connect with oaapn!...mandi cafasso [email protected] aprns lead in rural health eric snyder, dnp,...
TRANSCRIPT
APRNs across the state of Ohio have faced varying levels of both challenge and success when it comes to integrating into a health systems’ organized medical staff structure, let alone in a leadership role. While some health systems are ahead of the curve and have collaborative practice pretty much figured out, others are trying to catch up.
I am an acute care NP and an OAAPN board member currently serving as the southeastern region director. My career in healthcare began 22 years ago as a nurse aide in rural Ohio and I am now the medical director of the hospitalist program and president-elect of the medical staff at Trinity Hospital Twin City (THTC) in Dennison Ohio. I was fortunate to be elected to this influential position by my physician, my APRN and PA colleagues and with support from the hospital’s medical staff.
I came to Trinity Twin City in 2016 after having several conversations with then CEO Joe Mitchell regarding changing up their hospitalist service line. THTC is a critical access hospital in rural eastern Ohio which is part of Trinity Health Systems of Steubenville. As with many rural health systems, there is difficulty in recruitment and retention of physicians in those areas and thus APRNs have risen to help meet those challenges.
A plan was proposed to utilize and staff the hospitalist program with the majority of providers being APRNs. We were able to continue to prove this model over several years as a real winner for rural inpatient care both for the organization and the community it serves.
While APRNs had a strong local presence in primary care at the facility as well as a high level of collaboration between the APRNs and the local physicians, the medical staff bylaws did not
reflect this. I spent the first few years working with the medical staff and administration to update the bylaws with provider neutral language. Next, we advocated for not just allowing APRNs to attend medical staff meetings but to allow them a level of medical staff membership that would afford them an official voice through voting privileges on medical staff issues. This gave us a “seat at the table” to continue to showcase our leadership skills to the medical staff and administration. Teresa Gagliardi, MSN, RN, the VP of Hospital Operations at THTC had this to say, “We at THTC have been fortunate in the recruitment of Advanced Practice Providers (APPs). These providers have a solid nursing and healthcare background and it shows in their delivery of patient care. They are intelligent, engaged and respected individuals.
Spring 2019
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What’s Inside
APRNs are a Solution to Ohio’s Healthcare Shortage
Reimbursement & Government Affairs Updates
Calling All APRN Leaders!Join the Key Person Program
Meet Our Newest Board Members!
APRNs Lead in Rural HealthEric Snyder, DNP, APRN-CNP
2019 BOARD OF DIRECTORS
EXECUTIVE OFFICERSPresident
Joscelyn [email protected]
President-ElectKelly Shank
Immediate Past PresidentJesse McClain
SecretaryTracy Schwab
TreasurerDoug Caserta
DIRECTORS AT LARGE
CommunicationsErin Ross
EducationJoyce Karl
Full Practice Authority & ReimbursementChristine Williams
Government RelationsMary Jane Maloney
Prescriptive AuthoritySherri Sievers
REGIONAL DIRECTORSCentral
Bethany Parsell & Kimberly [email protected]
NortheastMeredith Foxx & Sara Pease
NorthwestDeb Schwaiger & Toni Harrison
SoutheastEric Snyder
SouthwestMandi Cafasso
APRNs Lead in Rural HealthEric Snyder, DNP, APRN-CNP
Connect with OAAPN!
www.oaapn.org [email protected] 866.668.3839 17 S. High St, Suite 200Columbus, OH 43215
Their patients think very highly of them as shown through our patient satisfaction scores.” She also adds that “APP participation in various committees and projects provides another perspective in getting the work done. Healthcare is complex and our APPs are committed to keeping up to date on what is evidence based practice.”
Eventually, I was able to help influence having the bylaws updated and became an active medical staff member. I continued to have conversations with administration and physician members of the medical staff and stayed engaged and enthusiastic about sharing ideas. I believe this did not go unnoticed as I was appointed chair of MSPIC (medical staff performance improvement committee) in 2018.
As the 2019 medical staff executive committee appointments came up, I decided to put my hat in the ring as a newly active staff member. Through a balloted voting process I was elected by a group of our physician and APRN peers (with their newly acquired voting privileges) as president-elect of the hospital medical staff.
