ARNP Care 6-96

Just a brief note to let you know the results of the prescriptive authority survey, so nobly done by Dan Morgenstern, are in. In brief, 85% of those surveyed believed that we should pursue expansion of prescriptive authority. Personally, I think that this is great news. The not so good news is that less than 25% were willing to facilitate the process. As a wise someone once said “no ticky, no laundry”. Need I say more?

I have met with Gail McGaffick and Tracy Lin and we have been brainstorming some strategy. This will be an ongoing process but only at the will of the membership.

ARNPs United Annual Meeting

Thursday, October 24, 1996 6:20 pm
at the Washington State Trade and Convention Center in Downtown Seattle. It is being held during the Pacific Northwest Primary Care Conference.

We're baaack! Believe it or not, it's been a very busy summer and fall promises to be just as active. And, we're beginning to gear up for the 1997 legislative session. More on that topic next month. There is no shortage of issues which ARNPs United needs to track in order to adequately represent nurse practitioners. In this month's article we'll highlight our work this summer with the Insurance Commissioner's office to develop standardized managed care rules, the recent Insurance Commissioner ruling on any category of provider and an update on Elections 1996.

Managed Care Rules. In late June, Gail was invited as the ARNPs United lobbyist to represent the organization as a member of a provider working group. Two other working groups were composed of representatives from health carriers and consumers. In addition to ARNPs United, the provider working group was composed of representatives from the Washington State Medical Association, the Washington State Hospital Association, Children's Hospital, the Washington Association of Naturopathic Physicians, Planned Parenthood, the American Massage Therapy Association, the Washington State Psychological Association, the Washington State Chiropractic Association, and the Midwives Association of Washington State.

The goal of the Insurance Commissioner's office in creating the work groups was to receive input on how best to consolidate and clarify the rules governing health carriers and managed care plans. Currently, the rules are scattered in many different places, they frequently conflict and are generally difficult to understand. Commissioner Senn and her staff believe that standardizing the rules in plain English will be better for consumers, providers and carriers. The rules will cover such topics as provider contracts, health service delivery and claim settlement standards, and dispute resolution and grievance procedures. Other subjects such as provider credentialing standards, utilization review standards, and quality assurance and improvement will be delayed for a variety of reasons including the need to coordinate with other state agencies, such as the Department of Health.

You would be proud to know that ARNPs United submitted extensive comments which were well received by other members of the provider working group and by the Commissioner's office. We want to thank several Legislative Committee members for their hard work in reviewing various proposals. They include Ann Darlington, Jenny Beth Kimberly, Frank Maziarski and Sally Plumly.

As a part of our participation in the working group, we learned that the Insurance Commissioner relies very heavily on complaints and concerns received from providers and consumers in order to determine when a problem exists with a health carrier. Apparently, no Commissioner in the country has sufficient staff to monitor insurance company operations in a comprehensive way. If you take no other information away from this article, please remember that your voice counts. In fact, during October Commissioner Senn will be holding a public hearing in Spokane on October 30 from 5:30-7:30 pm at the Ridpath WestCoast Hotel. An earlier hearing was held in the Seattle area. The purpose of these hearings is to collect comments from providers and consumers on what types of problems they've encountered with managed care.

Please know that comments to the Insurance Commissioner on problems with managed care are appropriate any time, but would be particularly helpful in the next month. Comments should be addressed to Beverly Smith, Health Policy Division, Office of the Insurance Commissioner, P.O. Box 40255, Olympia, WA 98504-0255.

Any Category of Provider. In an issue keenly watched by ARNPs United, we were pleased with a recent ruling by Commissioner Senn which directed health carriers to comply with the law. The Commissioner provided guidelines for health carriers to follow. To be specific health carriers must provide access to every category of health care provider to treat conditions that would be covered under the state's Basic Health Plan. That sounds a little complex, but the bottom line is that carriers must provide consumers access to ARNPs, licensed midwives, acupuncturists, naturopaths, etc. Access does not mean “direct” access, as gatekeepers may be used if that is what is generally required by the plan. Unfortunately, it does not mean that every ARNP will have an opportunity to be on a panel.

Plans which are not covered by the any category of provider requirement include those not regulated by the Insurance Commissioner's office which are the Basic Health Plan, self-funded employer plans, Medicare, and union trusts. For your information, Healthy Options administered by DSHS is considered a covered plan.

Unfortunately, the battle is not over on this issue. Health carriers are expected to challenge the Commissioner's ruling in court. In addition, we can expect a major effort by business and health carriers to substantially limit or eliminate any category of provider when the Legislature convenes in January. That's our segue to our next topic, the elections.

Elections. The votes have been counted for the primary election. While anything can happen, it looks like the House of Representatives will remain under Republican control, but with a smaller majority than its current 62 members. In the Senate, it's virtually a toss-up, with a slight advantage to the Republicans. We just reviewed some voter turnout statistics from the Secretary of State and only about 40% of the registered voters turned out for the primary. Because it's a presidential election year, the voter turnout is expected to increase dramatically for the general elections and that usually helps the Democrats. Who knows? Elections have been very volatile in Washington state in recent years, and more surprises are to be expected.

