AANA Anesthesia E-ssential

Vital Signs

VHA Full Practice Authority Rule Clears Important Administrative Hurdle; AANA Members Asked to Take Action

An AANA-backed proposed rule recognizing CRNAs and other APRNs to their full practice authority in Veterans Health Administration facilities has cleared an important administrative hurdle and is now in final review by the White House Office of Management & Budget (OMB). The action taken by the U.S. Department of Veterans Affairs to submit the proposed rule for final review on Jan. 8 means that the AANA’s efforts to expand veterans access to quality healthcare are one important step closer to being finalized and made law. But because there are no guarantees and the American Society of Anesthesiologists continues to object to the proposal, it also means that continued advocacy action by CRNAs is needed.

The administration has up to 90 days to publish the proposed rule in the Federal Register for public comment or to return it to the Veterans Administration for more work. Once it is published in the Federal Register, CRNAs and their allies will be asked to make their voices heard loud and clear for our veterans and to submit comments during a 60-day public comment period. At the end of the comment period, the VHA will review the comments and consider publishing a final rule.

AANA members can also share with their colleagues, family and friends, especially those who are veterans, the Veterans Access to Quality Care Alliance link to take action, at www.Veterans-Access-To-Care.com.

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CPC Facts

CPC Entry 2016

New graduates who pass the National Certification Examination (NCE) and initially certify between Jan. 1 and July 31, 2016, will enter the CPC Program on Aug. 1, 2016, and will be expected to demonstrate CPC compliance by July 31, 2020. These certificants can start meeting CPC Program requirements upon certification. For example, if an individual is certified on Jan. 15, 2016, he or she will need to demonstrate CPC compliance by July 31, 2020.

New graduates who pass the NCE and initially certify on or after Aug. 1, 2016, will immediately enter the CPC Program on the date of his or her certification. These individuals will be required to demonstrate CPC compliance four years later. For example, an individual who initially certifies on Sept. 15, 2016, will be required to demonstrate CPC compliance four years later, by Sept. 30, 2020.

For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on Aug. 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.

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Hot Topics

CPC Program CRNA and Vendor Live Webinars

On Jan. 28, 2016, the CPC Program Discovery Series will hold a live webinar for CRNAs to discuss the CPC Program, reviewing what’s new and what stays the same. The NBCRNA held its inaugural live webinar on Dec. 15, 2015, to help inform CE providers about the CPC Program. The live webinar, aimed at the CE Vendor audience, was recorded and is posted on the NBCRNA website on the CE Vendor page.

The upcoming webinar on Jan. 28, aimed at the CRNA audience, will have a maximum capacity of 1,000 participants, and will therefore be recorded and posted on the NBCRNA website. 

For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on Aug. 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.

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National CRNA Week Makes a Difference

CRNAs and nurse anesthesia students from coast to coast are gearing up to tell their patients and communities about “CRNAs: Making a Difference One Patient at a Time” during National CRNA Week, celebrated Jan. 24-30, 2016. This observance is intended to educate the public about the safe, compassionate anesthesia care CRNAs deliver to patients 24/7 for surgery, child birth, emergency situations, and pain management.

National Nurse Anesthetists Week was established in 2000 and renamed National CRNA Week in 2015. Now in its 17th year, CRNA Week is promoted by individual CRNAs, state associations, nurse anesthesia schools, public relations departments for various healthcare facilities, and through other creative resources, to inform the public about the millions of safe, high-quality anesthetics delivered by nurse anesthesia professionals each year.

“Every year, the amount of personal time and effort that CRNAs and student nurse anesthetists devote to the promotion of the nurse anesthesia profession continues to grow,” stated AANA President Juan Quintana, DNP, MHS, CRNA. “Our hope is that this year we generate even more awareness of our great profession.”

There’s still time to join your fellow nurse anesthetists around the country and order your CRNA Week supplies. It’s easy to obtain pens, buttons, and posters by simply visiting the special National CRNA Week area on the AANA website to place your order. The last orders for remaining promotional items will be accepted on Wednesday, Jan. 20.

Also, as an AANA member you’ll want to visit the PR Tools area on the member-side of the AANA website and the CRNAs: The Future of Anesthesia Care Today microsite for additional information and promotional tools to support your CRNA Week plans. You can access PR Tools and the microsite at www.aana.com/future-today.

Join the fun and excitement of spreading the word about who you are and what you do.

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New Ad Promotes CRNAs in Becker’s Hospital Review; President Quintana Featured In Modern Healthcare Commentary

The December issue of Becker’s Hospital Review, a leading magazine for hospital business news and analysis for hospital and health system executives, features a full-page, four-color ad promoting CRNAs as “making a difference one patient at a time.” View the ad here. Digital advertising that delivers the same message will also appear online in Becker’s CEO Report beginning in January. In addition, the January issue of Modern Healthcare features an excellent opinion-editorial by AANA President Juan Quintana, DNP, MHS, CRNA, titled Advanced Practice Nurses Still Face Too Many Barriers.

