associate Director Federal Regulatory and Payment PolicyRalph Kohl, Associate Director Federal Government AffairsCandida Richardson, AdministratorAANA Division of Federal Government Affairs25 Massachusetts Ave., Suite 550Washington, DC// //