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As nurse practitioners (NPs) are keenly aware, thelandmark 2010 Institute of Medicine (IOM) report“The Future of Nursing: Leading Change,Advancing Health” called attention to 4 key mes-sages and a number of specific recommendationsfor federal and state governments and other poli-cy makers to enable NPs and other nurses toachieve the full potential of their education andclinical preparation to care for patients. As theybecome realities, these proposals will have a sig-nificant impact on NPs in acute care settings andinstitutions. The ACNP is working closely with theAmerican Nurses Associations and other nationalorganizations representing advanced practicenurses (APRNs) to urge members of Congressand federal agencies to modernize outdated regu-lations and eliminate barriers that stand in theway of nursing’s future.

These messages are beginning to be heard inWashington. The Centers for Medicare andMedicaid Services (CMS) proposed revised hospitalconditions of participation (COP) last October thatclearly recognized the authority of hospitals to grantclinical privileges to both physicians and non-physi-cians to practice within their state laws regardlessof whether they are appointed to the hospital’smedical staff. The proposal seemed to recognizethe IOM’s recommendation that CMS “amend orclarify the requirements for hospital participation inthe Medicare program to ensure that advancedpractice registered nurses are eligible for clinicalprivileges, admitting privileges, and membership onmedical staff.”

However, the proposed changes were only a firststep. The ACNP and other APRN groups urgedCMS to go farther by requiring that NPs and otherproviders who are granted clinical privileges beacknowledged as full members of the medical staff.In comments submitted to the agency December23, 2011, NP organizations also urged the agency toestablish a minimum standard to assure promptreview of applications for privileges and that a fullexplanation is provided to the applicant if the hospi-tal denies privileges. The associations also encour-aged CMS to enable hospitals to assign the respon-sibility for organizing and overseeing the medicalstaff to an APRN if they choose to do so.

While CMS has the authority to take theseimportant steps through regulations, the ACNP isalso working with other nursing groups to edu-cate members of Congress about barriers APRNs

often face in securing clinical privileges andappointment to a hospital’s medical staff. In fact,discussions with congressional offices are alsoaddressing statutory and regulatory barriersincluding outdated definitions that limit someservices in Medicare and Medicaid to “physi-cians” even though the services are recognizedas part of NP practice. APRNs provide physicianservices as defined in the Social Security Act andare reimbursed through Medicare Part B for theirservices. But Medicare coverage policies contin-ue to arbitrarily pick and choose which servicesonly physicians can administer and which APRNsare recognized to provide. The Social Security Actand agency regulation and guidance must be con-sistent when referring to APRNs and physicianservices in order for patients to receive the carethey need exactly when they need it.

These barriers are scattered throughout currentregulations, but none are more obvious than theinability of NPs to order home health care servicesin Medicare. Support on Capitol Hill continues togrow for the “Home Health Care PlanningImprovement Act” (S. 227/H.R. 2267), and mem-bers of rural health care caucuses in both the Houseand the Senate have included these provisions intheir omnibus rural health bill, the “Rural Hospitaland Provider Equity Act” (S. 1680/H.R. 3859).

The ACNP is also working with its APRN col-leagues to eliminate requirements for supervisionof APRN services that limit patient access to careand increase health care costs, without increasingthe safety or the quality of care. NPs and otherAPRNs provide safe, quality care in hospitals, criti-cal access hospitals, ambulatory surgery centers,skilled nursing facilities, Centers of Excellence, andother health care facilities, all of which are associat-ed with federally mandated supervision require-ments that are not necessary. By eliminating theserequirements and applying an oversight standardthat ensures NPs can practice to the full extent oftheir licensure and scope, Medicare and Medicaidcan assure that patients will have increased accessto the care they need and deserve.

Achieving the future envisioned in the IOM reportwill be neither quick nor easy, but each step in thejourney will improve the ability of NPs to practice inacute care settings that recognize their educationand preparation and help them to provide high-qual-ity, cost-effective care for their patients. ACNP iscommitted to making that future a reality.

To Reach the Future, NPs MustEliminate Obsolete Acute Care Rules

Dave Mason, ACNP Government Relations Director, Mason Consulting, LLC

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Interview With Congresswoman Lois Capps

Congresswoman Lois Capps (D-CA) graduated fromPacific Lutheran University in Tacoma, Washingtonwith a BS in Nursing with honors and worked as anursing instructor in Portland, Oregon. She was swornin as a Member of the 105th Congress on March 17,1998, succeeding her late husband, former Universityof California, Santa Barbara professor, CongressmanWalter H. Capps. She is a respected and effectiveleader in Congress, especially on issues of related topublic health. Mrs. Capps has successfully spearhead-ed and passed legislation specifically to address thenational nursing shortage and improve Medicare cov-erage for patients suffering from Lou Gehrig’s disease.She serves on the powerful Committee on Energy andCommerce and also sits on the Health, Energy &Power, and Environment & the Economy subcommit-tees. From these posts, she focuses on Medicarereform, the nursing shortage, cancer, mental health,energy policy, and the protection of our air and water.Mrs. Capps’ extensive health care backgroundinforms her work in Congress; she founded andserves as the co-chair of the House Nursing Caucus.During her 20-year tenure as a nurse and public healthadvocate for the Santa Barbara School District, thou-sands of Santa Barbara’s children and families havebenefited from her personal care and leadership. ACNP: Congresswoman Capps, thank you for tak-ing some time to speak with us. With 2012 being anelection year, the conventional wisdom is that notmuch will be accomplished by Congress. Do youagree with that or is there a potential for somethingto be done?