And of course we don't want to end this article without asking you to exercise your right and privilege in a democracy...

As of the first week in October, the Medicare and Medicaid reimbursement bills that we have all been following will expire. Next year we will be starting again with new bill numbers. Legislative sponsors will need to reintroduce the bills. Therefore, we all need to be ready to use the off session time to meet our federal senators and representatives to educate them about the importance of these bills and the inclusion of advanced practice nursing reimbursement and nursing education funding remaining a part of any revisions that may occur in the bills that are introduced to the 105th Congress. As always, when there is an election we often find that we are starting over again with our political agenda and platform.

New faces on the hill in the "other Washington" and at home create new challenges and opportunities. The bills from last session will be important for us all to have an understanding of as we prepare to speak with our legislators.

House HR 1750 (Towns/Johnson). Sought to provide direct Medicare reimbursement to NPs and CNSs at 85% of the physician fee schedule regardless of geographic location or whether the NPs were under the supervision of a physician. It included a provision for bonus payments to practitioners choosing to work in health professional shortage areas.

Senate S.864 (Grassley/Conrad) Would have provided direct Medicare reimbursement to NPs and CNSs at 85% of physician fee schedule regardless of geographic location or supervision by a physician. It also included HPSA payments.

House HR 1339 (Richardson) Would have provided direct Medicaid reimbursement to ALL NPs and CNSs for services they are legally authorized to perform under State law.

Senate S 972 (Daschle) Would have provided direct Medicaid reimbursement to ALL NPs and CNSs for services they are legally authorized to perform under State law.

The Nurse Practitioner Association of Maryland is spearheading a campaign of active NP lobbying efforts to capture the "eyes and ears" of legislators with personal anecdotes. For ARNPs who are "on-line" a contact person from that organization is BJ Czarapata at E-mail address: bjczar@dc.infi.net. The physical location of the NPs in this organization means they are a logical source for NP-power to lobby with real NPs. We need to give them our support and also encourage that ALL lobbying efforts by ALL NP organizations and CNS organizations are conducted in a manner that exudes coordination NOT fragmentation. Most of us can tell stories about times when nursing lost an opportunity because of self directed controversy. We have since matured in our politics and are assuming a much greater role at state and national arena health care debates. It is imperative that we continue to build on our collective strengths!

The American College of Nurse Practitioners is in the process of identifying nurse practitioners who are qualified to serve as principle investigators on clinical trials for drug studies. If you are interested in submitting your name to this list, send your full name, mailing address, telephone contact numbers and fax number, E-mail address, and curriculum vitae to: Nancy J. Sharp, MSN, RN, American College of Nurse Practitioners, 1090 Vermont Avenue, NW, Suite #800, Washington, DC 20005, Tel: 301.408.7050, fax 202.408.0902, E-mail: ACNP@aol.com

The catalogue needed to apply for the February 15, 1997 NP examinations can be obtained by calling 800.284.CERT. The examinations offered in February will include Adult, Family, Pediatric, Gerontological and Acute Care Nurse Practitioner. For more details call the number listed above.

Monday, February 24, 1997 is Capitol Hill Day for NPs who attend the National NP Summit at the Mayflower-Renaissance Hotel in Washington, DC.

For more information about participating in this event, contact: ACNP Service Center in Denver, Colorado 800.525.6338 or fax 303.894.0448.

The Nursing Clinics of North America devoted the September 1996 journal to the topics of Advanced Practice Nursing and the Role of the Certified Registered Nurse Anesthetist. This publication includes the full spectrum of advanced practice roles for the nurse practitioner and the clinical specialist in a variety of specialties. Citation is Saunders, 31: 3, 1996.

Two options recommended for improving skills in recognizing heart sounds include: ”Rapid Interpretation of Heart Sounds and Murmurs” by Emanuel Stein and Abner Delman; and ”Understanding Heart Sounds and Murmurs” by Mary Conover and Ara Tilkian and produced by WB Saunders.

The Glaxo video library has made an interactive program called the "Nurse Practitioner Interactive Clinical Education Program" available on diskette for either Mac or Windows users. It can be loaded onto the computer hard drive. There is a process for submitting scores with a $10 fee to receive 6.6 continuing education credits. For more information call 800.824.2896.

Any readers who have some suggestions for colleagues regarding resources for computer, book or audio visual materials that are worth knowing about, please send your contributions to the editors!

ARNP position available for family practice clinic in Tacoma, WA area. Part-time position to start, becoming full-time. Salary and hours are negotiable. Please submit CV to 5922-100th St SW, Suite 26, Lakewood, WA 98499, Attn: Donna or fax to: 206.581.3787.

