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Vital Signs

Congress Finalizes Veterans Programs Extension Bill – After AANA Successfully Secured Elimination of Anti-CRNA Provision

Congress approved a bipartisan bill extending expiring benefits and programs for veterans (HR 5985) – but only after the AANA, CRNAs, and our coalition partners successfully got an anti-CRNA provision removed from the bill before the House passed it early in September. The bill at press time awaits the president’s signature into law.

It was passed by the Senate 89-0 on Sept. 19 and by the House Sept. 13 by voice vote. And it does not include a problematic section from the version that was introduced on Sept. 9, Sec. 415, that placed a one-year moratorium on the Secretary of Veterans Affairs approving full practice authority for CRNAs serving in the Veterans Health Administration. The AANA and its coalition partners were successful in persuading House leadership to remove that special-interest anti-CRNA section from the bill before the House approved it Sept. 13.

One lawmaker expressed concern that the anti-CRNA provision had been removed, however. In debate Sept. 13, Rep. Doug Lamborn (R-CO), a member of the House Veterans Affairs Committee, said that excluding the anti-CRNA provision represented a “missed opportunity.” Insulting CRNAs and calling into question their quality of care, Lamborn went on to say, “Our veterans deserve the absolute best care possible. They should not be used as test subjects when the VA tries to change how it delivers services. It is not right for the VA to give our veterans unsafe and risky health care.”

To make sure your CRNA voice is heard in Washington over Rep. Lamborn’s attacks on CRNAs, support your CRNA-PAC today at CRNA-PAC.com.
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Hot Topics

Your Membership Matters: Renew Today!

Support your profession, your state and national associations, and fellow CRNAs around the country, and avoid an interruption in your member benefits. Renew your membership for fiscal year 2017 now: It’s not too late!
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Nominations for 2017 AANA Elections Due December 1

Nominations for AANA elected offices and consent forms from nominees are due in the AANA office by December 1, 2016.

Each state association may submit one nominee for president-elect, vice president, and treasurer. In addition, state associations may submit one nominee for a director from their region. In 2017, directors from Regions 1, 4 and 5 are eligible for election. Finally, state associations may nominate one member from their region for the AANA Nominating Committee and one member for the Resolutions Committee.

Members are also allowed to self-nominate or nominate another member as long as the nominee meets the qualifications for office found in the AANA Bylaws and Standing Rules.

For information regarding the electoral process, please visit the Election Center. (Member login and password required.)
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Spokesperson Training for State Association Leaders

If you are a spokesperson for your state association, business, or some other entity, hone your skills at the popular Spokesperson Training for State Association Leaders, November 13-14, 2016, immediately following the Fall Leadership Academy. Conducted by The Coaching Group, a Chicago-based firm that has a long history of working with the AANA Board of Directors, state association leaders, and AANA members, the Spokesperson Training program combines discussion, exercises, role play, and lecture to deliver and reinforce the skills needed to be an effective spokesperson. The program teaches life skills that work in any setting, from media interviews to testifying, negotiations to difficult conversations.
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Upcoming Webinar Addresses Opioid Crisis

Register today for the American Association of Colleges of Nursing’s upcoming webinar “The National Opioid Crisis: Your Practice, Your Responsibility,” which will be held October 20 from 2-3 pm ET. Bruce Schoneboom, PhD, CRNA, FAAN, COL (Ret), USA, senior director of Education and Professional Development at the AANA, is a featured speaker. For more information and to register, visit aacn.nche.edu.
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New PQRS Tools Available on AANA.com

The AANA Research and Quality Division has developed new infographics to assist CRNAs with satisfactory reporting for 2016, including a PQRS Checklist, a Flowchart Algorithm, and two facts sheets on Qualified Clinical Data Registries (QCDRs). These resources and additional information on PQRS can be found at Quality-Reimbursement.
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MACRA—Prepare for New Quality Reporting in 2017

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 resulted in the new Quality Payment Program, which will replace PQRS and introduce additional performance categories under the Merit-Based Incentive Program (MIPS). Learn how to avoid future negative payment adjustments on your Medicare reimbursement by visiting our new MACRA FAQ page under the Quality Reimbursement.
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Award Winners Announced at Annual Banquet

Four CRNAs were honored for their outstanding contributions at the Nurse Anesthesia Annual Congress Annual Banquet, held September 13, in Washington, DC. Read on to find out about the winners of the Agatha Hodgins Award for Outstanding Accomplishment, the Helen Lamb Outstanding Educator Award, The Alice Magaw Outstanding Clinical Practitioner Award, and the Ira P. Gunn Award for Outstanding Professional Advocacy.

Agatha Hodgins Award
To recognize Certified Registered Nurse Anesthetists who have furthered the art and science of nurse anesthesia, the Agatha Hodgins Award, the highest accolade given by the AANA, was established in the mid-1970s.

