As discussed in June, we have started providing monthly updates on the status of bills that are of priority concern or focus for ENA. We will utilize this section to provide basic information such as new cosponsors that have signed on in the last month or updates on the status of the bill's movement through Congress.
On November 2, the House of Representatives passed the Protecting Patient Access to Emergency Medications Act (H.R. 304), following Senate passage of the bill on October 24. This activity has paved the way for this important legislation to now become law. The bipartisan bill, which was introduced by Rep. Richard Hudson (R-NC), will allow emergency medical services to continue to use standing orders to administer controlled substances, including lifesaving medications, to patients in need of emergency care. The use of standing orders has been standard practice by EMS agencies for more than 40 years.
ENA has supported this legislation since 2016, and designated it as a priority request at Day on the Hill in 2016 and 2017. Critical advocacy efforts through the EN411 Action Network resulted in more than 600 letters being sent to members of the U.S. House and Senate in support of the legislation.
According to the Centers for Disease Control and Prevention (CDC), more than 33,000 people in the United States died from opioid overdoses in 2015, the most on record. After months of deliberation, the Trump administration took an official step forward to address the crisis on October 26 by declaring the opioid epidemic a public health emergency under the Public Health Services Act. Although the move allows agencies to direct more of their existing funding toward opioid-related programs, it does not automatically infuse agencies with additional funding for these efforts. President Trump had previously vowed to declare the epidemic a "national emergency," which, under the Stafford Disaster Relief and Emergency Assistance Act, would have allowed for additional federal funds to be rapidly allocated to address the issue. Officials in the Trump administration had previously stated that declaration under the Stafford Act was not appropriate as the Stafford Act is typically reserved for emergencies related to natural disasters such as floods, hurricanes, wildfires, tornadoes and earthquakes. Multiple former Obama administration officials have since echoed this sentiment.
In a related development, on October 17, Rep. Tom Marino (R-PA), President Trump's pick to head the Office of National Drug Control Policy, a position widely regarded as the nation's "drug czar," pulled his name from consideration. An explosive October 15 report on "60 Minutes" identified Marino as the sponsor of legislation which hindered the Drug Enforcement Administration's (DEA) authority to go after drug distributors and companies that did not report suspicious orders for opioids, many of which included millions of pills. Despite being heavily supported by drug distributors and opposed by top DEA officials, Rep. Marino's bill, the Ensuring Patient Access and Effective Drug Enforcement Act, received bipartisan support in Congress and was signed into law in 2016 by President Obama. President Trump has not yet nominated a replacement for the Drug Czar position.
New research led by the Mayo Clinic found commercially insured patients who were prescribed opioids from the emergency department were 44% less likely to exceed a three-day supply than those written elsewhere. Those patients were also 38% less likely to exceed a daily dose of 50 milligrams of morphine equivalent, which is almost seven pills of five-milligram oxycodone per day. An opioid prescribing guideline from the Centers for Disease Control and Prevention (CDC) issued in 2016 cautions against exceeding a three-day supply or 50 milligrams of morphine equivalent per day for acute pain.
There is a reason for that, because patients prescribed a higher dosage were three times more likely to progress to long-term use. ED patients with acute pain were 46% less likely to progress to long-term opioid use than those who received their prescription somewhere else. One in five commercially insured patients in a non-ED setting received a dose exceeding the CDC guideline, according to the study, which was published September 26 in the Annals of Emergency Medicine.
Alex Azar, a former pharmaceutical executive and a top official at the Department of Health and Human Services (HHS) during the George W. Bush administration, has been picked to lead the agency by President Donald Trump. Azar had previously served as HHS general counsel, then as deputy secretary, before leaving government to join Eli Lilly as an executive. There he spent ten years, rising to become president of Lilly USA. Lilly USA is one of three manufacturers of insulin whose skyrocketing prices prompted a lawsuit from patients earlier this year. The U.S. list price of Lilly USA's Humalog insulin more than doubled under Azar's reign.
Azar previously clerked for the late Supreme Court Justice Antonin Scalia. Due to his background in the pharmaceutical industry, critics are concerned he will turn a blind eye to rising drug prices, which President Trump has vowed to tackle. Azar has also been highly critical of the Affordable Care Act and supports converting Medicaid from an entitlement program into block grants. Despite disagreeing with his politics, many Democrats acknowledge that Azar has the experience and credentials to run the nation's largest civilian agency, and a protracted confirmation process is not expected.