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AANA Immediate Past President Running for NC House of Representatives

Sharon Pearce, MSN, CRNA, AANA immediate past president, recently announced that she is running for an open seat in the North Carolina State House of Representatives, representing her home town of Lexington. If elected, she will be one of only two CRNAs to serve in a state legislature, the other being Jeanne Kirkton (D-MO-91) in Missouri. Pearce is being challenged by two opponents for the District 81 March 15 North Carolina Republican Primary, and she has an excellent chance of winning if she can gain name recognition. Of note, an anesthesiologist is running for a seat in another district. As there is currently no declared candidate for the seat from the Democratic Party, the winner of the GOP primary will be unopposed in the general election. Learn more about Sharon Pearce’s campaign, like her on Facebook, and follow her on Twitter.

AANA Immediate Past President Sharon Pearce’s campaign logo appears on bulletin boards and yard signs in and around Lexington, NC.

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Important AANALearn Announcement

In March 2016, AANA will be moving to a new platform for AANALearn.com. To accommodate a smooth transition between platforms, we are asking all users to complete their courses by Thursday, Feb. 18, 2016. If a user does not complete a course, AANA will re-enroll the user at no charge. Please note however, the user will need to start the course from the beginning. Therefore, we highly encourage all users to complete all “active” courses by Thursday, Feb. 18, 2016. If you have any questions, please do not hesitate to contact aanalearn@aana.com. Thank you.

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PQRS 2016 Has Arrived!

Although the 2015 PQRS reporting period ended on Dec. 31, 2015, there is still time to report via a qualified registry like CECity’s PQRSwizard to avoid the 2017 penalty. Please note that the CMS deadline for qualified registries to submit data for the PQRS 2015 reporting year is March 31, 2016; however, registry participants are required to submit their quality data to their registry at least one month prior. Log in to the myAAANA Registry Reporting for CRNAs page to find out more. In addition to up-to-date information on 2015 PQRS reporting, the AANA Quality and Reimbursement resource pages have been updated with new information on 2016 PQRS including links to the 2016 measure specifications. We will be continuously updating the 2016 pages as information becomes available from CMS, so be sure to visit the Quality and Reimbursement site on a regular basis.

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AANA Research Revamp and Webinar Series Announced

In an effort to encourage more interest in health services research (HSR), the AANA Research and Quality Division has revamped its Research Resources page to include a library list of Hot Research Topics and an HSR Webinar Series (member login required). The site will soon house HSR Dataset Resources as well. The first live HSR webinar is a two-part program titled “Conceptualizing a Study Design” and “Writing a Grant Proposal,” which will be held on Tuesday, Jan. 19, 2016, at 6 p.m. CST. A recording of the webinar will be made available to AANA members shortly thereafter. 

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Nomination Deadline for Daniel D. Vigness Federal Political Director Award is January 15

Is your state’s Federal Political Director (FPD) awesome? Then nominate him or her for the Daniel D. Vigness Federal Political Director Award, which is presented during AANA Mid-Year Assembly in April 2016. Named for the late Dan Vigness, CRNA, of South Dakota, the first AANA FPD of the Year, this honor recognizes a CRNA who has been involved in federal political campaigns, developed close working relationships with federal officials, led successful CRNA advocacy efforts, helped contribute and raise funds for the CRNA-PAC, and helped recruit CRNAs to participate in political campaigns. 

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Nominations Sought for AANA Recognition Awards: Deadline March 15

The AANA is seeking nominations for the following recognition awards, to be presented at the Nurse Anesthesia Annual Congress: Agatha Hodgins Award for Outstanding; Accomplishment; Helen Lamb Outstanding Educator Award; Alice Magaw Outstanding Clinical Practitioner Award; Ira P. Gunn Award for Outstanding Professional Advocacy; Clinical Instructor of the Year Award; Didactic Instructor of the Year Award; and Program Director of the Year Award. Visit Recognition Awards for further information and to download a nomination form. The deadline for receipt of nomination is: March 15, 2016.

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Nomination Deadline for Service on the 2016-17 CRNA-PAC is January 31

If you or a colleague would like to serve on the CRNA-PAC Committee, Jan. 31 is the deadline for submitting an application online. In September 2016, the nine-member committee will have two CRNA vacancies, each for three-year terms. One student registered nurse anesthetist vacancy will also open for a one-year term. Two members of the AANA Board of Directors serve on the CRNA-PAC Committee, each for a one-year term that may be renewed for one additional year while the member also serves on the Board.

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American Society for Enhanced Recovery Hosts 2016 Annual Congress in Washington DC, April 2016

American Society for Enhanced Recovery will be hosting the 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine April 20-22 in Washington, D.C. This three-day congress will address issues related to enhanced recovery and perioperative medicine from a multidisciplinary perspective. At the conclusion of this activity participants will be able to understand new care delivery models and approaches, and how to apply these models in their hospital. For more information, including a full list of speakers and topics, registration information and more visit the ASER website, or contact the ASER Office (info@aserhq.org, 414-389-8610).

