2022 Summer GAPNA Newsletter Volume 41 Number 2

Promoting Patient Health and Reducing Practice Barriers

By Abby Luck Parish

The American Association of Nurse Practitioners (AANP) policy conference was held in-person March 6-8, 2022, in Washington, DC. Each year, the policy conference provides updates and training for nurse practitioner (NP) policy advocacy, with an emphasis on promoting patient health and reducing barriers to NP practice.

Several sessions at the 2022 conference addressed the impact of COVID and policy-related opportunities. The conference kicked off with a timely session by AANP President April Kapu who addressed burnout and exhaustion in the workplace. She acknowledged emotions NPs are experiencing after 2 pandemic years and provided practical suggestions for managing these challenges.

Keynote speaker Rear Admiral Susan Orsega discussed the 1918 flu pandemic and commonalities with COVID-19. She also addressed preparation for future disasters with a mind toward health equity, including building community-based solutions, increasing health workforce capacity, expanding telehealth and telemedicine, creating an equitable health data ecosystem, and maintaining public health preparedness response blueprints.

Later in the conference, several NPs sharing their lived experiences during natural disasters and the COVID crisis. Their stories highlighted the ingenuity of NPs, along with the value of emergency preparedness and systems thinking. Finally, Penny Kaye Jensen, APRN, and Matthew Rogers, PA, shared their experiences working in the VA system, including innovations pioneered during the pandemic they hope to maintain, such as telehealth for rural Veterans.

APRN Compact

The conference was threaded with opportunities to address state policies, including a session with updates from around the nation and working breakfasts organized by state for advocacy planning. Participants informed one another about active policy efforts in their states and made plans to work together after the conference to move relevant state legislation forward.

One issue that is currently active in several states is the APRN Compact. The Compact will be implemented when it is adopted by at least seven states. So far only three have done so with legislation pending in at least one other state. While the proposed Compact legislation template allows a path for full practice authority for APRNs, it requires 2,080 supervisory hours. Depending on existing state laws, this could pose a new or higher barrier to full practice. Work with APRNs in your state to determine whether Compact adoption is a good fit for your practice environment.

Federal Policy

Federal policy was also discussed extensively at the conference. There were two sessions focused on the Center for Medicare & Medicaid Services (CMS), which is highly relevant to GAPNA members, since so many of our patients are enrolled in Medicare and are dual eligible. Jean Moody-Williams, Deputy Director of the Center for Clinical Standards and Quality at CMS, and Franklin Harrington, AANP Director of Reimbursement and Regulatory Affairs, provided critical updates on CMS policy and regulations that affect NPs.

GAPNA members might enjoy reviewing the newly released Medicare Beneficiaries at a Glance infographic. Both speakers addressed the CMS waivers which have been in place during the pandemic. These waivers have expanded patient care opportunities by providing access to nursing services, adjusting personnel qualifications/training and certification (e.g., permitting NPs to conduct regulatory visits for skilled nursing residents), allowing for delegation of tasks, and at times reducing supervision requirements. CMS is examining each flexibility to see which could/should be continued.

Some would require a legislative change, while others are purely regulatory. If you have an interest in advocacy related to continuation of CMS waivers, consider joining the GAPNA Health Affairs Committee!

NP Leadership

Underpinning these discussions of specific policies were sessions about topics such as policy research and value-based NP leadership. Betty Rambur noted that when CMS was chartered, the average American lifespan was 68-70 years. CMS was not designed to address the length of life and complexity of health problems managed today.

She further observed that we have a very reactive, fee-for-service system which promotes high technology, interventionalist care over interactive care or watchful waiting. Value-based care, especially risk-bearing care, greatly expands accountability horizons. Rambur noted that value-informed nursing practice can be viewed as part of our profession’s contract with society.

In a similar vein, Mary Wakefield, head of the Health Resources and Services Administration 2009-2015 and Deputy Secretary of Health and Human Services 2015-2017, spoke on the Future of Nursing 2020-2030 report.

The conference concluded with an interactive advocacy workshop in which participants practiced role playing and talking to their representatives about removing barriers to NPs ordering important services like diabetic shoes, cardiac rehab, and pulmonary rehab.

The session facilitators advised that a successful meeting with a lawmaker or their staff includes the following elements: approximately 10-minute duration, introductions, provision of background of NPs and the care they provide to patients, discussion of specific legislative issues of interest, questions and answers, offer of AANP and other professional organizations as a resource, thanking the congressional office for their time, and following-up to answer questions/update on legislation.

Are you interested in getting more involved in policy? GAPNA’s Health Affairs Committee welcomes your involvement! Or perhaps you’d like to attend the AANP policy conference next year. Watch for GAPNA’s call for Health Affairs Scholarship applications in November.

Abby Luck Parish, DNP, AGPCNP-BC, GNP-BC, FNAP