Page 4 • RN Idaho February, March, April 2018 The State of Idaho, Prenatal Care, and the Opiate Epidemic Kristy Schmidt, MR, RN Clinical Program Manager, St. Luke’s Health System, Women’s Services email@example.com Exploring Reimbursement Parity for Idaho’s Nurse Practitioners Melanie Nash, DNP, APRN firstname.lastname@example.org According to the Centers for Disease Control (CDC), the State of Idaho has a rate of 9.4-10.3 per 1,000 people of opiate misuse and dependence, including prescription drugs and heroin (2015). The same information from the CDC reveals that Idaho ranks among states with the lowest access to treatment for opiate use disorder at a rate of 0.7-3 per 1,000 people. This disproportionate rate of substance use to treatment availability has created a deficit in our communities for those seeking treatment and stabilization for substance use and addiction issues. In order to address the current state and national trends of opiate use and issues associated with addiction, Idaho must advance its access to safe, affordable, rural, and best practice treatment programs for patients needing services in all regions of the state. A particularly vulnerable population that is greatly impacted by the opioid epidemic is pregnant women. According to the National Survey on Drug Use and Health (NSDUH), 5.4% of pregnant women reported using illicit drugs within the last 30 days (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015). Women are more likely to seek help for addiction treatment during pregnancy (World Health Organization [WHO], 2014). Access to treatment for this population is frequently less available than the general population due to lack of pregnancy specific services and general misconceptions about how to care for these patients. This access to care must be improved, be made readily available, and Idaho must have increased resources and treatment options for this population. Caring for pregnant women with opiate use disorder has the potential to positively impact outcomes for the woman, the infant, the family, and the community. A care approach in assisting pregnant women with substance use issues is the pinnacle of population health. As a nursing community, we must advocate for this patient population by educating ourselves and others on substance use disorder. We must practice evidence based care for treatment during pregnancy and our hospital policies and state laws need to reflect this. The decriminalization of substance use during pregnancy is needed. It needs to be treated as a mental health issue and most patients do not have access to addiction services in the jail setting (American College of Obstetricians and Gynecologists, 2017; Stone 2015). Family-centered, gender specific, and trauma informed care must be implemented at all levels from the Obstetrical and Family Practice outpatient setting to Labor and Delivery and the Neonatal Intensive Care Unit (NICU) (SAMHSA, 2011). And finally, we must reflect on our own personal opinions, biases, and stereotypes regarding this patient population. We must understand that these biases may impact patient care in a non-neutral or non-compassionate manner. We must strive to change the stigma that is associated with pregnant women who have substance use issues in order to help them access services and care in a way that is non-punitive and non-judgmental. We should approach care in a way that provides positive interventions and support for women who seek treatment so that they may experience recovery. References American College of Obstetrics and Gynecology (2017). ACOG Committee opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. Obstetrics & Gynecology, 130, 81- 94. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on- Obstetric-Practice/co711.pdf?dmc=1&ts=20171205T2035293263 Center for Behavioral Health Statistics and Quality (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD. Centers for Disease Control [CDC]. (2015). The clinician’s role in addressing the opioid overdose epidemic. [Power Point slides]. Retrieved from https://emergency.cdc.gov/coca/ ppt/2015/9_24_15_opiod.pdf Stone, R. (2015). Pregnant women and substance use: Fear, stigma, and barriers to care. Health Justice, 3(2). doi: 10.1186/s40352-015-0015-5 Substance Abuse and Mental Health Services Administration [SAMHSA]. (2015). Results from the 2015 national survey on drug use and health: Detailed tables. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH- Substance Abuse and Mental Health Services Administration [SAMHSA]. (2011). Results from the 2011 national survey on drug use and health: Mental health findings, NSDUH Series H-45, HHS Publication No. (SMA) 12-4725. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. World Health Organization (2014). Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Retrieved from file:///C:/Users/ pentecor/Downloads/9789241548731_eng.pdf The Nurse Practitioners of Idaho (NPI) organization has partnered with Idaho certified registered nurse anesthetists (CRNAs) and certified nurse midwives (CNMs) to explore stakeholder position and future legislative options for “reimbursement parity” for nurse practitioners (NPs). Reimbursement parity requires insurance entities to provide equal reimbursement for the same work billed under the same codes. Currently in Idaho, NPs are paid 85% of what is paid to physician colleagues for the same health care services. Impact of Current Reimbursement Rates on NPs in Idaho Statistics from the Idaho State Board of Nursing (Rick Myers, personal communication, August, 10, 2017) for advanced practice registered nurses (APRNs) document there are 65 CNMs, 1363 NPs, and 516 CRNAs as active practitioners statewide. These numbers reflect hundreds of thousands of patient encounters per year. Colleen