Federal Political Director’s Annual Report for 2014

To My Fellow NVANA Colleagues:

CRNAs visit Capitol Hill – Mid-Year Assembly 2014

Over 900 AANA members traveled from all fifty States and Puerto Rico to advocate for CRNA practice and access to care with the elected members of the United States Congress in Washington, D.C. April 5-9, 2014. The AANA Washington DC office confirmed this was a record attendance for Mid-Year Assembly.

NVANA Delegates Attending 2014 MYA

Joanne Heins, President-NVANA
Jason Girouard, FPD-NVANA
Steven Sertich, current AANA treasurer candidate, former Region 5 director

AANA Business

AANA Board of Director’s meeting on April 5 was well attended. AANA President Dennis C. Bless and AANA Treasurer Cheryl L. Nimmo gave their respective association updates April 6 to the general audience of conference attendees. Leah Binder, President and CEO of Leapfrog Group was the keynote speaker, and her focus was on how to provide best “value” during her review of the current healthcare environment. Various regional updates were conducted as breakout session, as well as various PAC fundraisers. Candidates for AANA office were afforded time for speeches, including NVANA’s own Steven Sertich, CRNA, J.D.

Issues Addressed

CRNAs Provide Access to Safe and Affordable Healthcare

Through all anesthesia delivery models, care by CRNAs is extremely safe and 25% more cost-effective than the next less-costly model. (1). The Future of Nursing report by the Institute of Medicine (IOM) recommends “Nurses should be able to practice to the full extent of their education and training” and should be “full partners with physicians and other health care professionals. . .” in efforts to ensure patient access to high –quality care. (2) A study published in Anesthesiology discussed frequent supervision lapses by anesthesiologists using TEFRA definitions, even during low levels of supervision (3). Results of these reports had led to calls for elimination of supervision requirements.

Repeal SGR (Sustainable Growth Rate) Cuts and Reform Medicare Payment

AANA has requested members petition Congress to enact legislation to permanently repeal SGR cuts and reform Medicare’s reimbursement system. The Medicare Payment Advisory Commission (MedPAC) proposed to “fix SGR” by cutting anesthesia payments by 17% over 3 years. Medicare reimburses physician services at 80% of market rates, but reimburses Part B at approximately 45% of market rates. A permanent SGR “fix” was delayed for another year, and will be under review again in 2015. AANA stressed that Medicare payment reforms should recognize CRNAs the same as physicians as anesthesia standards are the same regardless of type of practitioner.

Ensuring Veteran Access to High Quality Care

Approximately 700 AANA members serve with the Veterans Health Administration (VHA). CRNAs are the oldest nursing specialty, and have been providing all types of anesthesia services for over 150 years. CRNAs have been providing the majority of the anesthesia services for the military, both in peace and combat, since World War I. VHA Nursing Handbook modernization which designates CRNAs and APRNs as Full Practice Providers (FPP) with Full Practice Authority (FPA) is supported by the AANA. VHA does not require physician supervision, and CRNAs are the sole anesthesia provider in some VHA facilities. Safety records of CRNAs have been demonstrated through the waiver of supervision requirement in the seventeen states which have exercised the opt-out process required by Medicare. It is recommended that you contact the VA and your congressional members to support the modernization of the VHA Nursing Handbook, support CRNAs/APRNs Full Practice Providers, and oppose the “Grimm-Kirkpatrick Letter”.

Provider Nondiscrimination

Provider nondiscrimination was enacted into law in 2010 to promote access to healthcare and patient choice of healthcare professionals in an attempt to reduce costs and foster competition. If health insurance plans are able to exercise the type and location of healthcare professionals they agree to reimburse, the law will allow them to discriminate among entire classes of licensed professionals. This not only creates a difficult situation for the licensed professional discriminated against, but also places the patient in financial jeopardy due to a higher out-of-pocket bill due to refusal of reimbursement. Rep. Andy Harris (R-MD) has introduced legislation, HR 2817, to repeal provider nondiscrimination. AANA requests ask that your congressional delegates oppose HR 2817.

Support Nurse Anesthesia Workforce Development

Title VIII Nursing Workforce Development for FY2014 is approximately $233 million. Nurse anesthesia educational programs receive approximately $3 million of these aggregate assets. Title VIII funding fell below the level of inflation in 2005, and has not kept up since. Graduate nursing education is supported in recent health policy decisions with the intention of APRNs providing clinical care for the ever-increasing demands in the healthcare arena. These developments are supported by organizations such as AARP and governmental agencies such as CMS. Demand for CRNA service is projected to continue to increase due to an increasing and aging population.

Other Issues

Other issues included opposition to the 96-hour rule for Critical-Access Hospitals, opposition to the CMS Two-Midnight Rule for hospital inpatient admission, continued support of CRNA interventional pain management, “meaningful use” of EMR, delay of ICD-10 implementation, and continued updates on medication shortages.

Visits to Congressional Delegation of Nevada on Capitol Hill

  • Senate Majority Leader Harry Reid (D-NV). This year we met with assistant for health affairs McKenzie Bennett.
  • Senator Dean Heller (R-NV). NVANA met with Ryan McBride, assistant for health affairs.
  • Representative Dina Titus (D-NV-1). We met with Katherine Cassling, assistant for health affairs.
  • Representative Mark Amodei (R-NV-2). We personally met with Congressman Amodei and his aide Anna Leieritz. We talked at length about implementation of the Affordable Care Act (ACA), and access to anesthesia care. Congressman Amodei personally requested to keep his office update about legislation regarding CRNAs. Anna Leieritz has since resigned her position at Congressman Amodei’s office- Stephanie Walker is the new assistant for health affairs.
  • Representative Joe Heck, D.O. (R-NV-3). We were unable to meet with Congressman Heck’s office due to scheduling conflicts. The following link is Dr.
  • Heck’s response to SGR debate. http://thehill.com/blogs/congress-blog/healthcare/202221-a-missed-opportunity-to-fix-the-sgr
  • Representative Steven Horsford (D-NV-4). District 4 is Nevada’s newest district since the 2010 census reapportioning, and Congressman Horsford became District 4’s first Congressman in 2012. NVANA delegates were unable to meet with the Congressman as he was in committee, but we did meet with his assistant, Nancy Juarez.

I want to thank those who took the time and effort to travel across the nation and attend this event. Joanne Heins and Steven Sertich were instrumental in helping with the Capitol Hill visits. I also want to thank Gina Kronenberg for her assistance and work as NVANA Treasurer. This is where your annual dues go: to protect CRNA practice and ensure access to “Safe and Effective Anesthesia Care” with the best value. It was a wonderful learning experience, and I encourage you to take the time to go next year. I also want to thank the Washington, D.C. office, including (but not limited to) Frank Purcell and Kate Fry, for their tireless efforts in both the year-round advocacy efforts and for the conference.

We are continuing to work on policy issues throughout year-round, so please feel free to keep the NVANA leadership informed of practice issues. Also, please contact your elected representative, as they do want to hear from you.
Jason Girouard, CRNA, MS


1) Dulisee B, Cromwell J. No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians. Health Affairs. 2010;29(8): 1469-1475.
2) Institute of Medicine (IOM). The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press, p3-13 (pdfp.108) 2011
3) Epstein R, Dexter F. Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics. Anesth. 2012;116(3): 683-691.


L to R: Jason Girouard, Steven Sertich, Congressman Amodei, Joanne Heins.

L to R: Jason Girouard, Steven Sertich, Congressman Amodei, Joanne Heins.


Joanne Heins & Jason Girouard in front of US Capitol between visits.

Joanne Heins & Jason Girouard in front of US Capitol between visits.