The 2016 award was presented to Charles “Chuck” Reese, PhD, CRNA. Reese is the first CRNA to have previously received the AANA Alice Magaw Clinical Practitioner and Helen Lamb Educator Awards. Reese recently retired as a senior anesthetist at Virginia Commonwealth University in Richmond, Va. In addition, he was the Associate Professor of Obstetrics, Gynecology, and Anesthesia. With a highly decorated Navy career, Reese is one of the first male CRNAs to earn the rank of Captain. As the sole (and first) anesthesia provider aboard the USS Nimitz, he provided care to over 100 sailors and marines following a major flight deck aircraft accident. Due to such actions, despite numerous life-threatening wounds, none of the soldiers cared for died from their injuries.

Helen Lamb Award
The Helen Lamb Award was established in 1980 in memory of Helen Lamb Frost, an AANA founding member, past president, and nurse anesthesia educator. This award recognizes the commitment of an individual to the educational standards of nurse anesthesia.

This year’s recipient is Edward Thompson, CRNA, PhD, FAAN. Thompson is a staff CRNA with Anesthesia Associates of Naples and works at Physicians Regional Hospital in Naples. A CRNA for more than 35 years, Thompson’s trail of contributions to the nurse anesthesia profession begins as an instructor of anesthesia at the Mayo Foundation for Research & Education in Rochester, Minn., to Program Director at both Mayo and the University of Iowa’s College of Nursing and Department of Anesthesia in Iowa City, Iowa. As program director in Iowa, Thompson took a once struggling program and transformed it into one of the top nurse anesthesia programs in the country. The Iowa program’s excellence continues today, boasting a 100 percent pass rate on the certification exam.

Alice Magaw Award
The Alice Magaw Clinical Anesthesia Practitioner Award was established in 1986 to recognize the accomplishments of Certified Registered Nurse Anesthetists who are involved in direct patient care.

The 2016 Alice Magaw Outstanding Clinical Anesthesia Practitioner Award goes to Randolf “Randy” Harvey, BS, RRT, CRNA. Harvey is chief of anesthesia at the Florida Eye Clinic Ambulatory Surgery Center in Altamonte Springs, Fla. For more than 25 years, he has blazed a trail in the field of ophthalmic anesthesia. Not just for CRNAs, but anesthesiologists and ophthalmologists as well. Harvey’s passion for ophthalmic anesthesia led to his being a founding member of the Ophthalmic Anesthesia Society. In addition, he serves as secretary and a scientific board member of the Ophthalmic Anesthesia Society.

Ira P. Gunn Award
The Ira P. Gunn Award was established in 2000 to recognize Certified Registered Nurse Anesthetists or other persons who make significant contributions to promoting and/or protecting the legal, legislative, and regulatory practice rights of nurse anesthetists.

The 2016 Ira P. Gunn Award was presented to Gary Jenkins, CRNA. Jenkins is a staff anesthetist and co-owner of Excel Anesthesia Services in Beaver Dam, Ky. A stalwart in the Kentucky nurse anesthesia and healthcare community, he has been a CRNA for more than 40 years of the Kentucky Association of Nurse Anesthetists’ 50 years of existence. Jenkins is the “behind-the-scenes” CRNA who has advocated for the profession vigilantly, playing a key role in writing legislation that required Anesthesiologist Assistants to be certified as Physician Assistants. This visionary foresight has protected CRNAs in Kentucky from AA encroachment. This law still stands today.

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Exemplary Educators Honored at Annual Congress Opening Ceremonies

The following educators were honored for their exemplary work and significant impact on nurse anesthesia at the AANA Nurse Anesthesia Annual Congress Opening Ceremonies, held Saturday, September 10, in Washington DC. Read on to find out more about the Program Director of the Year, Clinical Instructor of the Year, and Didactic Instructor of the Year.

Program Director of the Year
Michael Rieker, DNP, CRNA, FAAN, from Winston-Salem, N.C., has been named the 2016 Program Director of the Year. The Program Director of the Year Award, established in 1991, is presented to a CRNA who has made a significant contribution as a program director to the educational process of student nurse anesthetists. The award recognizes the commitment of individuals to the profession of nurse anesthesia and to the advancement of educational standards that further the art and science of anesthesia and result in high-quality patient care.

Rieker is the program administrator for Wake Forest School of Medicine, Nurse Anesthesia Program in Winston-Salem, N.C. In his 11 years as program director at Wake Forest, Rieker has led program advancement in four main areas: technology, didactics, organization, and value-added experiences. The entire curriculum was converted to an electronic format and delivered to students by way of a learning management system. This system includes not only PowerPoint presentations, but also external links, course videos, class Wiki activities, discussion boards and other resources. Daily clinical evaluations and graduate surveys are now in a web-based system and all student examinations are in an electronic format.

Didactic Instructor of the Year

Arthur Don Johnson, PhD, RN, COL(ret), from San Antonio, Texas, has been named the 2016 Didactic Instructor of the Year. The Didactic Instructor of the Year Award, established in 1991, is presented to an individual who has made a significant contribution to the education of student nurse anesthetists in the classroom.

A retired Colonel from the U.S. Air Force, Johnson is professor of nurse anesthesia and former director of research at the U.S. Army Graduate Program in Anesthesia Nursing (USAGPAN) and Northeastern University. He is an impassioned researcher, mentor, and highly respected didactic instructor. He has taken his skills as an instructor from Texas to the United Kingdom to California, Louisiana, and full circle back to Texas. He has been selected Teacher of the Year three times, and Researcher of the Year twice.