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Safe Injection Practices Coalition: A Model for Public-Private Partnership Success

In January 2014, The CDC Foundation partnered with Eli Lilly and Company to support and expand the Safe Injection Practices Coalition (SIPC) and the One & Only Campaign. Lilly’s support has significantly bolstered the impact of SIPC, allowing the One & Only educational campaign to greatly broaden its membership base, amplify reach to new audiences, and provide new resources to targeted settings in an effort to ensure every medical injection is safe. To learn more about SIPCs partnership with the CDC Foundation and Eli Lilly and Company, please visit this new post on the CDC Foundation Blog.

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Professional Practice

Joint Commission Accepting Applications for New Advanced Certification Program for Total Hip and Knee Replacement

The Joint Commission is now accepting applications for advanced certification for total hip and total knee replacement. The new certification is available for Joint-Commission-accredited hospitals, critical access hospitals, and ambulatory surgery centers. Standards include establishing an interdisciplinary team to collaborate in the care of patients undergoing total hip and total knee replacements. This interdisciplinary team includes an “[a]nesthesiologist or Certified Registered Nurse Anesthetist in accordance with law and regulation and the credentialing and privileging decisions of the organization.”

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State Government Affairs

Nomination Deadline for NEW AANA Award for State Government Affairs Advocacy is February 15

Has your state nurse anesthetist association made significant efforts in state government affairs advocacy this year? Describe your state’s efforts and enter to win the new AANA Award for State Government Affairs Advocacy, to be presented at the AANA Mid-Year Assembly in April 2016. This annual award is not tied to a specific “victory” in the state legislative or regulatory arena, but will be given based on the quality of the undertaken effort. Examples of state association efforts include successful lobby days, legislative/regulatory efforts, or increased member participation in grassroots or other efforts.

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Meetings and Workshops

2016 Mid-Year Assembly Travel

The AANA Mid-Year Assembly has quickly become the most important advocacy meeting of the year for CRNAs. We encourage all AANA members to make reservations early this year. The meeting will be held in the heart of Washington, D.C., during the National Cherry Blossom Festival. The popular festival draws hundreds of thousands of tourists each year and we expect hotel and travel rates to increase as we near the date of the meeting. Attendees receive special rates at the Renaissance Washington, DC Downtown (offer subject to availability) through March 3. Also, travel discounts for major airlines are available with our promo codes available on our web site. 

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Registration Now Open! COA/AANA Doctoral Workshop at ASF

Don’t miss out on the COA/AANA 1.5 day-workshop, 2022 is Closer than You Think: Transitioning to the Doctoral Degree, on Sunday-Monday, February 28-29, 2016, in San Antonio, Texas. Key activities to establish doctoral degree offerings consistent with the COA’s Practice Doctorate Standards and COA Policies and Procedures will be covered. The content is valuable for programs establishing both entry-level and CRNA post-master’s doctoral degrees. Topics include key considerations in getting started, review of the Practice Doctorate Standards, developing requirements for the scholarly work/doctoral project, developing and mapping the curriculum to COA and national standards, and tips for success in the submission and review of doctoral applications.

Who should attend:

  • Nurse anesthesia program administrators
  • Deans of academic units affiliated with nurse anesthesia programs
  • Nurse anesthesia faculty

The fee is $295 per person by January 26 and $350 per person thereafter. CE credits can be earned.

Program details are available on the COA website.

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Registration Open for Assembly of School Faculty

We're excited to announce that advance registration is now open for the 2016 Assembly of School Faculty. Join us in historic San Antonio on February 25-27, 2016, for the premier convergence of nurse anesthesia program faculty.

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Save the Dates for These Popular Hands-On Workshops

Jack Neary Pain Management Workshop

  • Rosemont, IL
  • April 23-25, 2016

Jack Neary Pain Management Workshop II

  • Rosemont, IL
  • October 29-30, 2016

Upper and Lower Extremity Nerve Block Workshop

  • AANA Foundation Learning Center
  • March 19-20, 2016
  • September 24-25, 2016

Essentials of Obstetric Analgesia/Anesthesia Workshop

  • AANA Foundation Learning Center
  • April 20, 2016
  • November 2, 2016

Spinal and Epidural Workshop

  • AANA Foundation Learning Center
  • April 21-23, 2016
  • November 3-5, 2016
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Foundation and Research

AANA Foundation 2016 Award Nominations Deadline is February 1

Each year the AANA Foundation presents awards at the AANA Annual Congress to individuals who have made a difference in the nurse anesthetist community. Take the time to recognize someone you appreciate. The deadline for Award nominations is Feb. 1, 2016.

See Applications and Programs to access the nomination/application forms for:

  • Advocate of the Year. Presented to an advocate committed to supporting the AANA Foundation and encouraging others to do the same.
  • John F. Garde Researcher of the Year. Presented to an individual who has made a significant contribution to the practice of anesthesia through clinical research.
  • Rita L. LeBlanc Philanthropist of the Year. Presented to an individual who has donated time, talent and direct financial support to the AANA Foundation and other deserving organizations.
  • Janice Drake CRNA Humanitarian Award. Presented to a CRNA who wishes to volunteer and provide anesthesia, education, and training in underserved areas.

Forward the completed form to the AANA Foundation–email to foundation@aana.com or mail to 222 S. Prospect Avenue, Park Ridge, IL 60068.