WellNet, the first network of primary care provider (PCP) directed, multi-disciplinary clinics is expanding practice sites throughout the state of Washington. Qualified PCPs interested in the WellNet opportunity, please contact Dr. Ordoubadi for more information at WellNet, 2709 - 64th Ave NE, Tacoma, WA, phone: 800.861.6556. WellNet offers competitive salaries, full benefits and retirement plan, insurance, profit-sharing, full and part-time positions available.

Association of Reproductive Health Professionals' Annual Reproductive Health `96

November 14-17, 1996. Location: Nashville, TN at the Stouffer Renaissance Hotel. This meeting will be held in conjunction with Planned Parenthood Federation of America and cosponsored by the National Association of Nurse Practitioners in Reproductive Health. Sessions focus on interaction of AIDS and other STDs, diagnostics and the consequences of STDs, contraception, cancer prevention and detection, pregnancy management and the latest in primary care therapies. The method will be lecture style. ARHP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The credit hours earned will be in Category One of the Physician's Recognition Award of the American Medical Association. All sessions are also approved by ACNM and CNM for accreditation.

November 22-24, 1996. Location: Amelia Island, FL at the Ritz-Carlton. Sessions focus on contraception and cancer, practical guidelines for evaluation, diagnosis and treatment of disorders common to the mid-life woman. Nationally respected speakers will discuss the latest research, future trends and public policy. The method will be lecture style. ARHP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The credit hours earned will be in Category One of the Physician's Recognition Award of the American Medical Association. All sessions are also approved by ACNM and CNM for accreditation.

December 6, 1996. Location: LaQuinta Inn, 1425 - 27th St East, Tacoma, WA. A variety of pharmacotherapeutic topics of interest to all ARNP specialties will be presented in general and concurrent sessions. Contact Pacific Lutheran University CCNL, phone: 206.535.7683, fax: 206.535.7590, E-mail: ccnl@plu.edu

If you have a Master's Degree in Nursing and would like to become a Family Nurse Practitioner, our program is for you. At the Pacific Lutheran University Center for Continued Nursing Learning we offer courses scheduled to accommodate the working nurse. Our Post Master's Family Nurse Practitioner Program consists of 240 classroom hours and 630 clinical hours. For more information on this exciting and innovative program, contact us at 206.535.7683 or E-mail at: ccnl@plu.edu

Masters of Science in Nursing & Post-Masters NP Pathways in Family & Adult/Gerontology

Earn your Master of Science in Nursing degree at Seattle Pacific University in our evening and weekend program. The MSN Program is a full (one year) or part-time (two year) program meeting one night a week and three Saturdays per quarter. Flexible packaging of courses and individual tailoring of your MSN degree are only a few of the benefits of SPU's Master of Science in Nursing Program. We also have master-post masters NP Pathways in Family and Adult/Gerontology. For more information, visit our web site at: http://paul.spu.edu/, call 206.281.2888 or 800.899.1769, write 3307 Third Ave West, Seattle, WA 98119 or E-mail us at: msninfo@spu.edu

Editorial Information
ARNP Care Office
212 Railroad Ave N, Kent, WA 98032
206.852.9042 Fax 206.480.0002
care@nurse.net

Copy deadline is the second Tuesday of the month prior to publication. Ads may be accepted later then this on a space available basis. Position Available Ads per insertion of less than 66 words are $45, of 66 to 130 words are $75. Continuing Education Announcements per offering for up to three (3) insertions of a BRIEF description are $35, sponsoring organizations of ARNPs United may publish CE announcements at no charge. New Product Announcements per product for one insertion of 130 words or less are $75. Ad Inserts are $480 for one issue. All ads are subject to space limitations and editing. Call for detailed rate information. Mail copy to ARNP Care, 212 Railroad Ave N, Kent, WA 98032. Phone 206.852.9042. Fax 206.480.0002. E-mail care@nurse.net

You may believe that because this newsletter arrives every month you are a member of ARNPs United. That is wrong. Since 1989 ARNP Care has been sent to every ARNP in Washington regardless of membership status. This is in imminent danger of stopping due to a lack of funds. Remember the number of members is what makes an organization strong and credible with the legislature and others. So join us today. Individual memberships are $150 per year. Lifetime memberships are $1000. Student currently enrolled in a ARNP program may join for $50 per year. Make your check out to ARNPs United and mail it to: ARNPs United, 212 Railroad Ave N, Kent WA 98032.

Thank you for being one of the ARNPs in this state who have joined ARNPs United. Without your support it would not have been possible to have hired a lobbyist and had such a successful legislative session in 1995. It is also clear that without your support the organization would not have been capable of moving forward in developing a solid framework to build on the grassroots efforts of the ARNPs in this state. ARNPs who are not members of ARNPs United have received ARNP Care printed on lavender paper to let them know they are not members.

Editors: Susan Caverly, MA, ARNP Robert T. Smithing, MSN, ARNP Madeline D. Wiley, MSN, ARNP	Production Staff: Melanie Finley, Kelly Libby, & Pete Mullin
Contributing Editors: Ted Ritter, MN, ARNP	Publisher: Nurse Practitioner Support Services