Shakelford, APRN, FNP, Vice-President of the NPI, stated (personal communication, December 13, 2017) that the motivation behind the pay parity exploration is to meet the primary care needs of our predominately rural state. Naylor and Kurtzman (2010) supported this goal and identified the need for NPs to practice to their full authority so that they can continue to make important contributions to high-value primary care. In 2015, Melanie Nash, DNP, APRN, surveyed (manuscript in preparation) Idaho independent nurse practitioner practice owners and NPs who provide care in NPowned practices to better understand their perceptions and barriers to NP-provided care in Idaho. Overwhelmingly, these care providers cited the 85% reimbursement rate to NPs by private insurers and the Centers for Medicare and Medicaid Services (CMS) as a dynamic barrier to practice financial stability, to expand their practice, and to provide patient access to care. According to Dr. Nash’s work, independent NP practice owners, particularly in rural areas, struggle to sustain a business when practice overhead is paid out at 100%, but the NP receives only 85% of the standard reimbursement for services. Successful Pay Parity Legislation in Oregon Oregon’s current nurse practitioner payment parity law, Senate Bill 1503 (2016), is the first law in the country to require private insurance companies to reimburse primary care and mental health nurse NPs, physician assistants (PAs), and physicians at the same rates when they perform the same services. It evolved when in 2013, the Oregon Nurses Association (ONA)/Nurse Practitioners of Oregon, and their lobbyists, developed legislation after several NPs alerted the nursing organizations that Oregon’s insurance companies were arbitrarily cutting NP reimbursement (personal communication, Dr. Larlene Dunsmuir, ONA, December 16, 2017). The ONA asserted this practice jeopardized patient access to care. The original legislation included a sunset clause, which was set to expire in 2017. The 2016 Oregon legislative session removed the sunset clause, passing Senate Bill 1503 (2016), and it was signed into law. The law requires insurers to provide equal reimbursement to primary care and mental health NPs, PAs, and physicians. Call for Support and Dialogue The movement toward equal reimbursement for the same services, billed under the same billing codes, serves the interest of a growing Idaho population, which needs access to health care in local communities. As the 2018 Idaho legislative session begins and ANA Idaho nurses prepare to meet their Idaho congressional representatives, the NPI organization welcomes the support and open dialogue with colleagues and health care stakeholders about this issue. The goal of the NPI, by forwarding and stimulating the reimbursement parity discourse, is to provide Idahoans with appropriate and timely patient access to APRN health care providers in their own community and to encourage NPs to practice in Idaho. References Nash, M. (2017). Idaho NP independent practice owners and providers: A survey. Manuscript in preparation for submittal for publication. Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893-899. doi: 10.1377/hlthaff.2010.0440. Retrieved from http://firestats.com/wp-content/uploads/2013/07/S2-Naylor.pdf Nurse Practitioners of Idaho. (2017). Retrieved from http://www.npidaho.org/ Nurse Practitioners of Oregon. (2016). Legislature votes to make NP payment parity law permanent. Retrieved from http://www.nursepractitionersoforegon.org/general/custom. asp?page=news20160225 S. Bill 1503, 78th Oregon Legislative Assembly 2016 Regular Session. (2016) (enacted). Retrieved from https://olis.leg.state.or.us/liz/2016R1/Downloads/MeasureDocument/ SB1503/Introduced
February, March, April 2018 RN Idaho • Page 5 In the News... ANCC Awards First National Healthcare Disaster Certification ANA press release The new American Nurses Credentialing Center (ANCC) National Healthcare Disaster Certification is the first interprofessional certification designed to verify the competence of the individual disaster health care professional. ANCC has awarded its first National Healthcare Disaster Certification to Wesley L. Marsh Jr., MBA, CCHW, FAEM, CHEP, NHDP-BC, system safety/life safety and emergency manager at Brooks Rehabilitation in Jacksonville, FL. “We recognized the need to develop a customized credential that would validate the expertise of national healthcare disaster professionals,” said ANCC Director of Certification Marianne Horahan, MBA, MPH, RN, NEA- BC, CPHQ. Obtaining the certification was a key next step in Marsh’s professional development because, according to him, “it validates your mastery of specific skills and demonstrates that you have the knowledge to perform your job effectively, which in turn improves patient and staff satisfaction.” “I was very impressed with its thoroughness,” Marsh said of the exam he was required to pass in order to be awarded his credential (NHDP-BC). “It covered a broad base of topics, especially in terms of healthcare disaster decision making.” Before his current position, Marsh worked for the Florida Department of Health as a Strategic National Stockpile, Cities Readiness Initiative, and Medical Reserve Corps coordinator. Additionally, he currently serves as vice president of the First Coast Disaster Council and is Medical Service Corps Officer in the U.S. Air Force Reserve. “The ANCC National Healthcare Disaster Certification immediately communicates competence,” Horahan noted. “It assures employers and the public that health care disaster professionals have mastered an interprofessional body of knowledge and skills related to all phases of the disaster cycle.” Actively licensed individuals, including RNs, APRNs, emergency management professionals, public and behavioral