Federal Political Director’s Annual Report for 2015

Federal Political Director’s Annual Report 2015

Dear Fellow NVANA Colleagues and Family Members:

Mid-Year Assembly, Washington D.C.

AANA members from across the United Stated attended Mid-Year Assembly (MYA) held at the Crystal Gateway Marriott in Arlington, Virginia from 18-22 April, 2015. Military CRNAs were represented as well. MYA is the annual advocacy conference for CRNA practice on the Federal level, and updates Congress regarding our concerns on legislative and policy issues which will affect delivery Safe and Effective Anesthesia Care. MYA also provides the opportunity to build relationships with members of Congress while we visit Capitol Hill.

L to R: Jason Girouard, Steve Hamilton, Rep. Cresent Hardy, Steven Sertich.


NVANA Delegates Attending MYA 2015

Steven Sertich, Pres-Elect, NVANA, former Region 5 director

Steven Hamilton

Jason Girouard


Advocacy Issues for 2015

CRNAs Provide Access to Safe and Affordable Healthcare

Recent studies have led researchers to recommend that supervision for CRNAs to be eliminated (1). The CRNA-model of a full –range anesthesia delivery is at least 25% more cost effective than medical-direction models, with maintaining high standards of quality and patient safety (2).The Institute of Medicine (IOM) recommend all APRNs, including CRNAs, practice to their full extent of their education and training (3). Also noted was frequent lapses in TEFRA requirements with as few as 2 CRNA being medically-directed simultaneously, which creates significant issues in CMS claims compliance (4).

Ensure Veterans Access to High Quality Care

CRNAs have been delivering anesthesia for over 150 years, with documentation of nurse anesthestists dating back to the Civil War. Sponsored by Sen. Mark Kirk (R-IL), SB 297 allows for Full Practice Authority (FPA) for APRNs, but omits CRNAs from this legislation. AANA/NVANA asks that SB 297, The Frontlines to Lifelines Act, be opposed with a “NO’ as it is currently written. If SB 297 is amended to include FPA for CRNAs, then it should be supported with a “YES” vote. It believed this bill will have long-term reverberations for CRNA practice going forward.

Restore Rural Access to Nurse Anesthesia Services

Medicare Part A cost-based pass-through reimbursement has been put at risk. CMS has twice denied rural pass-through funding for CRNA standby and on-call services, thus denying claims for Medicare funding which these hospitals have come to rely upon to keep their doors open and provide rural health services. Legislation reversing these policies must be introduced, while we oppose the Medicare Access to Rural Anesthesiology Act of 2013 (or similar legislation). This legislation will allow for addition funding for anesthesiologist in rural areas, which will in turn increase cost of services by an estimated 300% with no documented alteration in outcome or increase in services provided.

Pass SGR Legislation and Ensure Proper Implementation

On April 14, 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; President Obama signed it shortly thereafter. This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015 for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended. CMS immediately began work to implement these provisions. This was the result of sustained efforts by organization such as AANA, and individual advocacy by CRNA and other practitioners. Good work, and congratulations to everyone involved.

Support Nurse Anesthesia Workforce Development

CRNA education programs collectively received about $3 million annually through the Title VIII Nurse Workforce Development Programs. The Affordable Care Act included a 4-year pilot Graduate Nursing Education (GNE) project to aid in caring for the increased demand of higher coverage rates combined with projected demographic shifts in the future. We ask all CRNAs and APRNs support Title VIII program renewals.

Visits to Elected Official in Washington, D.C.

  • Senator Harry Reid (D-NV). We met with Legislative Correspondent Kimberly Miller-Tolbert. Sen. Reid has recently declared his intention to retire from Congress at the end of his term
  • Senator Dean Heller (R-NV). We met with Ryan McBride, Legislative Assistant.
  • Dina Titus (D-NV-1). We met with Elizabeth Decker, Legislative Assistant.
  • Mark Amodei (R-NV-2). We met with Stephanie Walker.
  • Rep Joe Heck, D.O. (R-NV-3). We met with Michael Lisowski.
  • Cresent Hardy (R-NV-4). We met personally with Rep. Hardy. Mr. Hardy is from the Mesquite area, and this is his first-term in Congress.

Speedy Recovery for Stephen Panter, CRNA

Steve Panter moved to Carson City in the early 1970s. He is NV CRNA #002! When he started practice, there was no CRNA subsection in the Nurse Practice Act. In addition to 40-plus years of practice in Carson City/ Northern Nevada, he co-wrote the CRNA portion of the NPA which took over one-year to get approved. Steve recently had major surgery, and is recovering at home with his wife Marian.


Other Issues

SB 181, which allows the introduction of Anesthesiologist Assistant practice into Nevada, pass without opposition through the State Senate during this period. SB 181 moved into the Assembly Commerce and Labor Committee in May. SB 181 initally failed in Committee, but was resurrected via parliamentary procedure. SB 181 was not voted upon the Assembly floor as it did not have the votes to pass. I want to thank all those involved (albeit, not inclusive, nor in any particular order): Chad Brown, Annette Teijero, Steven Sertich, Steve Panter, Joanne Heins, Norma Sorell, Brenda Koiro, Margaret Wilson, Rand Bracken, Steve Hamilton, Susie West, Art Savignac, Gina Kronenberg, Ed Mohr, Sean Higgins, and Diana Girouard.   Again, this is not meant to be a fully-inclusive list. Thank you for everyone’s input on this; it was crucial in our victory.

Please consider starting and maintaining relationships with our elected official before it becomes critical.   Phone calls are good, letters are appreciated, but meeting in person opens new horizons in these relationships. Whether it is local events, walking the halls of the legislature, meeting locally, or walking with candidates while canvasing districts during the election period, these personal relationships will pay dividends into the future.

Thank you,

Jason Girouard, CRNA, MSN


1) Dulisee B, Cromwell J. No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians. Health Affairs. 2010;29(8): 1469-1475.

2) Hogan, P., Seifert, R., Moore, C., and Simonson, B. Cost Effectiveness Analysis of Anesthesia Providers. Nursing Economic$, 2010:28(3): 159-169.
3) Institute of Medicine (IOM). The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press, p3-13 (pdfp.108) 2011
4) Epstein R, Dexter F. Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics. Anesthesiology. 2012;116(3): 683-691.