Clinical Instructor of the Year
Howard Burtnett, MHS, CRNA, from York, Pa., has been named the 2016 Clinical Instructor of the Year. The Clinical Instructor of the Year Award was established in 1991 to recognize individuals who have made a significant contribution to the teaching of nurse anesthesia students in the clinical area.

Both civilian and military work experiences have taken Burtnett across the country through several states and he also was deployed as an anesthesia provider to Germany in the mid-1990s. Burtnett has used his clinical prowess in mission work in Bolivia, Zambia and Croatia, but has mainly applied his considerable talents to teaching student registered nurse anesthetists in the U.S. Army and several civilian programs. He has written for several clinical publications and is a recipient of the Order of Military Medical Merit and a member of the Phi Kappa Phi Honor Society.

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Free Student Loan Best Practices Webinar Available Online

A recording of a free "Student Loan Best Practices" webinar presented by DRB Student Loan in partnership with the AANA is now available online.
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Professional Practice

Board Adopts New Practice and Practice Management Resources

At Annual Congress, the Board of Directors adopted the following new documents, which can be accessed on the AANA website.

Airway Management: Use of Succinylcholine or Rocuronium provides practice considerations for facilities, particularly ambulatory surgery centers, endoscopy clinics, or office settings, regarding the risks and benefits of succinylcholine compared to rocuronium when selecting a neuromuscular blocking agent and addressing management of a malignant hyperthermia crisis.

Professional Attributes of the Nurse Anesthetist provides a framework of the non-clinical knowledge, skills, attitudes and judgments that are fundamental for successful transitions into various nurse anesthesia practice roles (e.g., clinicians, educators, researchers, administrators) over a career. These non-clinical attributes may be referenced for ongoing professional development and career engagement through ongoing self-assessment and peer review. See CRNA Fact Sheet.

Ketamine Infusion Therapy for Psychiatric Disorders and Chronic Pain Management provides practice considerations for the use of intravenous ketamine therapy for psychiatric disorders, such as major depressive disorder, bipolar disorder, and post-traumatic stress disorder, as well as post-operative and chronic pain management. Visit Ketamine Infusion Therapy.

Ketamine Infusion Therapy, Considerations Checklistserves as a practice management supplement to Ketamine Infusion Therapy for Psychiatric Disorders and Chronic Pain Management, Practice Considerations. It presents considerations for CRNAs exploring the opportunity of providing ketamine therapy services. Read the full document at Ketamine Infusion Therapy.
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Meetings and Workshops

ASF Registration Now Open

Attention nurse anesthesia educators: Register now for the Assembly of School Faculty, Feb. 23-25, in Fort Lauderdale, Fla. The ASF is the only forum that brings all nurse anesthesia educational programs together to discuss and define the future of the profession.
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Registration Open Now for Fall Leadership Academy

Learn to lead at any level, in all practice settings, at the Fall Leadership Academy, Nov. 11-13, 2016, in Rosemont, Ill. Featuring more than 20 expert speakers and five educational tracks, Fall Leadership Academy is designed to expand your leadership skills as well as your network of colleagues. 
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Foundation and Research

AANA Foundation Award Winners Honored at the AANA 2016 Nurse Anesthesia Annual Congress

The 2016 AANA Foundation award winners were honored at the AANA Annual Congress held in Washington, DC. Read more about the Foundation Award winners.

John F. Garde Researcher of the Year: Tamra Dukatz, MSN, CRNA
Dukatz is a staff nurse anesthetist at Beaumont Health in Royal Oak, Michigan and a clinical instructor for the Oakland University Beaumont School of Nurse Anesthesia. After her son and daughter were both diagnosed with type 1 diabetes, Dukatz began to conduct clinical trials regarding insulin glargine. Tamra’s work on insulin glargine has also been published in four journals, and she has presented at numerous national meetings. Tamra’s enthusiasm has inspired her students to conduct research that is implemented into practice, impacting patients’ lives.

Advocate of the Year: Christina Kloepping, MSNA, CRNA
The 2016 Advocate of the Year recipient is Christina Kloepping, MSNA, CRNA, who is the first student to receive this prestigious award. Kloepping was a student at Rosalind Franklin University and helped initiate the inaugural student advocate program launched in 2015. She began her career as an emergency medical technician, then a nurse in the ER to the ICU, and finally entered anesthesia. Being involved with the Foundation was always a logical choice for Kloepping given the high value she places on research. Just one example of her advocate accomplishments was at the WIANA Meeting where she raised $1,700 for the AANA Foundation. Kloepping balances her passion for nurse anesthesia and the AANA Foundation with her family – her husband and three children.

Rita L. LeBlanc Philanthropist of the Year: John T. “Jack” Hitchens, BA, CRNA
Jack served on the AANA Foundation Board of Trustees from 2008 to 2014 as Co-Vice Chair of Fundraising, Treasurer, and Board Chair in 2013. He currently serves on the Steering Committee for the RISE Above Campaign and the Audit Committee. Hitchens has been a faithful donor since the 1980s, a Friend for Life, and a Silver member of the Gertrude Fife Cumulative Giving Society. Jack’s passion as an overseas volunteer anesthesia provider and Boy Scout Leader exemplifies his true dedication to giving to others beyond the AANA Foundation. Jack’s life and choices to give to others make him an extraordinary recipient of this award.