Thank you in advance for recognizing a member of the nurse anesthesia community. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.

Appreciation can make a day, even change a life.
Your willingness to put it into words is all that is necessary.

Margaret Cousins

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Post-Doctoral and Doctoral Fellowship Application Deadline is February 1

Attention Researchers…Post-doctoral and doctoral fellowship applications are currently available on the AANA Foundation. The deadline for submission is Feb. 1, 2016. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.

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Register Today for the February Fiesta on the Riverwalk at ASF

If you’re planning to attend the AANA Assembly of School Faculty (ASF) in February, you won’t want to miss the AANA Foundation’s February Fiesta at La Paloma Riverwalk in San Antonio. If you’ve already registered for ASF and would like to purchase event tickets, please contact Margaret Brennan, AANA registrar, at (847) 655-1180. If you have any questions, please contact Luanne Irvin, AANA Foundation development officer, at (847) 655-1173. We hope to see you there!

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Federal Government Affairs

Pre-Submit Your VHA APRN Full Practice Authority Comments Now

Supporting veterans access to quality healthcare can be done with one new click, as the AANA has now made it possible for members to pre-submit comments to the Veterans Health Administration (VHA) in favor of CRNA and APRN full practice authority.

Already, tens of thousands of AANA member messages have landed on Capitol Hill. With the VHA anticipated to publish a proposed rule expanding veterans access to quality healthcare with CRNA and APRN full practice authority, that rule is expected to be followed by a public comment period. CRNA voices will need to be heard during the regulatory public comment process. With the American Society of Anesthesiologists telling its members that they have to submit 20,000 comments to such a rule, and hosting phone trees to mobilize its members in many healthcare facilities against CRNA full practice authority, AANA members and their colleagues, family, and friends all must take action and be heard.

AANA members can pre-submit statements for CRNA and APRN full practice authority that will be submitted during the public comment period at https://www.crna-pac.com/composeletters.aspx?AlertID=315 (AANA member login required). Colleagues, friends and family can use the site of the Veterans Access to Quality Care Alliance website, www.Veterans-Access-to-Care.com, to make their voices heard.
Update on AANA and CRNA Efforts to Ensure Veterans Access to Quality Care

  • Your voice still needs to be heard on Capitol Hill. Encourage your friends and family to also take action through the Veterans Access to Quality Healthcare Alliance microsite. The AANA is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill now has 44 bipartisan cosponsors, most recently Rep. Ruben Gallego (D-AZ-7). The AANA also backs legislation in the Senate, S 2279, the “Veterans Health Care Staffing Improvement Act,” sponsored by Sens. Jeff Merkley (D-OR) and Mike Rounds (R-SD) with eight bipartisan cosponsors.
  • An independent assessment of the VHA completed by the RAND Corporation recommended the agency move forward with the full practice authority proposal for APRNs in the VHA, saying the policy is also a cost saving measure. Read the full recommendation starting on p. 266 of this document, this document. The AANA and APRN organizations have supported the independent assessment in a letter to the VA Secretary and Chair and Ranking Member of the House Veterans Affairs Committee. (AANA member login required).
  • Year-end budget legislation adopted by Congress finalizes AANA-backed VHA full practice authority advisory report language that the House and Senate had previously approved. It’s another positive outcome for our veterans, and for the AANA, CRNAs and our APRN colleagues.
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How Does Congress’ Year-End Budget and Tax Package Affect CRNAs?

Congress closed out 2015 by enacting a major appropriations package (HR 2029) and a tax measure containing funding and provisions of interest to CRNAs, many of which the AANA and its members worked throughout the year to address. The provisions of specific CRNA interest include:

  • Report language is finalized that supports the VHA’s process for considering full practice authority for CRNAs and other APRNs. That language was included in FY 2016 Military Construction – VA Appropriations bill reports earlier in 2015, and was adopted by reference in HR 2029. For supporting veterans access to care through CRNA and APRN full practice authority, this good outcome averted the possibility of this year-end budget package including anti-CRNA language.
  • Title 8 Nurse Workforce Development programs are funded similar to 2015 levels. Title 8 would receive a total of $229.472 million, a decrease of $2.15 million below FY 2015. The Advanced Education Nursing Program important to nurse anesthesia educational programs would receive an increase of $1 million, and the NURSE Corps Loan Repayment and Scholarship programs would receive an increase of $1.35 million. Together with the broader Nursing Community, AANA supported this initiative. See page 104 of the Labor-HHS-Education section report language.
  • Agency for Healthcare Research and Quality (AHRQ) funding is reduced about 25 percent below 2015 levels. Funded at $334 million for FY 2016, AHRQ receives about $106 million below FY 2015 levels, a 24 percent reduction that compares favorably with the Senate’s proposed 30 percent cut and the House’s proposal to eliminate the program entirely. Though AANA and nursing organizations supported fuller funding of AHRQ, the agency’s budget suffered from congressional criticism that its work duplicated the efforts of other agencies. See page 54 of the Labor-HHS-Education section report language.
  • National Institutes of Nursing Research (NINR) is funded at $146 million, a slight increase. AANA supported boosting its funding. Total National Institutes of Health funding is $32 billion, up $2 billion from FY 2015.
  • The Food and Drug Administration (FDA) is funded at $2.72 billion in discretionary funding, $132 million over FY 2015 and $14 million below the president’s budget request. Total funding for FDA including user fees is $4.68 billion. Various medical product safety activities – including additional funds for the Combating Antibiotic Resistant Bacteria initiative, orphan product development grants, foreign high-risk inspections, and precision medicine – are increased by over $24.3 million.
  • A moratorium is imposed on two major Affordable Care Act (ACA) tax provisions. The ACA’s medical device tax, a 2.3 percent excise tax on medical devices, is subject to a moratorium during CY 2016 and 2017. The so-called "Cadillac Tax", a 40 percent excise tax on the value of certain higher-value employer-provided health plans is postponed for two years from its original effective date, to 2020. Delay or repeal of this tax was supported by employers and unions. The package also provides a one-year moratorium on the annual excise tax imposed on health insurers for CY 2017.
  • Other ACA provisions in the package include a $15 million cut in funding for the Independent Payment Advisory Board (IPAB) which has not yet been named or had its cost-cut recommending powers triggered; elimination of funding to health plans associated with the “risk corridor” program, which opponents had regarded as an automatic bailout for health plans that lose money participating in ACA exchanges; transfers funding out of the ACA “prevention fund”; and a provision directing the HHS and Treasury Offices of Inspector General to report on improper payments of ACA tax subsidies.
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    Congress Reconvenes for New Session, Sends President Obama an ACA Repeal Bill

    The U.S. House convened on Tuesday, Jan. 5, for the Second Session of the 114th Congress, and promptly passed and sent the President a major budget bill already adopted by the Senate that repeals several major provisions of the Affordable Care Act (ACA).

    While on Jan. 8 the president vetoed HR 3762, the actions underscored that through “budget reconciliation” parliamentary procedures, a Congress and a President in opposition to the ACA could adopt legislation that repeals much of the 2010 law after dozens of unsuccessful attempts to date.

    The Senate opened its session on Monday, Jan. 11, with President Obama appearing before a joint session of Congress on Tuesday, Jan. 12, the earliest State of the Union date since 1977. Congress’ 2016 session features at least one week of district work period each month, and will be broken up by primary elections scheduled through the spring and summer, and by a long summer break for the late July national political conventions and traditional August recess. For CRNAs, expect Congress to begin taking up its 2017 budget process shortly, consider developing legislation to address the problem of opioid abuse and diversion, and vote on legislation tailor-made to differentiate between the policy approaches of the two major political parties.
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    AANA, APRN Groups Request that Qualified Health Plan Networks Include APRNs

    In comment letters sent to Medicare the week of Dec. 14, the AANA and APRN organizations requested that APRNs, including CRNAs, be included in the networks of qualified health plans participating in federally facilitated marketplaces.

    The AANA comment letter, sent by AANA President Juan Quintana, DNP, MHS, CRNA, and the APRN letter, sent in by nine national nursing organizations, was in response to the Department of Health and Human Services’ Notice of Benefit and Payment Parameters for 2017 proposed rule. This proposed rule sets forth payment parameters related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for federally facilitated marketplaces.

    The proposed rule solicited comments regarding provider network adequacy. The letters state that patients benefit from a healthcare system where they receive easily accessible care from an appropriate choice of safe, high quality and cost-effective providers, such as APRNs. Therefore, the AANA and APRN groups recommended that APRNs be included in all health carrier network plans, which will help ensure network adequacy, access and affordability to consumers. The letters also recommended that qualified health plans design their network participating provider selection criteria so as not to discriminate against qualified licensed healthcare providers acting within their state scope of practice laws and regulations.

    View the: AANA’s comments, the APRN organization’s comments, and the proposed rule .
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    Major New Study Shows Healthcare Costs Covered by Commercial Plans Have No Relationship to Healthcare Costs Under Medicare

    Variation in healthcare delivery costs has been an important line of inquiry for CRNAs and policymakers concerned that healthcare costs have for so long grown more quickly than the economy. Healthcare delivery costs under Medicare have for more than a decade been examined by the Dartmouth Atlas, showing significant cost variation around the country.

    Now comes a new study of healthcare costs under major commercial health plans by researchers at Yale and the National Bureau of Economic Research, and it shows there is no relationship between Medicare and commercial plan healthcare cost variations. At the same time, healthcare costs are back on the rise after years of limited growth, forcing healthcare policymakers back to the drawing board and the Federal Trade Commission to examine whether the recent trend in hospital, medical group and health plan mergers has reduced competition and increased costs.

    See the study, coverage of the paper, including an article in the New York Times. A new examination of healthcare cost growth published in Health Affairs. The Government Accountability Office published on Dec. 18 a paper on a related topic titled “Increasing Hospital-Physician Consolidation Highlights Need for Payment Reform,."
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    CRNA-PAC Thanks You for a Great 2015

    CRNA-PAC wishes to thank the thousands of AANA members who supported the profession’s efforts on Capitol Hill in 2015. Your generosity allowed our PAC to disburse more than $500,000 to CRNA-friendly federal candidates in 2015 and have our voice heard on key policy issues including Medicare reimbursement, CRNA practice, and educational funding. View the CRNA-PAC 2015 recap video of AANA members representing CRNA-PAC at political events throughout the country.
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    Book Your Meeting, Hotel and Travel Now for Mid-Year Assembly 2016 in Downtown Washington, D.C.

