Medicare: ANA Advocates for Nurses and Patients at MedPAC, RUC and CPT Meetings
Medicare policies touch the lives of many of our patients, and reimbursement issues directly or indirectly affect financial compensation for many staff RNs and advanced practice RNs. Many APRNs are enrolled as Medicare providers, and are directly reimbursed for caring for Medicare patients. ANA GOVA staff had the opportunity recently to advocate for nurses and patients at recent meetings of MedPAC, and the RUC and CPT committees.
MedPAC, the Medicare Payment Advisory Commission, advises Congress and CMS (the Centers for Medicare & Medicaid Services) on how to restrain Medicare costs and assure quality and access for Medicare beneficiaries. MedPAC makes recommendations on the several payment systems for Medicare providers, including the Physician Fee Schedule which sets reimbursement rates for physicians, APRNs, and other Medicare practitioners. The Commission meets 7 times each year, and produces reports to Congress each March and June with specific recommendations for legislation and regulatory action. MedPAC’s cost-cutting initiative are so highly regarded that Congress is considering creating a “super MedPAC” which would have independent decision-making authority.
The seventeen commissioners include Jennie Chin Hansen, RN, MSN, FAAN, but she is there primarily to represent AARP, of which she is president. Unfortunately, MedPAC lacks an APRN perspective or in-depth knowledge of APRN roles (particularly for nurse midwives and clinical nurse specialists), and ANA plans to nominate an APRN. At the October 8-9, 2009 meeting, ANA GOVA staff urged the Commission to shift its focus to recognize the contributions of all types of Medicare providers, including APRNs. While several commissioners have noted the growing contributions and importance of non-physician providers — Commissioner Thomas Dean, MD said “we should have every professional working at the top of their license” to help solve the shortage of primary care providers — MedPAC’s official recommendations, reports and data focus almost exclusively on physicians.
October’s MedPAC meeting included the following topics, which were the subject of staff presentations and discussion by the commissioners:
• Aligning medical education with health system needs
• Case studies and metrics for high performing systems
• MIPAA 168-Comparing Quality in Medicare Advantage and Fee For Service Medicare Policy Options
• Pricing services in Medicare’s physician fee schedule
• Exploring the in-office ancillary exception in the physician self-referral law
• Caring for Medicare beneficiaries with mental illness
• Provider consolidation and prices
Each MedPAC meeting includes public comment periods, and interested parties are encouraged to send written comments and meet with MedPAC staff. Meeting agendas are posted a week in advance, after which electronic comments are now accepted and then posted online. MedPAC’s website is www.medpac.gov. The next meeting is November 5-6, 2009.
ANA representatives also recently attended meetings of the RUC and CPT Committees, along with myself, as staff support. The AMA created the Current Procedural Terminology (CPT) coding system to value services and procedures, and the CPT Committee reviews proposals for CPT code changes. The RUC is the “Resource-Based Relative Value Scale (RBRVS) Update Committee,” created by the AMA to advise CMS on the “relative value” (compensation rate) for each of the physician services that have a CPT code. Nurse practitioners and clinical nurse specialists who bill Medicare independently receive 85% of the physician rate, while certified nurse midwives receive 65%. The ANA is the only nursing organization authorized to have representatives on the CPT and RUC Healthcare Professionals Advisory Committee (HCPAC). RUC and CPT committees meet three times each year, and their deliberations and decisions are strictly confidential.
Janet Selway, DNSc, CRNP, our new RUC HCPAC representative, and I attended the RUC and RUC HCPAC meeting on October 1-3, 2009. Dr. Selway provided valuable input into nurse staffing and other clinical costs as a member of the Practice Expense Subcommittee, which convenes for an entire day at the start of each RUC meeting. Practice expense includes clinical staff and supplies, and accounts for about 44% of the relative value — along with physician work, the most contentious issue, which accounts for 52%, and professional liability insurance, 4%. Dr. Selway participated in a “facilitation committee” which assisted medical societies with their valuation proposals, and was part of the workgroup convened for new immunization administration codes. The RUC made value recommendations on close to thirty different types or groups of services, which included immunization administration and obstetrical care. We plan to attend the next RUC meeting on February 4-7, 2010, and also review upcoming RUC proposals for possible comments. More information about the RBRVS is available on the AMA website, www.ama-assn.org, under “Physician Resources: Solutions for Managing Your Practice.”�
On October 15-17, 2009, Julie Chicoine, JD, RN, CPC and I attended the CPT Editorial Panel and CPT HCPAC meeting. Julie serves as a member of the CPT Literature Review Workgroup and Vaccine Coding Caucus. She also participates in the Chronic Wound Dermal Substitute Workgroup, which apparently resulted from discussions with nursing professionals that brought to light current coding issues for wound substitutes. The CPT Editorial Panel issued decisions on over forty proposals to create, delete, or change CPT codes for services and procedures. We plan to attend the next CPT HCPAC meeting in October 2010, and Julie will continue her ongoing activities for the workgroups and review ongoing proposals for potential comments. The AMA has many resources available to help health care professionals with coding issues, including education sessions. Information about these can be found on the AMA website.
Eileen Shannon Carlson, JD, RN