Janice Drake CRNA Humanitarian Award: Richard Henker, PhD, RN, CRNA, FAAN
Henker works at UPMC-Presbyterian Hospital in Pittsburgh and provides anesthesia care at hospitals worldwide. In addition, he has been a guest lecturer and visiting professor at universities around the globe, including eight universities in Japan alone. He serves as a site reviewer for the Commission on Collegiate Nursing Education, and a member of the American Nurses Association Committee on Nursing Practice Standards and Guidelines. He is on the Board of Directors for Health Volunteers Overseas and the program co-director for the Nurse Anesthesia Overseas HVO site at Lao Friends Hospital for Children. Dedication to serving others who are less fortunate, whether through education or by providing anesthesia, exemplifies his character and makes Richard more than deserving of this award.

For a complete listing of AANA Foundation award recipients including fellowship and scholarship awardees, please view the AANA Foundation FY16 Annual Report by visiting AANA Foundation.
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Announcing the AANA Foundation 2016-2017 Board of Trustees

The AANA Foundation welcomes the Board of Trustees for the 2016-2017 year. Serving on the board are:

  • Chair Wilma K. Gillis, BSN, CRNA, APNP
  • Chair-elect Ladan Eshkevari, PhD, CRNA, Lac
  • Co-Vice Chair Professional Development Charles A. Griffis, PhD, CRNA
  • Co-Vice Chair Fundraising Stephanie E. May, DNAP, CRNA
  • Treasurer John A. Jelinek, BS
  • Trustees
    • Paul D. Beninga, MS, CRNA
    • Ronald R. Castaldo, PhD, MBA, MS, CRNA, CCRN
    • Vicki C. Coopmans, PhD, CRNA Stephen Finder, DNP, CRNA
    • Leslie Jeter, MSNA, CRNA
    • Amy Langan, BA Kathleen C. Thibeault, MSN, CRNA, APRN
    • Bruce Weiner, MS, CRNA
    • Wanda O. Wilson, PhD, CRNA
  • Student Representative Kathryn A. Cowap, BSN, RN

The Foundation would like to thank the following outgoing Board of Trustee members for sharing their time and expertise:

  • Cheryl L. Nimmo, DNP, MSHSA, CRNA
  • Monica G. Masemer, MSN, CRNA
  • Sandra K. Tunajek, DNP, CRNA
  • Donna I. Vierthaler, MHS, CRNA

The AANA Foundation greatly appreciates their board participation, leadership, and insights and looks forward to continuing to work together in the future.

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AANA Foundation FY 17 Program and Annual Fund Kicks Off
The AANA Foundation officially kicked off FY17 and program and fundraising efforts are well underway. For a quick recap, program application deadlines are as follows:
  • November 1, 2016 – Research Grants (General)
  • December 1, 2016 – Student Scholarship Donors
  • February 1, 2017 – Award Nominations; Post-Doctoral and Doctoral Fellowships; Palmer Carrier, CRNA Scholarship
  • March 1, 2017 – Student Scholarship Applications; Dean Hayden Student Research Scholarship
  • April 1, 2017 – “State of the Science” Oral Poster Presentation
  • May 1, 2017 – “State of the Science” General Poster Presentation; Research Grants (General)
  • June 15, 2017 – Friends for Life
  • Open Submission – Program Administrator’s Outstanding Student Researcher Award; Office Based Research Grant; Veterans Research Grant

Please be a part of our success and support nurse anesthesia research and education today! It’s easy to make your tax-deductible donation:
  • online at AANA Foundation
  • Mail to AANA Foundation at 222 S. Prospect Avenue, Park Ridge, IL 60068
  • Call the Foundation at (847) 655-1170
Thank you in advance for your continued support of our profession!
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Federal Government Affairs

Status Update on VHA Proposed Rule for CRNA and APRN Full Practice Authority

The AANA continues to work with a broad coalition of groups in support of improving veterans' access to care through full practice authority for CRNAs and other APRNs at the VHA. Here is a brief rundown of activities to keep members apprised of current actions.
  • Regulation: The Department of Veterans Affairs published its proposed rule on APRN full practice authority in the Federal Register on May 25, triggering a 60-day public comment period that ended on July 25, having captured over 223,000 public comments. The next step is for the federal Office of Management and Budget (OMB) to disclose that it has received a draft final rule from the VA to evaluate for possible publication in the Federal Register. Once the OMB receives that draft final rule, it has up to 90 days to evaluate then publish it or return it to the VA for more work.
  • Legislation: The AANA continues to encourage members of the U.S. House of Representatives to cosponsor the “Improving Veterans Access to Quality Care Act” (H.R. 1247) and members of the Senate to cosponsor the “Veterans Health Care Staffing Improvement Act” (S. 2279), which have 57 and 11 bipartisan cosponsors respectively.
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Key House Committee Approves Legislation Reauthorizing Title 8 Nurse Workforce Development Programs Important to CRNAs, Educational Programs

The House Energy & Commerce Committee on September 21 approved H.R. 2713, the Title 8 Nursing Workforce Development Reauthorization Act, clearing it for action by the full House soon. Sponsored by CRNA-friendly Reps. Lois Capps D-CA (who is retiring from Congress at the end of her term) and Dave Joyce R-OH, the bill is a mostly straight reauthorization of federal nurse and APRN workforce development programs and is supported by AANA and the major national nursing organizations.