    The AANA Mid-Year Assembly to be held April 2-6, 2016, returns to downtown Washington, D.C.! But because our site and our dates coincide with additional major events in the Nation’s Capital – namely the 2016 Cherry Blossom Festival and parade – AANA members are encouraged to register and book their lodgings and air travel as early as possible.
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    Deadline is Jan. 15 to Nominate CRNAs, Legislators for AANA Honors; Apply to the CRNA-PAC Committee by Jan. 31

    If you would like to nominate a legislator or CRNA to receive an AANA honor relating to advocacy and policy, or to apply to the CRNA-PAC Committee for a term beginning in FY 2017, your deadlines to submit applications are approaching.
    • National Health Leadership Award applications are due Jan. 15, 2016. Established in 1992, this award is presented during AANA Mid-Year Assembly to an individual working at the federal government level who has made a significant contribution to the formation of national health policy critical to CRNAs.
    • Daniel D. Vigness Federal Political Director Award applications are also due Jan. 15, 2016. Established in 2001, this honor was renamed in 2013 in tribute to and memory of its first winner. This award is presented annually at the Mid-Year Assembly to an individual who has made a significant contribution to the advancement of the national healthcare agenda of Certified Registered Nurse Anesthetists (CRNAs) by coordinating grassroots CRNA involvement at the state level or through special contributions to the federal political process.
    • CRNA-PAC Committee nominations are due Jan. 31, 2016. The committee seeks applications from CRNAs to fill two vacancies for three-year terms beginning Sept. 1, 2016, and applications from student registered nurse anesthetists to fill one vacancy for a one-year term also beginning Sept. 1, 2016.
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    The AANA is expecting at any time for Medicare to publish a major proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). Enacted by Congress in the spring of 2016, MACRA changes Medicare payment to reward quality outcomes, cost-efficiency and better health instead of volume. The AANA has already submitted to the Medicare agency several recommendations promoting the use of CRNAs and other APRNs, citing their safety record and cost-efficiency.
    • Additional lawmakers announced over the holidays that they would not run for reelection in 2016, most recently Reps. Richard Hanna (R-NY), Robert Hurt (R-VA), Steve Israel (D-NY), Jim McDermott (D-WA) who is the top Democrat on the House Ways and Means Health Subcommittee, and Lynn Westmoreland (R-FL).
    • Stay up to date on CRNA reimbursement issues by obtaining Version 3 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” (requires AANA member login and password).
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    The following is an FEC required legal notification for CRNA-PAC

    Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
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    Visit www.crnacareers.com to view or place job postings
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    Featured Career Opportunity

    Certified Registered Nurse Anesthetist (CRNA) – U.S. Army Nurse Corps


    The US Army Medical Recruiting Brigade honors Certified Registered Nurse Anesthetists during National CRNA week. Click here for information on CRNA training and career opportunities.
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    Healthcare Headlines

    Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

    Using Statins Before and After Heart Surgery Can Help Reduce Cardiac Complications, Mortality Risks

    Operations requiring patients to remain under anesthesia for an extended period of time are known to produce an intense inflammatory reaction that can trigger grave complications or even death. Research now suggests that statins, drugs with anti-inflammatory characteristics that are indicated for treatment of high cholesterol, may mitigate these risks in one such type of procedure: coronary artery bypass grafting (CABG) surgery. Investigators analyzed both preoperative and postoperative statin use to gauge the effect on patient outcomes, finding that the medicine was well-tolerated and that any risk of adverse events was more than offset by the likely benefits. "It appears that taking statins prior to CABG surgery can help protect patients against developing atrial fibrillation, an irregular heartbeat that is a common complication following heart surgery," according to one of the researchers, Islam Elgendy, MD, from the University of Florida in Gainesville. "Statin use also seems to be associated with a reduced risk of death during and immediately after surgery." The study is accessible online now and will be published in the February print edition of The Annals of Thoracic Surgery.

    From "Using Statins Before and After Heart Surgery Can Help Reduce Cardiac Complications, Mortality Risks"
    News-Medical (01/13/16)

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    Intra-Op Opioids Heighten Risk for PDNV in Children

    Medicating pediatric patients with opioids during surgery increases the likelihood of post-discharge nausea and vomiting (PDNV), report researchers at the University of Texas Southwestern Medical Center/Children's Medical Center. They looked at data from 1,021 children, 142 of whom developed the complication. Analysis indicated a PDNV rate of 8.3 percent among those who received no intraoperative opioid analgesia, but the share spiked to 14.4 percent for kids who received short-acting opioids and to 25.3 percent when long-acting opioids were administered. On the other hand, age, gender, time from PACU discharge to first oral take, and length of car ride home appeared to have no impact on PDNV. However, Proshad Efune, MD, a resident at the center when the study was conducted, said her team was surprised at the absence of a correlation with antiemetics . "We always thought that intraoperative antiemetics would make a difference in terms of PDNV, but it seems the effect of the opioids outlasts the effect of the antiemetics, particularly in the case of intraoperative administration of long-acting opioids," she noted.