Capps: I always remain hopeful that we cancome together to help the American people. Weneed to do more to help get our neighbors back towork, support research and innovation, and domore to help all Americans live healthy lives. In thehealth care space, we will be working on reauthoriz-ing key Food and Drug Administration programsthat foster medical innovation and bring new curesand treatments from the lab to the patient.

ACNP: Is bipartisanship still alive in Washingtonor a relic of the past?

Capps: There has certainly been less bipartisan-ship in Washington during this Congress. For exam-ple, prior to this Congress, I have always been ableto find a lead Republican cosponsor for my women’s

heart health bill, the HEART for Women Act. This billhas passed the House of Representatives twice inprevious Congresses with near unanimous supportfrom both Democrats and Republicans. This year,however, I was unable to find a lead Republicancosponsor for the legislation. The legislation was thesame; it’s the Congress that’s different, unfortunate-ly. However, as of March 1, this bill has 36 cospon-sors, 4 of whom are Republican, so perhaps the tideis shifting.

ACNP: What are your priorities on health careduring this session of Congress?

Capps: My biggest priority on health care duringthis session of Congress is working to ensure theeffective implementation of the Affordable Care Actand protect it from the continuing barrage of attacksfrom its opponents in Congress. It is important toremember the completely broken system we hadjust 2 years ago. We need to make sure the law hasa chance to work to help shift our health care sys-tem from one of “sick care” to one that promoteshealth and prevention.

I have also introduced several health relatedpieces of legislation, including the HEART forWomen Act, which would strengthen our nation’sfight against heart disease in women, the NurseSafe Staffing Act, to ensure that hospitals have astaffing plan to ensure optimal patient care, and theEmergency Medic Transition (EMT) Act of 2011,which would make it easier and faster for veteranswho served as military medics to earn certificationas civilian Emergency Medical Technicians.

ACNP: You sit on the House Energy &Commerce Committee where a lot of importantdecisions are made on Medicare Part B as well asMedicaid. Do you see any legislation moving oneither program?

Capps: Last year the leadership in the House ofRepresentatives put forward a plan to turnMedicare into a voucher program and block grantMedicaid. Ending the Medicare guarantee and turn-ing it into a fixed-contribution voucher program is anidea still very much favored by the Republicanmajority in the House of Representatives, so Iwould expect the Energy and CommerceCommittee to take up that proposal again.Fortunately, there seems to be little interest in this

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proposal on the Senate side. We need to be vigilantin protecting these programs and access to healthcare for all those they serve.

ACNP: Every few months, Congress has to dealwith the so-called “doc fix.” This of course is thelegislation regarding the Sustainable Growth Rate(SGR) – the formula that sets payment rates basedon economic growth to physicians, nurses, andother health care professionals who acceptMedicare. We seem to deal with the problem of the“doc fix” year in and year out. What is the potentialfor a long-term resolution of this problem whichaffects all health care providers?

Capps: I have been working on this issue sincemy first days in Congress. To be clear—the SGR for-mula is flawed and the cuts it proposes year afteryear are simply unsustainable. That is why I havecontinually voted to repeal the formula. In fact, theHouse of Representatives passed a permanentrepeal of the “SGR” formula in its version of thehealth care bill. We worked hard to get it into theSenate bill but I was disappointed that it was not.

I remain hopeful that we can reach a long-termresolution to this issue, because as you said, itaffects all health care providers and every singlemember of Congress.

ACNP: What would you like to see in terms ofany further health care reform, or do you think thatthe politics associated with the Affordable Care Actwill be an obstacle to further legislative activity inthe near future?

Capps: I would like to see more done to expandour health care workforce, include removing barri-ers to nurses practicing at the full extent of theirlicense and training. I am biased, of course, but Ibelieve that we provide a holistic approach to carethat can help manage chronic disease, improvepatient care, and lower health care costs. Moreover,as a public health nurse, I think there is more wecan do to promote prevention and public health tohead off disease before it starts.

But you are right, to date in this Congress the pol-itics associated with the Affordable Care Act havebeen an obstacle to further legislative action onhealthcare priorities. Instead, the primary focus ofthe new leadership of the Health Subcommittee inthis Congress has been to attack the AffordableCare Act. Opponents of the law know that they willnot be able to repeal it outright, which is why we’veseen so many bills to repeal key programs or provi-sions in the law, including funding for school-basedhealth centers and the rule governing women’s pre-ventive health services.