A similar bipartisan companion bill has been introduced in the Senate by Sens. Jeff Merkley (D-OR) and Richard Burr (R-NC), S. 3245, also with AANA support. The legislation is a candidate for enactment during the post-election lame-duck session of Congress.

Nurse anesthesia educational programs and some nurse anesthesia students benefit from Title 8 programs such as the Advanced Education Nursing program for expanding and modernizing educational infrastructure, the Nurse Faculty Loan program, and the Nurse Anesthetist Traineeships program. In the current congressional appropriations process not yet finished on Capitol Hill – and not likely to be finished until late fall, after the elections — Title 8 programs are level-funded for FY 2017 relative to FY 2016 amounts.
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Congress Trying to Wrap Up and Depart Washington for Nov. 8 Elections – Including some Unfinished CRNA Business

Congress is trying to get its unfinished business done before recessing for the stretch run to the November 8 elections. Some of that unfinished business includes CRNA issues and priorities. At press time a Senate test vote was scheduled for Tues., Sept. 27.

As part of a “continuing resolution” (CR) funding bill intended to keep Uncle Sam open for business from the Oct. 1 federal fiscal New Year’s Day through Dec. 8, the Military Construction and Veterans Affairs appropriations bill would fund veterans’ programs the entire year. That bill also includes advisory report language, sought and secured by AANA, that takes a neutral point of view on the VHA CRNA and APRN Full Practice Authority issue – a critical matter for CRNAs, as the profession’s opponents on Capitol Hill had sought to use the appropriations process to attack and block veterans increased access to CRNA services.

The CR would also keep Title 8 nurse workforce development programs, Medicare and Medicaid, and the Affordable Care Act health plans running.
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AANA Advances Key Payment and Policy Priorities at CMS, HHS

Through the late summer and early fall, the AANA has been busy promoting fair CRNA reimbursement and seeking to eliminate barriers to CRNA practice through responses to regulatory proposals published by the federal government. These include:
  • Medicare should convene CRNAs and other qualified professionals to develop a recommendation on the valuation of codes associated with anesthesia for colorectal cancer screening and for moderate sedation services, the AANA stated in a comment letter submitted to the agency on Sept. 1 in response to its Physician Fee Schedule (PFS) CY 2017 proposed rule. Read the AANA comment on the PFS proposed rule Read the PFS proposed rule.
  • In two separate comments to the Medicare agency related to MACRA implementation, the AANA recommended that CMS develop episode groups that fairly account for the true cost of furnishing anesthesia care services for a particular episode of care or procedure. Read the AANA comments on CMS’s proposals on Patient Relationship Categories and Codes and on Episode Groups. Read the CMS proposals on Patient Relationship Categories and Codes and on Episode Groups.
  • The AANA requested on Aug. 12 that Medicare Administrative Contractor (MAC) Novitas Solutions remove a FAQ on medical direction from its website because it included problematic language that stated that medical direction payment could be made when the seven TEFRA conditions were not met, among other concerns. In response to AANA’s concerns, Novitas has removed the problematic FAQ from its website. Read the AANA letter.
  • Prescriber education should emphasize a multimodal approach to pain management and leverage existing efforts by the AANA and APRNs, the AANA stated in a comment letter submitted to the U.S. Department of Health and Human Services (HHS) on Sept. 2 in response to its request for information (RFI) on opioid prescriber education and training opportunities. Read the letter and read the HHS Request for Information.
  • In its response to Medicare’s proposed rule on hospital payment for 2017, the AANA on Aug. 30 encouraged the use of innovative cost-effective models in healthcare delivery such as anesthesia services provided by CRNAs and advised Medicare to remove the costly and unnecessary requirements related to physician supervision of CRNA anesthesia services. Read the AANA comment letterRead the proposed rule.
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Ralph Kohl Succeeding Purcell as Senior Director Federal Government Affairs

AANA Executive Director/Chief Executive Officer Wanda Wilson, PhD, MSN, CRNA, has named Ralph Kohl, a four-year veteran of the AANA’s Washington, D.C., office, to succeed Frank Purcell as senior director, Federal Government Affairs. As announced during the AANA Annual Congress earlier in September, Purcell departed effective Sept. 30 to serve as CEO of the American College of Nurse-Midwives.

As senior director, Kohl will direct AANA Federal Government Affairs legislative, regulatory and reimbursement advocacy, lead AANA’s Washington staff team, help keep the CRNA-PAC and volunteer member advocacy networks and systems robust, and continue the AANA tradition, directed by the Board of Directors on behalf of the membership, of ensuring that our CRNA voice in Washington is strong, clear and effective.