The effort by Senate Republicans to repeal and replace the Affordable Care Act (ACA) was defeated in a dramatic vote on the Senate floor on July 28. Majority Leader Mitch McConnell (R-Ky.) had offered an amendment, referred to as the "skinny" repeal, that would have done away with the individual and employer health insurance mandates, but would have left many other parts of the ACA intact. McConnell was hoping to pass a bill out of the Senate and then begin negotiations with the House of Representatives on a consensus bill. This McConnell amendment lost on a 49-51 vote. Sens. McCain (R-AZ), Murkowski (R-AK), and Collins (R-ME) voted against the amendment, as did all 48 Democrats (including 2 Independent Senators who usually align with Democrats).
Leadership on both the Senate Finance Committee and Senate Health, Education, Labor and Pensions (HELP) Committee announced that they would hold hearings on health care reform in September. The focus of the hearings will likely be limited to stabilizing the insurance market.
According to the Centers for Disease Control and Prevention (CDC), fatalities related to the opioid epidemic reached an all-time high in 2015, killing more than 33,000 in the United States. That's more than the number of people killed by either guns or car accidents. New analysis reveals, however, that these statistics might be severely underreporting the extent of this public health crisis.
Dr. Christopher Ruhm of the University of Virginia noticed that specific drugs causing an overdose are often not listed on death certificates, which would lead to undercounting and underreporting of accurate cause of death data. After reviewing CDC data from 2014 alone, it was discovered that a drug was not identified on death certificates in fatal overdoses in nearly 20 percent of cases. Despite evidence of national underreporting, the study found that some states were better than others when it. For example, Rhode Island, Connecticut and New Hampshire have rigorous reporting requirements and listed a drug on death certificates 99 percent of the time. In other states, however, the reporting rates are as low as 50 percent. Overall, Dr. Ruhm suggests that national mortality rates (deaths per 100,000 individuals) for opioids were actually 24 percent higher than reported, and rates for heroin 22 percent higher.
On July 27, the House Energy and Commerce Committee advanced the Stop, Observe, Ask, and Respond (SOAR) to Health and Wellness Act (H.R. 767) in a bipartisan voice vote, to address the scourge of human trafficking in the United States. The SOAR Act would enhance and codify a program at HHS to train health care providers to identify and appropriately respond to victims of human trafficking. The bill was introduced in the House on January 31 by Reps. Steve Cohen (D-TN), Adam Kinzinger (R-IL), Tony Cardenas (D-CA) and Ann Wagner (R-MO). After being approved by the Energy and Commerce Committee, this bill now awaits action on the House floor. A senate companion bill, S. 256 was introduced on February 1 by Sens. Heidi Heitkamp (D-ND) and Susan Collins (R-ME).
ENA has submitted letters of support for both bills. In addition, a recent column that appeared in the Hill by ENA President Karen Wiley highlights the growing problem of human trafficking and calls for the mandatory training for health care professionals to better-identify potential victims of human trafficking.
During the same July 27 markup that saw the SOAR Act advance, the House Energy and Commerce Committee approved by voice vote H.R. 880, the MISSION Zero Act. This bill, which would provide grant funding to allow military trauma teams and providers to work alongside their civilian counterparts, is a priority for ENA and was one of the main "asks" for this year's Day on the Hill. This bipartisan legislation had previously been approved by the Health Subcommittee on June 29. The MISSION Zero Act now awaits action on the House floor.
With Administration Officials Suggesting its Obsolescence, Many Wonder - 'What is the CBO?'
A renewed effort on Capitol Hill to attack health care policy reform has once again raised the profile of the sometimes-mysterious Congressional Budget Office (CBO). Since 1975, the CBO has produced independent analyses of budgetary and economic issues to support the congressional budget process and also provided cost estimates for proposed legislation. Over the past 40 years, its analyses and projections have been both lauded and criticized - by Republicans and Democrats alike, usually depending on which party is in power and proposing the legislation in question.
Supporters argue that while CBO estimates are rarely perfect, the projected trends are usually correct and that the CBO provides useful analysis to lawmakers. Detractors question the need for CBO's existence at all. The latest being White House Office of Management (OMB) Director Mick Mulvaney, who recently told a media outlet that the days of CBO's authority "has probably come and gone." Mulvaney was reacting to the most recent CBO projection that the current version of the Republican healthcare bill, theAmerican Health Care Act of 2017 (H.R. 1628), will result in 23 million Americans losing health insurance (the original version of the bill would have resulted in slightly more-24 million-losing healthcare, the CBO reported).
Trump Budget Eliminates Funding for Emergency Care for Kids
A day after President Trump released the details of the Administration's fiscal year 2018 budget, the Emergency Nurses Association released a statement with 10 other health organizations opposing the proposed elimination of funding for the federal Emergency Medical Services for Children (EMSC) program. Funding for the EMSC program has remained relatively flat since 2010, and was funded in fiscal year 2017 at just over $20 million. The statement was released on May 24, coinciding with Emergency Medical Services for Children Day. All told, the budget would reduce spending on safety-net programs like EMSC and Medicaid by more than $1 trillion over 10 years.