    From "Intra-Op Opioids Heighten Risk for PDNV in Children"
    Pain Medicine News (01/12/2016) Vlessides, Michael

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    Long-Term Opioid Use Associated With Increased Risk of Depression

    Researchers out of Saint Louis University, reporting online in the Annals of Family Medicine, warn that use of narcotic painkillers for more than 30 days raises the risk of depression. They analyzed data from 100,000-plus patients across three healthcare systems with diverse patient traits and demographics. Everyone in the study population was a new opioid user with no depression diagnosis at the time they began taking the prescription; yet 9 percent of the patient sample in one cohort, 11 percent in another, and 12 percent in the third suffered new-onset depression with long-term use of opioid analgesics. The investigators theorize that use of drugs like fentanyl, morphine, and oxycodone for longer than 30 days could cause low testosterone and changes in neuroanatomy, among other plausible biological explanations. More research is needed to determine which patients are most vulnerable to opioid-related depression, according to the Saint Louis University team.

    From "Long-Term Opioid Use Associated With Increased Risk of Depression"
    Medicalxpress (01/12/2016)

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    Hypnosis During Awake Surgery for Glioma Has Positive Impact

    While asleep-awake-asleep anesthesia is the accepted standard during craniotomy for glioma, new research suggests hypnosis may be a viable alternative for older patients. Seniors take longer to awaken from the first step in the traditional process, making it difficult to perform an intraoperative neuropsychologic evaluation within the first half-hour, explains France's Ilyess Zemmoura, MD, PhD. Additionally, his team sought to improve patient comfort during surgery as well postoperative quality of life "by avoiding the traumatism created by awake surgery," he says. A total of 37 patients underwent successful hypnosedation during brain tumor resection, and follow-up surveys revealed little to no negative psychologic impact. Moreover, hypnosis reportedly made some uncomfortable moments during surgery—including local anesthesia of the scalp and bone flap removal—less unpleasant for patients. Only two study participants indicated they would not elect for hypnosedation if they needed to have awake surgery again. Zemmoura and colleagues are now focusing on better identifying which patients are suggestible to hypnosis and which are not so that they can stay on track with asleep-awake-asleep anesthesia for those unlikely to respond to hypnosis.

    From "Hypnosis During Awake Surgery for Glioma Has Positive Impact"
    Medscape (01/08/16) Harrison, Pam

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    Methylnaltrexone for Opioid-induced Constipation Might Also Improve Overall Survival in Advanced Cancer Patients

    While methylnaltrexone is approved by the Food and Drug Administration as palliative care for seriously ill patients who get no relief from traditional laxatives, new research suggests the opioid receptor antagonist could also let cancer patients live longer. The study found that people in the advanced stages of cancer who received methylnaltrexone injections for opioid-induced constipation had a median survival rate of 76 days, compared with 56 days for participants given a placebo. Lead study author Jonathan Moss, MD, PhD, from the University of Chicago Medicine, said the findings support earlier animal and cellular research indicating that tumor growth and metastasis is slowed with intervention from opioid receptor antagonists. A similar pattern was not observed, however, in patients with advanced illness other than cancer. "We had thought the improved survival might in part be related to improved GI functions, but the fact that patients with other forms of advanced illness did not show extended survival makes it much less likely as an explanation," Moss conceded.

    From "Methylnaltrexone for Opioid-induced Constipation Might Also Improve Overall Survival in Advanced Cancer Patients"
    Anesthesiology News (01/06/16) Doyle, Chase

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    Hospital Staff Largely Uneducated on Naloxone Administration for Opioid Overdose

    While cases of opioid-induced respiratory depression (OIRD) and opioid overdoses continue to plague hospitals, research points to a naloxone education module as a tool for increasing staff knowledge and improving safety. Used properly, naloxone can counter the effects of OIRD; but mistakes by medical and surgical professionals can trigger sometimes-fatal withdrawal symptoms. After an initial study revealed room for improvement, researchers from Thomas Jefferson University in Philadelphia tested the knowledge of 36 participants—20 of them anesthesia providers, including five PACU nurses—before and after completing a naloxone education module. The information covered proper administration of the opioid receptor antagonist, side effects, the drug's use in chronic opioid users, and proper management of an opioid overdose. "Most in the anesthesiology field scored rather well," according to lead study author Steve McGrath, MD. "However, those not as experienced with the medication did not score as well on the initial survey, which could be concerning, as many of the times this medication is administered, it's in a situation where anesthesia personnel would not be present." He called the module "very effective" in filling in some of the knowledge gaps and said his team aims to integrate it into a hospital-wide platform.