“Ralph is a person of great skill and integrity,” said Purcell. “I have known him for more than a decade. He puts the members first, and is a respected and effective advocate on Capitol Hill for CRNAs. It has been my privilege to serve the membership and the profession of nurse anesthesia. Ralph is ready for this post and will do a terrific job.”

Over four years with the AANA, Ralph has served as associate director, Federal Government Affairs, distinguishing himself as a key contributor to the AANA’s advocacy efforts on Capitol Hill. His recent focus has been on helping to advance veterans access to quality care through Full Practice Authority for CRNAs and other APRNs in veterans’ healthcare facilities. He was critical to the introduction of pro-CRNA legislation in the House and Senate that garnered 80 cosponsors from both sides of the aisle and both chambers of Congress. His leadership has drawn the support of several Veterans and Military Service Organizations for the CRNA point of view on Full Practice Authority. His previous work included a senior role with the American Occupational Therapy Association where he collaborated with the AANA through the PARCA coalition for provider nondiscrimination.

Originally from Long Island, N.Y., Kohl earned his bachelor’s degree at Drexel University in Philadelphia where he played varsity lacrosse. He and his family live in suburban Alexandria, Va.
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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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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.

Prescription Analgesics Are More Widely Used Than Tobacco, New Federal Study Finds

A recent Substance Abuse and Mental Health Services Administration report finds that 35 percent of American adults were given analgesic prescriptions by medical providers last year. The report indicates that in 2015, more American adults used prescription analgesics than used cigarettes, smokeless tobacco, or cigars combined. Opioid analgesics are still widespread despite recent federal efforts to impose tighter restrictions on their prescription and use. Reducing the scope of the opioid epidemic has been a priority for President Obama. Earlier this year the White House requested $1.1 billion from Congress for fighting opioid addiction. But critics have argued that Drug Enforcement Agency (DEA) policies are undercutting federal efforts to curb opioid abuse. For instance, earlier this year, DEA refused to reduce restrictions on marijuana use, arguing that there was insufficient evidence of marijuana's medical benefits. Multiple studies have found that access to medical marijuana is associated with reductions in prescription analgesic abuse and overdose rates. The DEA also recently announced a plan to ban the use of kratom, a Southeast Asian plant with opiate-like qualities. However, many users of kratom report that the plant has helped them quit using more powerful prescription analgesics. Researchers are worried that without kratom available to them, these users will return to prescription analgesics or move on to heroin. http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm

From "Prescription Analgesics Are More Widely Used Than Tobacco, New Federal Study Finds"
Washington Post (09/20/16) Ingraham, Christopher

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Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures

To gauge the ideal number of opioids patients need after surgery, researchers considered how much medicine 642 study enrollees were prescribed postoperatively and how many doses they actually took. Although the investigation was limited to five types of procedures—partial mastectomy (PM), partial mastectomy with sentinel lymph node biopsy (PM SLNB), laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), and open inguinal hernia repair (IH)—researchers observed great fluctuation in prescribing patterns. Patients generally used less than one-third of the opioids they were prescribed; and fewer than 2 percent refilled the medication. Based on what was prescribed and what was actually taken, they then determined the number of pills that would be adequate for 80 percent of patients in each surgical category. Instead of 20 pills each for PM and PM SLNB, the calculations showed that prescribing 5 for the former and 10 for the latter would give patients sufficient relief from postoperative pain while avoiding excess medication that could be diverted for misuse. Additionally, the investigators recommended slashing the doses for LC, LIH, and IH by one-half from 30 pills to 15.

From "Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures"
Annals of Surgery (09/16) Hill, Maureen V.; McMahon, Michelle L.; Stucke, Ryland S.; et al.

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Can Meditation Help Patients' Pain After Surgery?

A trial in progress at New York City's Mount Sinai Hospital is exploring the use of meditation to alleviate postoperative pain with less opioid use. The focus of the study is on spine-surgery patients, who may suffer residual pain for six weeks or longer after the procedure. Participants are randomized to learn a simple form of mediation and begin practicing it two weeks prior to their operation and six weeks following it. They receive narcotic pain relief as well, while the control group is treated with opioids only. The research results may not be available for a couple of years, but some participants are already reporting relief from meditation. The technique previously has shown merit for other medical and psychological conditions, but the Mount Sinai investigation differs because it targets the kind of acute post-surgical pain that usually demands opioids. However, Patricia Bloom—clinical associate professor of geriatrics—emphasizes that she and spine surgeon Arthur Jenkins have no expectation of replacing the need for painkillers. "We are trying to understand," she explains, "can you help people's pain to resolve faster and can you make their need for narcotics less."

