Somewhat older readers of One Strong Voice might recognize “Who do you trust?” as the answer to a trivia question: What TV show did Johnny Carson emcee prior to his long run on “The Tonight Show”? But this question also does have a long history in this country. The answer(s) to this question are also regularly reported by the Gallup Organization from their fall poll on the most trusted professionals in the United States.
In November 2012, the number one trusted profession in the country was nurses. In fact, nurses have been the most trusted profession in the United States for eleven years running. (It would have been 14 years, but the firefighters topped the list in 2001 shortly after 9/11. Nurses were number 2 that year.)
Surprisingly enough for those chronic poll watchers; Congress doesn’t seem to trust nurses, in particular, advanced practice registered nurses like nurse practitioners and clinical nurse specialists.
The situation arises due to a recent “clarification” of some Medicare provisions involving ordering Durable Medical Equipment (DME) for Medicare patients. Some Medicare changes had been made due to a concern about the potential for fraud and abuse in ordering services for covered patients. In particular, Congress wanted to prevent blank physician prescription pads from being used to generate claims for power wheelchairs, home blood glucose monitors, oxygen tanks, seat lift chairs, etc. possibly for Medicare mystery patients of uncertain eligibility. This was believed to have also been the case with pharmaceutical prescriptions for Medicare, Medicaid, and private patients. The primary thrust of the recent changes was to document a face-to-face encounter between a Medicare Part B patient and the DME prescribing clinician. No more “fill-in-the-blank” DME prescriptions for patients unseen with made-up maladies pulled from thin air.
ANA strongly believes that Medicare funds should not be misspent in any fashion—not just in this fashion. ANA also concurs with the requirement that a face-to-face meeting should be documented by the prescribing clinician. However, the important point is to produce specific documentation of a clinician-patient encounter establishing the need for DME. Additional physician certification would just be gilding the lily.
By not trusting APRNs (and PAs) Congress created the opportunity for interrupted patient treatments and delay in patients’ receipt of DME needed for their care. Cancer patients might not able to get a hospital bed for home care for days. Needed respiratory supplies for COPD patients may become delayed. Nurse practitioners have much more experience than physicians in dealing with tubes, stomas, tracheostomy tubes, and central venous access devices, but getting the right-sized DME to the patient will have to wait on a physician for whom this may not be an everyday task.
Further, Congress authorized additional payment to physicians for this redundant certification. “Cut Medicare costs!” may seem like a staple from every member’s speeches, but additional Part B payments for redundant paperwork nonetheless became a Congressional mandate. Not to mention—in the first place—that APRNs in States with required physician collaboration arrangements often pay thousands of dollars every year for the privilege. Isn’t enough, enough?
ANA has petitioned CMS to amend or indefinitely delay the rules promulgated to implement this mandate. In response to ANA’s advocacy the implementation date has been moved back to 2014. But because the redundant certification was written into law there is only so much CMS can do. Congress needs to make the fix.
In contrast to the 85% of Gallup respondents who thought that the honesty and ethical standards of nurses was very high or high, only 10% thought members of Congress met the same standards. 54% rated Congress members’ honesty and ethics low or very low. If Congress had put trust in the publicly acknowledged most trustworthy—registered nurses—they could have kept Medicare costs down without jeopardizing patient care. Can you trust your Congress member to understand and vote for the obvious and simple fix? Do please write your Congress member that you’d like to trust this fix will be accomplished.