    From "Hospital Staff Largely Uneducated on Naloxone Administration for Opioid Overdose"
    Pain Medicine News (01/06/2016) Leung, Martin

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    Adductor Canal Catheters Found Best for Pain Soon After TKA

    While intraarticular catheters are gaining popularity as a pain relief strategy, one study has found adductor canal catheters to be the superior approach—at least following total knee arthroplasty (TKA). Researchers from Philadelphia's Thomas Jefferson University Hospital randomly assigned 85 TKA patients to receive one of the two options and then evaluated pain levels during their first physical therapy session the day after surgery. According to the findings, the adductor canal catheter group reported markedly lower pain rating scores on a scale of 0 to 10. Additionally, those patients required less opioid treatment in the first two days of the postoperative period. Oxycodone consumption reached a mean 25 mg for the adductor cohort at 24 hours versus 37 mg for the intraarticular patients, with the difference widening to 35 mg compared with 50 mg at 48 hours following the procedure.

    From "Adductor Canal Catheters Found Best for Pain Soon After TKA"
    Anesthesiology News (01/05/16) Vlessides, Michael

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    Opioid Overdose Deaths Hit Record in 2014

    The U.S. Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control reports that the number of overdose deaths from opioids and heroin in the country reached 47,055 between 2000 and 2014. A report in CDC's Morbidity and Mortality Weekly Report found that 61 percent of all drug overdose deaths in 2014 involved some type of opioid. The rate of opioid overdoses has tripled since 2000, with the rate of deaths rising 14 percent between 2013 and 2014, up from 7.9 per 100,000 people to 9.0 per 100,000 people. CDC Director Dr. Tom Frieden said that the rise in opioid deaths is "alarming." He added, "To curb these trends and save lives, we must help prevent addiction, and provide support and treatment to those who suffer from opioid use disorders. This report also shows how important it is that law enforcement intensify its efforts to reduce the availability of heroin, illegal fentanyl, and other illegal opioids."

    From "Opioid Overdose Deaths Hit Record in 2014"
    Business Insurance (01/04/16) Goldberg, Stephanie

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    Survey: Doctors, NPs, Patients Concerned About Opioid Dangers

    A new Medscape survey has found that 74 percent of health professionals are very concerned about growing abuse or misuse of opioid analgesics. Only about half, however, discuss safe storage and proper disposal of the drugs with their patients. A poll by WebMD similarly found that 42 percent of consumer respondents said they hold on to unused opioid tablets for future use. Most who had recently used an opioid analgesic reported trying other methods first, such as OTC drugs or alternative medicines; but only about 26 percent found that these were effective. Many health professionals also said they suggest alternatives to opioids for their patients. The surveys found that both health professionals, including doctors and nurse practitioners, and patients are concerned about opioid misuse.

    From "Survey: Doctors, NPs, Patients Concerned About Opioid Dangers"
    Medscape (12/30/15) Anderson, Pauline

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    Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose

    Almost all patients who overdose on prescription opioids continue to receive prescriptions for them, new research shows. The retrospective cohort study involved more than 2,800 commercially insured patients aged 18–64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between 2000 and 2012. According to the data, 91 percent of patients received prescription opioids after an overdose. In addition, 7 percent of the patients had a second overdose. Two years after the first overdose, the cumulative incidence of repeated overdose was 17 percent for patients receiving high dosages of opioids following the first overdose and 8 percent for those receiving no opioids. An editorial accompanying the study suggests that many providers may not know when their patients overdose. "There are currently no widespread systems in place, either within health plans or through governmental organizations, for notifying providers when overdoses occur," writes Jessica Gregg, MD, of Central City Concern in Portland, Ore. Gregg also notes that many providers receive little training and have few resources to address chronic pain or addiction.

    From "Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose"
    Annals of Internal Medicine (12/29/15) Larochelle, Marc R.; Liebschutz, Jane M.; Zhang, Fang; et al.

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    Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube Size on Pain Control and Pleurodesis Efficacy Among Patients With MPE

    Researchers conducted a Phase III trial to assess the effect of chest-tube size and analgesia—nonsteroidal anti-inflammatory drugs (NSAIDs vs. opiates—on pain and efficacy related to pleurodesis in patients with malignant pleural effusion. The study included patients requiring pleurodesis in 16 U.K. hospitals. Of 206 patients undergoing thoracoscopy, they received a 24F chest tube, and were randomized to receive either opiates or NSAIDs. The 114 not undergoing thoracoscopy were randomized to one of four groups: 24F chest tube and opioids; 24F chest tube and NSAIDs; 12F chest tube and opioids; or 12F chest tube and NSAIDs. Pain scores in the opiate group compared with the NSAID group were not significantly different, but patients in the NSAID group required more rescue analgesia. Pain scores were lower among participants in the 12F chest tube group compared with the 24F group. The 12F chest tubes compared with 24F chest tubes were associated with higher pleurodesis failure and more complications during insertion. NSAID use showed noninferior rates of pleurodesis efficacy at 3 months.

    From "Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube Size on Pain Control and Pleurodesis Efficacy Among Patients With MPE"
    Journal of the American Medical Association (12/22/15) Vol. 314, No. 24, P. 2641 Rahman, Najib M.; Pepperell, Justin; Rehal, Sunita; et al.

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    Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly to AANA members.

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