From "Can Meditation Help Patients' Pain After Surgery?"
Wall Street Journal (09/20/16) P. D1 Lagnado, Lucette

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Pre-Op Score Is Effective Tool for Predicting In-Hospital Mortality

The Preoperative Score To Predict Postoperative Mortality (POSPOM) aims to provide a more subjective, and thus more accurate, approach for estimating risk of in-hospital mortality following surgery. While other models predict death for various kinds of operations, POSPOM gives more weight to preoperative comorbidities that could play a role. Based on a list of 17 different "potential predictors," scores range from 0 points—representing the lowest risk—to 50. To test the system, the international team of researchers who created it analyzed data from more than 5.5 million surgical patients in France who had undergone a procedure requiring anesthesia. Roughly half were randomized to the prediction model, with the others assigned to a derivation cohort. POSPOM predicted 14,933 deaths compared to 12,786 deaths that actually did occur among the derivation patients. According to the Canadian, U.K., South American, and French researchers, the new tool offers "good calibration and excellent discrimination for in-hospital mortality." They even believe that POSPOM, with its unique focus on preoperative clinical factors like age and cardiac arrhythmia, may be more effective than current standards—including the American Society of Anesthesiologists physical status score.

From "Pre-Op Score Is Effective Tool for Predicting In-Hospital Mortality"
General Surgery News (09/19/16) Van Voorhis, Scott

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AAP Strengthens Advice Against Codeine for Kids' Coughs, Pain

In a new report, the American Academy of Pediatrics increases its warnings about prescribing codeine for children. According to Charles Cote, an anesthesia provider in Boston and a co-author of the report, clinicians and parents should, when possible, choose alternatives such as acetaminophen and ibuprofen for pain or simple solutions such as ice or popsicles after tonsillectomies. A rare genetic variation can make some people metabolize codeine too fast, the Pediatrics report notes, while a different genetic variation makes the drug ineffective for some individuals. An FDA review cited in the report identified 21 codeine-related deaths in children younger than age 12 years and 64 cases of severe breathing problems over 50 years. The researchers call for better education of parents and physicians as well as further study of the risks and benefits of codeine and nonopioid analgesics for children.

From "AAP Strengthens Advice Against Codeine for Kids' Coughs, Pain"
Associated Press (09/19/16) Tanner, Lindsay

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FDA Considers Rules for Pediatric Opioid Trials

FDA's Anesthetic and Analgesic Drug Products Advisory Committee, the Drug Safety and Risk Management Advisory Committee, and the Pediatric Advisory Committee held a two-day joint meeting on current procedures for clinical trials of opioids in children. Charles Berde, MD, of Boston Children's Hospital, warned that children can develop a "profound opioid tolerance" and use of the drug may lead to withdrawal syndromes in infants and children. Berde and others noted that although FDA's current policy requires evidence of efficacy, most evidence comes from trials in adults. Berde said that children and adults have some epidemiologic differences in their responses to pain. Chris Feudtner, MD, of Children's Hospital of Philadelphia, argued that the opioid epidemic needs to be examined from both an individual and a population point of view but insisted that population concerns should not be the deciding factor in the labeling of a medication. "FDA should not be asking for longer labels. The label shouldn't be about whether that medication is going to disappear from your medicine cabinet at some point," said Feudtner. "We can address this problem through prescribing practices, but it should not be a labeling issue." He warned the committee not to "overstep" regulatory requirements and take on other tasks, such as public health considerations, just because "other players have stepped away," and reiterated that the issue is about drug regulation, not trying to control a public health problem.

From "FDA Considers Rules for Pediatric Opioid Trials"
MedPage Today (09/15/16) Walker, Molly

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New Paper Provides Insights Into Impact of Music Therapy on Anxiety of Surgical Patients

New research at University Hospitals Seidman Cancer Center examined the benefits of music therapy for surgery patients and different ways to approach such a program. The study paper, appearing in AORN Journal, is based on a two-year investigation of 207 breast cancer patients. The women were randomly assigned to listen to a live song performed bedside, to use ear buds to hear a recorded song on an iPad, or to receive no exposure to music in the surgical area before undergoing biopsy. Based on self-reported stress levels, represented on a visual scale, preoperative anxiety dropped 42.5 percent for the live music listeners and 41.2 percent for the recorded-music group when compared to the controls. Jaclyn Bradley Palmer—one of two music therapists who worked with an anesthesia provider on the study and subsequent paper—believes the approach could improve patient care. "As an interdisciplinary surgical staff member, the music therapist may help nurses achieve patient-related goals of anxiety reduction, pain management, effective education and satisfaction," she explained. "And by having professional music therapists facilitate surgical music therapy programs, nursing workloads also may be reduced."

From "New Paper Provides Insights Into Impact of Music Therapy on Anxiety of Surgical Patients"
News-Medical.net (09/13/2016)

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Epidural Better for AAA Repair

Research shows that patients undergoing open abdominal aortic aneurysm (AAA) repair have fewer complications and better survival prospects when given an epidural, in addition to general anesthesia, for surgery. The finding comes from a retrospective analysis of 1,540 patients, nearly 64 percent of whom received the dual approach. The survival rate for those who were administered both epidural and general anesthesia was about 74 percent compared with about 65 percent for those given general anesthesia only. The combination group was also significantly less likely to experience postoperative bowel ischemia or pulmonary complications, require surgical reintervention at 30 days, or need dialysis. "Epidural analgesia in addition to general anesthesia should be strongly considered in suitable patients undergoing elective AAA repair," conclude the researchers, who reported their results in JAMA Surgery.