ACNP: Do you anticipate that the US SupremeCourt will strike down the Affordable Care Act asunconstitutional and if it does, do you have anythoughts on how Congress or the Administrationwill react?

Capps: I do not anticipate that the US SupremeCourt will strike down the Affordable Care Act. Ibelieve that the Commerce Clause providesCongress with broad authority to regulate healthinsurance, and to date the rulings at the lowercourts have largely found the law constitutional.

ACNP: Given the economic situation and theproblem with the debt and deficit, do you anticipatethat there will be the continued likelihood of cuts toMedicare and Medicaid year after year?

Capps: We all know that health care is thebiggest driver of our long-term debt, which is why Ifirmly believe that we need to do more to slow thegrowth of health care spending. However, I dis-agree with the approach from the other side of theaisle that says that you can just shift more and moreof the cost of health care onto patients andproviders. That’s not a solution and that doesn’tmake the health care system better. It might lowerthe federal bill, but just by raising the burden onseniors and families with fixed incomes. I dobelieve we can better target interventions to havethe greatest impact. For example, 5% of Medicaidbeneficiaries account for 50% of Medicaid spend-ing. Improving the care of these patients can have amarked financial impact. Moreover, we can makethe system better by eliminating waste, fraud, andabuse, allowing the federal government to negoti-ate drug prices for Medicare Part D, and incentiviz-ing the quality of care rather than just the quantityof care.

ACNP: What are your thoughts about the roleand future of nurse practitioners in the health caresystem?

Capps: I think that nurse practitioners play a veryimportant role in the health care system and onethat will grow over time. As the health care law isimplemented, more Americans will have access toprimary care and we’ll need a strong primary careworkforce to ensure that all Americans can see amedical professional for their basic health care.Nurse practitioners are highly qualified to adminis-ter primary care services and we will need them toensure access to primary care for all Americans.

That is why I championed 2 provisions in thehealth care law to expand the role of nurse practi-tioners as primary care providers: the nurse man-aged health clinics and the expansion of school-

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Award deadlines are approaching fast! Hurry to sub-mit your nominations for the following awards byJuly 10, 2012. See our Web site (www.acnpweb.org)for full details of criteria and selection process. Buthurry – we know the competition will be tough againthis year!

• ACNP Nurse Practitioner Student ScholarshipAward – recognizes an individual NP studentwho has made an outstanding contribution tothe profession through his or her studies andactivities in the community.

• ACNP State Affiliate Award – recognizes aState Affiliate who has shown impressive lead-ership action in tackling either a state legisla-

tive or regulatory issue impacting patients, con-sumers, and NPs in that state.

• ACNP Community Service Award – presented toan NP who contributes significantly through vol-unteer efforts in the community; including but notlimited to local or state health care, educational,political, nursing, or NP organizations.

• ACNP Sharp Cutting Edge Award – recognizesleadership in managing a multidisciplinary coali-tion, directs an innovative resolution to a long-standing problem for NPs, uses or providesexemplary service to a particular patient popula-tion, or provides exemplary work or service onbehalf of NPs.

ACNP Awards for Excellence – Call for Nominations

based health centers. These are 2 models that workand can be built upon to deliver increasing amountsof primary care, especially in traditionally under-served communities.

ACNP: As a nurse who is also a member of con-gress, what advice do you have for nurse practition-ers who may wish to get involved in politics, eitheron a state, local, or federal level?

Capps: My advice to any nurse who wants to getinvolved in policy advancement is to get out there andbe heard. When I began my career as a nurse, nurseswere never asked nor expected to be involved in fed-eral policy making but now we have to be. You do notneed to run for Congress to have an impact on poli-cy—there are many ways to be involved in advocacywith local and national organizations. But no matterhow you get involved, nurses are the backbone of ourhealth care system and it is your input is essential aselected officials legislate on related issues.

I am encouraged by so many nurses who areeducating themselves to become the next genera-tion of leaders in our nursing community. Thesevoices will be the ones that have the greatestimpact on the future of health policy.

ACNP: You are a cosponsor of H.R. 2267, theHome Health Care Planning Improvement Act of2011, a bill that allows nurse practitioners and otheradvanced practice nurses to order home healthservices. We greatly appreciate your leadership onthis issue. Do you think there is a possibility that thebill could move this year?

Capps: I am very proud to be a cosponsor of thisbill. I believe that if enacted, it would affect somenecessary changes and provide some much need-ed assistance to patients, nurses, and otherproviders. I am encouraged by the fact that it is abipartisan bill, which is increasingly rare. This billneeds more support in order to move, however, andI encourage anyone who would like to see it pass tocontact their Representative and ask for him or herto sign on. Congress needs to hear from folks onthe front lines of our health care delivery systemand nurses should never underestimate the impor-tance and power of their lobbying efforts, both onbehalf of their patients and profession. The morethat Members of Congress hear from their con-stituents about this bill, the greater the likelihoodthat it will move.