health specialists, social workers, and other health care workers are candidates for ANCC National Healthcare Disaster Certification. Candidates must have experience in an actual disaster or disaster exercise and a certificate of completion for at least one FEMA emergency management course. “This certification will support the mission and vision of the hospital,” which was recognized as an ANCC Magnet® Hospital last year, said Joanne S. Hoertz, MSN, RN, CRRN, senior vice president of nursing at Brooks Rehabilitation. Reference ANA. (June 2017). ANCC Awards First National Healthcare Disaster Certification TM . Nursing Insider News. Retrieved from http://nursingworld.org/HomepageCategory/ NursingInsider/Archive-1/2017-NI/June17-NI/National- Healthcare-Disaster-Certification.html Take Action On Opioid Public Health Emergency ANA Press Release President Trump declared the opioid epidemic a public health emergency on Oct. 26. 2017. Nurses see the devastating impact of the opioid crisis every day. And because of their profession and passion to advocate for their patients, nurses are uniquely positioned to lead the way on finding solutions to alleviate the suffering of individuals and families affected by the opioid epidemic. In the Senate, the American Nurses Association (ANA) has signed on to support the Combating the Opioid Epidemic Act, introduced by Bob Casey (D- PA) and Ed Markey (D-MA). In the House, Reps. Paul Tonko (D-NY) and Ben Ray Luján (D-NM) introduced H.R. 3692, the Addiction Treatment Access Improvement Act, with support from ANA and our nursing partners. ANA encourages you to send an email to your representatives in Congress encouraging them to support critical, nurse-backed legislation to battle the opioid epidemic that is harming communities across America. Use this tool at http://p2a.co/zj8L4IN. Stay up to date with ANA’s Capitol Beat blog at http:// anacapitolbeat.org/. Reference American Nurses Association (ANA). (2017). ANA Issue Brief. Available: http://nursingworld.org/DocumentVault/ Health-Policy/Issue-Briefs/ANA-IssueBrief-Opioid- Epidemic.pdf Drug Shortages in America: A Quick Synopsis Margo Hickman, BSN, RN email@example.com Medication shortages have been a hot topic amongst Treasure Valley nurses. Floor nurses are being updated weekly about new medications on backorder due to a critical shortage nationwide. New processes are rolling out to help mitigate the effect felt by a lack of IV medications used daily in hospitals, like IV fluids, antibiotics and analgesics. Who manages medications and a lack thereof nationwide? Is there something specific happening to cause shortages? When can we expect a resolution? A brief inquiry into these questions uncovered some interesting facts. The Food and Drug Administration (FDA) is the organization responsible for monitoring proper production and distribution of food, medications and medical supplies in America by conducting safety and quality checks on products, ensuring proper labeling, verifying product effectiveness, and assisting in future product developments. The FDA has an entire branch devoted to medication shortages: The Drug Shortage Program. Their website maintains a list of medically necessary products that help maintain public health and further categorizes them into those currently in shortage, those resolved and drugs that have been discontinued. They list common reasons for the shortages such as lack of active or inactive ingredients, demand increase for the drug, delays in shipping and issues complying with standards of manufacturing. Anyone, person or business, can report a medication in short supply, and the FDA updates and maintains the list on a regular basis (FDA 2017). There have been shortages in IV fluids for multiple years now, but this shortage has been exacerbated by hurricane damage done to one of Baxter’s main production locations in Puerto Rico. The FDA released a statement November 14th of 2017 addressing this issue. Reportedly, Baxter is using production plants in various countries while the Puerto Rico plant recovers. This helps minimize the gap between supply and demand of IV fluid bags while the Puerto Rico location is not yet operating to capacity. In the statement by the FDA, they assure Americans that these outsourced locations have safety and production processes properly vetted to ensure they would pass requirements for product use within the United States. They also describe their efforts to fast track approval submissions made by new production plants who would like to start producing IV fluids and/or medications. The end goal is to have more locations producing the same products, thereby increasing their availability nation-wide (FDA 2017). Hurricane Maria has earned a top spot on the devastating natural disasters list and FEMA predicts another 6-10 months at the time of this publication before all of Puerto Rico will have power restored. With this update, it is unlikely the gap between supply and demand will be reduced in the near future. Hospitals across the nation are doing everything they can to We all have a role to play in preparing Idaho for the challenges of responding to a public health emergency or natural disaster. Please share your nursing skills by registering with the Medical Reserve Corps in your area. Training is free. Join us today! www.volunteeridaho.org continue providing patient care as effectively as possible with the supplies they have access to (Fema 2017). References Food and Drug Administration (FDA). (2017). Drugs Home Page. Retrieved from https://www.fda.gov/Drugs/default.htm Federal Emergency Management Agency (FEMA). (2017). Hurricane Maria. Retrieved from https://www.fema.gov/ hurricane-maria You’ve always dreamed of being a nurse. Now find your dream job at nursingALD.com FREE to Nurses!