From "Epidural Better for AAA Repair"
MedPage Today (09/09/16) Phend, Crystal

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iPads May Be Just as Effective as Sedatives at Calming Kids Down Before Surgery

A new study out of France finds that distracting young kids with tech devices works just as well as sedatives in allaying pre-surgery jitters. The researchers enrolled 112 patients, all between the ages of four and 10 years, who were undergoing a procedure requiring general anesthesia. They compared 58 who were allowed to play games on an iPad for 20 minutes prior to anesthesia induction against 54 who were simply given midazolam. Anesthesia was more easily received and more effective in the tablet group, they found. "Use of iPads or other tablet devices is a non-pharmacologic tool which can reduce perioperative stress without any sedative effect in pediatric ambulatory surgery," declared researcher Dominque Chassard, MD. The results, recently reported at the World Congress of Anaesthesiologists, dovetail with earlier research demonstrating the power of video games to distract kids right before an operation.

From "iPads May Be Just as Effective as Sedatives at Calming Kids Down Before Surgery"
Global News (Canada) (09/04/16) Bogart, Nicole

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Review: Continuous Infusion NSAIDs for Peri-Op Pain

Based on the findings of a literature review, perioperative pain can be controlled effectively through continuous infusion of non-steroidal anti-inflammatory drugs (NSAIDs). A search of the PubMed and MEDLINE databases turned up two dozen studies, both prospective and retrospective in nature, that assessed intravenous or intramuscular continuous infusion NSAIDs in the treatment of surgical pain. Most of the research—which included abdominal surgery, orthopedic procedures, and pediatric operations—compared continuous infusion NSAID against another analgesic or against placebo. The results indicated that continuous infusion of agents including diclofenac, ketoprofen, and ketorolac delivered sufficient pain relief while curtailing the need for opioids. Additionally, though the data were limited, there was evidence that the approach also reduced nausea and sedation.

From "Review: Continuous Infusion NSAIDs for Peri-Op Pain"
Monthly Prescribing Reference (09/16) Han, Da Hee

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Childbirth Pain Linked to Risk of Postpartum Depression

Researchers in Singapore have uncovered a possible correlation between postpartum depression and duration of pain after childbirth. Presenting recently at the World Congress of Anaesthesiologists in Hong Kong, the team from Duke-NUS Medical School described their followup on 138 healthy women who received an epidural while delivering their first baby. The new mothers reported their pain levels in the weeks after childbirth; meanwhile, readings on the Edinburgh Postnatal Depression Scale (EPDS) signaled which women were suffering from the condition. With EPDS scores of 12 or higher, the investigators determined that 5.8 percent of the new moms had in fact developed postpartum depression by week four or later. The women with the highest scores were those who also reported being in pain for longer than four weeks, and the lowest scores were for mothers who experienced no pain at all following childbirth. "The research findings support the need to address pain comprehensively to lessen the risk of developing PND [postnatal depression], and a larger study is being conducted to evaluate the impact of pain and PND in pregnant women," remarked medical student and study co-author Wei Du.

From "Childbirth Pain Linked to Risk of Postpartum Depression"
Medical News Today (09/01/16) Whiteman, Honor

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Five-Year Study Reveals Patients Operated on at Night Twice as Likely to Die as Patients Who Have Daytime Operations

The risk of postoperative death is nearly twice as high for patients who have surgery at night compared to those who are operated on during normal work hours, a Canadian study has found. Researchers performed a retrospective review of 30-day in-hospital mortality, looking at all operations at Jewish General Hospital in Montreal over a five-year period ended in March 2015. After adjusting for known risk factors such as age and American Society of Anesthesiologists (ASA) score, the colleagues from McGill University Health Centre compared deaths among patients who underwent procedures in the day, evening, or nighttime hours. They discovered that patients who had surgery late in the day were 1.43 times as likely to die and patients who had night surgeries were 2.17 times more likely to pass away than those who underwent procedures during normal daytime working hours. The team speculated that mortality tied to night operations may reflect provider fatigue during anesthesia and surgery, overnight hospital staffing issues, or delays in treatment, among other factors.

From "Five-Year Study Reveals Patients Operated on at Night Twice as Likely to Die as Patients Who Have Daytime Operations"
Medical Xpress (08/30/16)

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Two New AAAHC Institute Tools Help Protect Patients, Avoid Risks

Toolkits that aim to enhance patient safety through preoperative evaluations and safe injection practices (SIP) are now available from the AAAHC Institute for Quality Improvement. SIP has been a persistent problem, with more than 700 U.S. patients contracting hepatitis or being infected with bacterial pathogens this way between 1998 and 2014. The new toolkit, however, offers a checklist to help health care organizations evaluate risk, create a training plan to address shortcomings, and implement comprehensive infection control and prevention programs. The ambulatory surgery and preop evaluation toolkit, meanwhile, offers best practices for collecting medical history and physical health information during the first meeting with a patient and for conducting a pre-anesthesia physical exam. The goal of these steps is to understand patients' risks before surgery in order to ensure safe and positive outcomes.

From "Two New AAAHC Institute Tools Help Protect Patients, Avoid Risks"
Infection Control Today (08/24/16)

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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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