The times they are a changin'

Health care and politics may make strange bedfellows, but for right now they are intertwined, and health care providers cannot afford to be complacent.

In 2012, the Supreme Court confirmed the legality of the Affordable Health Care Act. In the first months of 2013, bills related to the delivery of health care and patients were introduced in 44 state legislatures. This year may well be a landmark for health care legislation on the state level.

Some of the issues facing states this year include the Patient Protection and Affordable Care Act (ACA), regulations governing advanced practitioners (physician assistants, nurse practitioners and clinical nurse specialists), use of the title “doctor,” and patient safety and public health. The ACA issues will focus on the new insurance exchanges, which are state based, and defining new regulations for Medicaid eligibility. With many states facing financial shortfalls, any change that will require increased funding will be challenged.

How APs can get involved

Advanced practitioners (APs) need to be a part of these discussions. Including APs can often give patients better access to health care, thus improving outcomes. Many states are considering changes to their state practice laws. While APs have national certification, they are licensed by individual states and governed by the scope of practice in that state. Groups such as the Institute of Medicine have encouraged states to allow APs to practice within the scope of their training. Recently, physician assistants (PAs) in Kentucky were successful in repealing a law that required a newly certified PA to practice with a physician on site for the first 18 months.¹ However, recognizing that we can be a voice in policy is only the first step. Making that voice heard takes time, planning and work. Whether it is on a state or national level, we have to present a unified front and utilize all avenues to make our point. The Kentucky PAs were aided by an article in the Wall Street Journal that described their situation and gave it national attention. In addition to writing letters and making personal appeals to legislators, the PAs utilized social media such as Twitter and Facebook to make their case. Not only were they addressing this issue with the lawmakers, but they garnered public support.

Explaining to Capitol Hill what we do

Many of our lawmakers, in state capitols and in Washington, D.C., have no concept of dialysis. Indeed, most of the public has little understanding of the impact of kidney disease on patients and families. When they can put a face and a name on an issue, it becomes more alive. The first step is to know who represents you and your district. There are several ways to identify who represents what district on both the state and national levels. A Google query is often the easiest and best way to find a name and an address. The value of personal contact cannot be underestimated. Over the Memorial Day weekend this past May, 8,000 PAs attended the American Association of Physician Assistants annual meeting; of that group, 2,000 went in person to Capitol Hill to visit their representatives and their staffs.

For Congress, it is also important to identify the person in that office who handles health affairs. This person is the one who gives information to the representative or senator and is key to providing information that can shape health policy. The health affairs representatives often appreciate information we can provide. Suzanne Miyamoto, Director of Government Affairs for the American Association of Colleges of Nursing, emphasizes the need for groups to plan an approach when weighing in on a policy change. Asking 100 people to write letters is not as effective as a coordinated campaign where people write with a similar theme to a designated person or agency. Sending an occasional email or letter to a legislator will not establish a relationship. On the local level, health care providers should identify which legislators are on committees that can affect health policy. Once identified, these lawmakers should be contacted frequently.

Getting to know them

Face to face contact is very effective. Legislators frequently come to their home district. Inviting lawmakers to a dialysis unit will often be the first time they have ever seen a treatment or met a dialysis patient. Kidney disease thus moves out of the abstract and into the concrete. As a nation and as health care providers, we share the goal of delivering better health care in a cost efficient manner. For the past several years, the American Nurses Association has made a concentrated effort to make their voice heard. Debra Hain, PhD, APRN, represented the American Nephrology Nurses Association on a health policy workgroup that prepared the white paper, “The value of nursing care coordination,” and a position paper that emphasized the role of nurses in care coordination. Dr. Hain was the voice for nephrology practitioners stressing the need for care coordination for kidney patients. Recently, the White House Domestic Policy Council invited a panel of experts to present examples of how advanced practitioners can improve quality and health outcomes in a cost effective environment.

The Kentucky PA experience demonstrates how a coordinated campaign utilizing various media can make a difference. The key is coordination. -by Jane Davis, DNP, CRNP; Kim Zuber, PA-C

References

1. Kopanos T. State of the states. JNP. 9 (1); 2013; A11