"For more than 30 years, the EMSC program has worked to improve the quality of care children receive, no matter where they live or require treatment," said the statement opposing the elimination of the program. "Children are not just little adults - emergency services and equipment like ventilation and airway equipment, defibrillators, and life-saving drugs need to be sized and dosed especially for children." While the president's budget acts as a roadmap for the Administration's priorities, it does not carry the weight of law. All federal spending decisions, including specific cuts to programs must be approved by Congress.
The EMSC program is the only federal program devoted to improving pediatric emergency care, including in pre-hospital EMS systems and hospital emergency departments. It funds critical research that aims to improve screening of children in the emergency department for substance use such as opioid dependency as well as the screening of teens at risk for suicide that may be linked to substance use or mental health disorders. ENA has issued an Action Alert encouraging EN411 Legislative Action Network members to write their members of Congress opposing the elimination of funding for EMSC.
As Summer Begins, CDC Report Recalls Zika Risks
Earlier this month, the Centers for Disease Control and Prevention (CDC) released a report on a large study of the rate of birth defects for each trimester in which the mother became pregnant. The study confirmed earlier studies that a first trimester infection puts the fetus or child at greatest risk for developing related birth defects. In women with a confirmed Zika infection during the first trimester, 8% had a baby or fetus with Zika-related birth defects. That fell to 5% in the second trimester and 4% in the third.
As of June 7, there have been 627 Zika cases reported in the United States and its territories during 2017. All but one of the 125 cases in the United States were attributable to travel, while all 502 cases in U.S. territories were thought to have been acquired from local mosquitoes. The CDC continues to advise women who are pregnant or who may become pregnant to take precautions if living in or visiting south Florida, Texas, the U.S. territories, or anywhere with hot and humid conditions that are prone to mosquito infestations. As of June 15, Brownsville in Cameron County, Texas, is the only designated Zika cautionary area in the United States. Miami-Dade County in Florida was removed from this list June 2.
Senate Republicans Hope for Healthcare Vote by July 4 Recess
Senate leaders are pushing to complete and vote on its version of a Republican healthcare bill before theJuly 4 recess so they can move onto other business, such as tax reform. Getting 50 votes needed to pass it - with Vice President Mike Pence breaking the tie - may prove difficult, however. Republicans currently control 52 seats and important differences on any replacement legislation remain between moderates and conservative members.
As passed in the House, the bill includes provisions that would roll back the expansion of Medicaid that was included in the Affordable Care Act (ACA), as well as fundamentally change how Medicaid operates and how states receive funding from the federal government. Overhauling Medicaid, however, may prove to be a difficult proposition. The House bill proposes to freeze federal funding for the Medicaid expansion in 2020, then gradually phase-out the expanded program. Some Republican senators are considering a more gradual phase-out, and some say they won't support a phase-out at all. There also is little agreement on how to lower the cost of insurance premiums and deductibles while ensuring access to coverage, a key goal of Obamacare repeal and replace efforts. According to Republican leadership in the Senate, the bill - which passed the House of Representatives on May 5 - will need considerable changes before it can be brought to the floor for a vote.
This bill is still in committee of origin. If you have an opinion about whether it should or shouldn’t go out of committee for a vote contact the Senate Health and Provider services Committee.
This bill is very similar to the immunization bill from last session, and it has the same problems: allows hospitals to overrule an individual's healthcare provider regarding whether an immunization is needed or medically contraindicated, allows hospitals to overrule an individual's determination of whether the individual's religion precludes immunizations, and provides hospitals immunity for wrongful termination of employees. Moreover, nurses are not even included in the bill's definition of "health care professional." SB 133 is assigned to the Health and Provider Services Committee.
Also assigned to the Health and Provider Services Committee, would benefit from your support to move it out of committee.
Recommends an interim study committee be assigned the topic of Indiana's trauma care system, including statewide uniformity and funding. SB 174 is assigned to the Health & Provider Services Committee.
Adds an available INSPECT entry for when a patient is participating in a pain management contract with a designated practitioner. On 2/1, the Health & Provider Services Committee amended and passed SB 151. The amendment allows more government entities to access INSPECT and to add the content of SB 157 to the bill. SB 157 requires PLA to form a workgroup to study the collection of data regarding overdose intervention drugs. On 2/7, the Senate passed SB 151, which heads to the House.