According to Dr. Tim McKnight, MD, the immediate past president of THTC medical staff, “Our APRNs have excellent clinical skills. Eric’s humble interpersonal approach with the medical staff and proven leadership capacity has earned him the respect of his peers and is the reason he was elected to this leadership position.”
We as APRNs are working on the frontlines right along with our physician colleagues. We are all trying to do our part to provide good patient care together. The culture at our facility has been excellent in that all people who are engaged and interested in improving patient care delivery have an official voice and the ability to contribute.
Ohio’s APRNs have a lot to offer organizations and their medical staffs. From large urban centers to rural critical access facilities, all healthcare providers who are engaged and motivated to make a difference should have the opportunity to share their knowledge and experience regardless of background or title. This diversity can only add value to the pursuit of quality patient care.
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2 | OAAPN SPRING NEWSLETTER
Ohio Hospital Association Speaks OutONGOING DISCUSSION: CNP vs. ACNP
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NOT AN OAAPN MEMBER?Join online today at www.oaapn.org/join
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I am an Advance Practice Registered Nurse (APRN) and I am proud of who I am. I am a medical professional who is part of a multidisciplinary team that cares for patients. As APRNs we are an integral aspect of that team.
As we move forward in our efforts to remove the mandatory Standard Care Arrangement (SCA) it is important for us to be mindful of how we present ourselves as professionals in our field. While social media is a great way to stay connected, it can also be quite harmful. Anytime I post on social media, I think about who may read this and what are the potential ramifications. In order to be treated as professionals, we need to act as such. Now is our time to shine.
I believe it’s vital that we perform our job to the best of our ability.
This includes being proactive and informed of the ever-changing guidelines within our practice. It is important to remain knowledgeable in order to provide the best possible care that our patients deserve.
It’s essential that we set the example regarding how providers can work together as part of an integrative team. By mentoring newer APRNs, we can instill knowledge and assist in their professional growth. Taking the time to precept students is another way we can give back. When I precept, I utilize that time to talk to the students about the importance of maintaining professionalism and what being an APRN truly means. If we want people across the state to respect our profession, and support us in our legislation, then we need to take this all into consideration.
President’s MessageJoscelyn Greaves, APRN-CNP, OAAPN President
Are you an APRN leader in your community? Do you want to be a force that drives change for patients and APRNs across Ohio? Join OAAPN’s Key Person Program (KPP) and help lead the effort to improve the future for Ohio’s APRNs and increase access to care across the state. As a Key Person, you will be a part of one of OAAPN’s most crucial efforts – advocating to lawmakers on behalf of Ohio’s APRNs and patients.
OAAPN will provide you with the tools and training necessary to establish positive relationships with your legislators and deliver our targeted messaging, which is always patient-centered and promotes the value of APRNs.
This is your opportunity to advocate for improving access to care for patients across the state and retiring unnecessary regulations that block access to APRN care.
To serve as a Key Person, you must be an OAAPN member and an Ohio resident. The first step to becoming a Key Person is to sign up on our website: www.oaapn.org/advocacy/kpp.
Not a member? Join online at: www.oaapn.org/join
If you have any questions about the KPP program, please send us an e-mail at [email protected].
Calling All APRN Leaders! Join the “Key Person” Program and Make a Difference
OAAPN SPRING NEWSLETTER | 3
APRNs are a Solution to Ohio’s Healthcare Shortage
Nearly 1.4 million Ohioans lack access to primary care services. Only 55% of patient demand is met by our current provider workforce, leaving a shocking 45 percent without available care. This trajectory is expected to worsen as baby boomers age and the incidence of chronic disease worsens. And Ohio is bracing for a widening gap in care that will directly impact resident health.
In addition, we are in a mental health crisis. Currently we have only 214 psychiatrists in Ohio with active licenses and 774 psychiatric trained APRNs. As the number of psychiatrists continues to deplete, the access to mental health will as well. According to the U.S. News & World Report’s 2018 Best State Rankings Ohio is 36th in the nation for healthcare quality, despite the world-class healthcare facilities that call Ohio home. Ohio can and must do better.
A major practice barrier is the mandated Standard Care Arrangement (SCA). Instead of promoting collaboration, these agreements are an expensive hurdle for APRNs looking to expand their reach, including in communities where patients are starved for care. Often APRNs pay thousands of dollars for a physician to provide ceremonious oversight, when in practice, APRNs are trained to provide these services autonomously.
