On April 8, 2013, the American Nurses Association (ANA) provided detailed comments on key developing quality issues, to the Institute of Medicine (IOM) and the Centers for Medicare and Medicaid Services (CMS). ANA has devoted significant time and resources to providing the nursing viewpoint in the development of quality initiatives, as a member of the Measure Application Partnership and a partner in the National Priorities Partnership.
Marilyn Tavenner, MHA, BSN, RN, cleared the first hurdle on her path to being the first Center for Medicaid and Medicare Administrator in six years. On April 23rd, she was approved, by a strong margin, by the Senate Finance Committee. Unfortunately, the last step, a vote by the full Senate, has been held up due to “a hold” being placed on her vote by Senator Harkin (D-IA). Ms. Tavenner was nominated to head CMS by President Obama in early February. Tavenner joined CMS in February 2010 and became acting administrator in December 2011.
On January 1, 2013, new coding and reimbursement policies go into effect for many psychiatric/mental health services. Many services will be paid at higher levels.The new policies recognize the challenges of caring for patients with severe mental illness, multiple co-morbidities and complex medications, in community settings as well as hospitals and other inpatient facilities. his is great news for advanced practice registered nurses (APRNs), psychiatric registered nurses (RNs), and other mental health providers.
The 2014 Medicare Physician Fee Schedule Final Rule contains several issues of interest to nurses. In addition to new coding and reimbursement related to care coordination and psychiatric services (see In the Agencies) the Centers for Medicare & Medicaid Services, CMS, set new Medicare policies for:
Recent changes to the “Conditions of Participation” (CoPs) for hospitals participating in Medicare and Medicaid will give nurses more flexibility in key areas — nursing care plans, standing orders, medication administration, infection control, and medical staff participation by advance practice registered nurses (APRNs). In the notice of final rule, the Centers for Medicare and Medicaid Services (CMS) recognized the contributions and leadership of registered and advance practice nurses, even quoting from ANA’s comments. CMS also decided to grant critical access hospitals (CAHs) more flexibility in how they operate. With the Joint Commission involved in ensuring hospitals comply with the CoPs, the guidelines can also have an effect beyond Medicare/Medicaid hospitals.
CMS, the Centers for Medicare & Medicaid Services, recently announced that the Hospital Compare website will now include data about central line-bloodstream infections (CLABSIs) occurring in hospital intensive care units. Nurses are well aware that these are among the most serious of all healthcare-associated infections. CMS noted that these infections result in thousands of deaths each year, and nearly $700 million in additional costs throughout the U.S.