To address this situation and improve access to care for Ohio’s patients, OAAPN plans to re-introduce our bill to retire and the mandatory SCA. If passed, this bill would allow health systems to determine the most appropriate workforce mix, resulting in optimal cost efficiencies that promote access and quality care. While
not changing APRN’s scope of practice, it would help remedy Ohio’s healthcare provider workforce shortage while continuing to maintain safeguards and restrictions governing opioid prescribing. It would most importantly promote professional collaboration with other healthcare professionals. It does not change APRN scope of practice.
Last year the Trump administration released a report called Reforming America’s Healthcare System through Choice and Competition. According to the report, states should consider changes to outdated statutes to allow all healthcare providers to practice to the top of their license thereby utilizing their full skill set. It was great to see the Administration’s commitment to ensuring that unnecessary barriers to practice do not limit access to high-quality health care. “OAAPN agrees that outdated laws should be removed and that all healthcare providers should practice to the top of their license, education, and training,” said Joscelyn Greaves, APRN-CNP, OAAPN President. “We look forward to working with the Ohio legislature to ensure patients have access to health care delivered by their provider of choice.” Allowing APRNs to practice to the full extent of their education, training, and experience, would have clear consumer benefits, particularly in rural and poorer areas.
It’s time we fix our healthcare supply and demand problem. APRNs are the solution, and lawmakers are the catalyst for change. We need to come together as one voice and support legislation this coming year.
SAVE THE DATE!
APRN Day at the Statehouse October 8, 2019 Columbus, OH
4 | OAAPN SPRING NEWSLETTER
Are you tired of archaic regulations and policies that govern your practice? How about laws that increase cost and decrease efficiency in patient care? Then it’s time to take a stand and promote change by becoming an OAAPN member. Your membership dues support OAAPN’s legislative efforts to remove practice barriers for Ohio’s APRNs.
Just in the past two years, OAAPN has spearheaded the passage of two major pieces of legislation, HB 216 & HB 111, further advancing APRN practice by eliminating unnecessary regulations.
Without your membership, gains such as these would not be possible! This year, we will continue to work on legislation to remove the mandatory standard care arrangement.
It’s important that you stay connected and current, renew your membership and invite other APRNs to join as well. Collectively we are a force to be reckoned with! Thank you for all that you do as a provider and as an OAAPN member to improve the health and wellbeing of Ohio’s residents!
Join or renew online at www.oaapn.org/join
You Make a Difference by Being a Member!Tracy Schwab, APRN-CNP, OAAPN Secretary
Meet Our Newest Board Members!
What is your hope for Ohio APRNs and OAAPN in 2019 and beyond?Build professional relationships, increase membership and network with fellow APRNs so that we may deliver better care to our patients. Many of us attend meetings every month and see other APRN titles on patients charts and/or professional directories. However, we don’t know one another and don’t know how we can come together to communicate with one another in our community and beyond to deliver better healthcare to our patients.
Why did you feel it is important to volunteer on the OAAPN Board?It is a professional and personal obligation to help shape our practice. I meet many APRN students and APRNs who have never heard of OAAPN. I ask them if they know about the organization that builds, supports and advocates for our practice? This generally opens up conversations and leads to a new relationship and/or member.
Toni Harrison, APRN-CNPNorthwest Region Co-Director
What is your hope for Ohio APRNs and OAAPN in 2019 and beyond?I hope that APRNs an practice without barriers to provide uninterrupted, efficient care to our patients. I would like to see that APRNs across the state have a better understanding of how our practice is governed and feel empowered and knowledgeable about how to be a grassroots advocate for Ohio patients and the profession.
What advice would you give to current APRN students? Join a professional organization! There are many perks to doing this as a student! Also, don’t be afraid to get involved early in your career. Being active in an organization provides excellent mentorship opportunities and aids in growing confidence.
Mandi Cafasso, DNP, APRN-CNPSouthwest Region Co-Director
OAAPN SPRING NEWSLETTER | 5
The Ohio Legislature started its 133th General Assembly (GA) at the beginning of this year. All bills, which were pending before December 31, 2018, were voided including HB 726 - OAAPN’s bill to remove the mandated standard care arrangement.
The GRC’s responsibilities include but are not limited to:
• Reviewing public policy measure which could impact Ohioans healthcare from an APRN perspective. This review includes participation on legislative committees, sound health policy, provider neutrality and scope of practice infringement. The actual work involves researching evidence, refining bill language, meeting with lawmakers or those who influence the political decisions, writing and/or providing testimony (proponent or opponent) and being present where decisions are made.
• In addition to new legislation, which, if passed, would change state law, the GRC also monitors new rules or revisions from many state agencies including the Ohio Board of Nursing.
• The GRC has sub-committees which work on specific issues which impact the GRC mission:• Board of Nursing:
• Attend BON meetings• Attend APRN Advisory meetings: Live streaming• Review and research rule changes, attend interested party meetings• Active issues:
• Guidance for prescribing medications when patient has not been seen by the prescriber.
• Clarifying scope of practice among different nurse practitioner populations• Sub-committee of OAAPN’s Full Practice Committee
• Draft language for removal of mandated standard care arrangement and research and draft language for any negotiated revisions
• Research for potential legislative changes germane to GRC’s mission• Signature Authority: death certificates, wrestler forms• Preceptor Tax Credit • Authority to consult pharmacist to dose & monitor certain medications• Schedule 2 prescribing in Home Care
• Coordinate OAAPN’s APRN Day at the Statehouse on October 8, 2019
Government Relations UpdateMary Jane Maloney, DNP, APRN-CNP, Chair, Government Relations Committee
6 | OAAPN SPRING NEWSLETTER
Come to Columbus and learn about the legislative process and effective strategies to communicate with your legislators. You’ll then get into the action with your colleagues to visit legislators and educate them about OAAPN’s legislative initiatives to modernize APRN practice in Ohio. More information and how to register will be coming early this summer.
SAVE THE DATE!
APRN Day at the Statehouse October 8, 2019 Columbus, OH
Reimbursement HighlightBethany Parsell, APRN-CNP & Christine Williams, APRN-CNP
What can you do if your primary care patients are charged a higher copay to see you than a primary care physician?
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The lowest copays should be for office visits to a primary care nurse practitioner, physician, or physician’s assistant. Patients pay higher copays for specialist and emergency department visits.
OAAPN has worked diligently for many years to ensure that APRNs were recognized as primary care providers and/or primary care medical homes for Medicaid and commercial insurers.
There has been a recurring problem with some commercial payers and Medicare Advantage plans: higher patient copays for patient visits made to primary care nurse practitioners. This higher copay for a primary care nurse practitioner visits decreases patient access to care and patient choice. It creates incentives for patients to see primary care physicians instead of the APRN.
This problem is not unique to Ohio. We found that the problem may happen because the insurance company may erroneously assign the category of specialist to all credentialed nurse practitioners and require specialty copays, or the insurance company may claim they are unable to credential nurse practitioners as primary care providers (PCPs), or the credentialing and billing paper work only allows for a physician provider check off.
APRNs must make sure that they are identified on the credentialing paperwork as providing primary care services and working in a primary care practice.
To ensure you are credentialed properly:1. Complete the credentialing process to include applying for your NPI number and be sure you select the
correct taxonomy code. (Credentialing departments often do this for you.) 2. Ensure you are credentialed correctly with the insurance company. With come insurance carriers you can
select more than one taxonomy code or code description to adequately describe the type/specialization.3. Request to change the taxonomy code as a primary care provider or primary care medical home working in a
primary care practice.4. Pay close attention to the credentialing process and ask the insurance company to address the issue on the
credentialing paper work.
And, remember that sometimes the problem is not in the credentialing paper work, but in the billing paperwork where the APRN may be designated as a specialist.
What to do if you cannot get this resolved? OAAPN is here to help! Send us an e-mail at [email protected]. Note: You must be an OAAPN member to receive this benefit.
OAAPN SPRING NEWSLETTER | 7
17 S. High St, Suite 200Columbus, OH 43215
Registration opens August 2019
OCTOBER 24-26, 2019 HYATT REGENCY COLUMBUS CONVENTION CENTER COLUMBUS, OHIO