This bill in its current form only extends to employees of Home Health Agencies. It will set the precedent for expansion in my opinion. Contact your legislator in the house now to voice your opinion. (3/4)
Requires home health agencies to drug test all applicants, and to test all employees at least annually, as well as when the agency has reasonable suspicion the employee is engaged in the illegal use of a controlled substance. Allows the agencies to discipline or terminate employees for a positive result or a refusal. On 1/31, Senate amended SB 513 provide home health agencies civil immunity for employee discipline or termination resulting from a drug test. On 2/2, the Senate passed SB 513, which heads to the House.
Still time to voice an opinion on this bill, note the suggested information is not scientifically supported. Contact your legislator in the Senate Judiciary Committee. 3/4
Before a chemical abortion is undertaken, requires the pregnant woman to be informed that the procedure may possibly be reversed. On 2/27, the House passed HB 1128. The bill is in the Senate and assigned to the Judiciary Committee.
Hospitals are required to offer certain services to sex crime victims, which are reimbursed by the Indiana criminal justice institute. Currently, HIV prophylactic medication is paid at the discretion of the institute. SB 279 removes this discretion and requires offer of and reimbursement for HIV prophylactic medication to sex crime victims. This would increase annual costs by $115K-768K. Senator Lanane, the bill's author, testified in committee that the issue was brought to his attention by a couple SANE nurses. On 2/28, the Senate passed SB 279, which now goes to the House.
Hospital police departments currently must operate on the property of a hospital. SB 112 expands property to include surrounding grounds and hospital satellite offices and facilities. It also allows them to function at a health system, which is defined as any entity affiliated with the parent corporation of a hospital or any entity affiliated with the hospital through ownership, governance, or membership. On 1/24, the Senate passed SB 112, which now heads to the House.
Encouraging your support for this bill. The Jobs Creation Committee is a group of appointed business persons who make recommendations on job creation for health related jobs. This bill supports moving this function to the Professional Licensing Agency, a more suitable match.
Your Support can be sent to your House Representative now. (3/4)
Transfers the duties of the JCC to the Professional Licensing Agency (PLA), so instead of the JCC gathering information and making recommendations to the PLA, the PLA would undertake that responsibility. The JCC reviews all licensed professions in an effort to reduce government regulation. You may recall that the JCC held a hearing on nursing in October. Under SB 114, the JCC would issue a final report this summer, which would include any recommendations for a change in nursing regulation. On 1/26, the Committee on Commerce and Technology passed the bill. On 2/6, the Senate passed SB 114, which heads to the House.
This bill would require you, as a licensed healthcare provider, to complete training on suicide prevention. Contact your representative in the House to voice your opinion. (3/4)
DMHA is authorized to require licensed healthcare providers to complete an evidence based training program concerning suicide assessment, treatment, and management. EMS providers are required to complete suicide prevention training before receiving a state license or certificate. Requires suicide prevention programming in schools. On 2/15, the Health & Provider Services Committee passed SB 506, and on 2/23, the bill passed the Senate. SB 506 now heads to the House.
Assigned to the Public Health Committee of the House. Contact them to support move out of committee.
Removes the collaboration requirement for advanced practice nurses. Addresses language in code sections on (1) community mental health center services, (2) HIV testing, (3) prescribing stimulant medication for children with ADD or ADHD, and (4) APN prescriptive authority. HB 1409 is assigned to the Public Health Committee.
Requires the Indiana Emergency Medical Services Commission and the Department of Health to evaluate the use of air ambulance services in Indiana and implement statewide standards with the goal of preventing the overuse of air ambulance services. This does not apply to transfers between health facilities. On 2/14, the Committee on Homeland Security and Transportation passed SB 119, and on 2/20 the bill passed the Senate. SB 119 now heads to the House.
If you have feelings one way or the other your personal stories will have an impact. This bill does not affect intrahospital transport, only scene transport. Call or write your House Representative now.
Remains in Committee, contact the House Courts and Criminal Code Committee to have this moved to vote.
In memory of the Indiana nurse who was murdered by her estranged ex-husband, HB 1518 reforms Indiana law regarding arrest warrants, charges of domestic violence, and protective orders. HB 1518 is assigned to the Courts and Criminal Code Committee.
Requires the health department to issue registrations to approved physicians, caregivers, and patients researching the use of hemp oil to treat intractable epilepsy. SB 15 exempts those registered from criminal penalty associated with hemp oil. No provision is made for a nurse, so the current language would preclude a nurse from being involved in the dispensing of the hemp oil in the study. ISNA offered committee testimony asking for nurses to be included in the immunity provisions of the bill, and the committee members appeared receptive to the proposal. On 2/7, the committee amended and passed SB 15. The amendment adds nurses and pharmacists to immunity provisions and allows pharmacists to dispense up to a 30-day supply. On 2/13, the Senate amended SB 15 to specifically include advanced practice nurses. On 2/14, the Senate passed SB 15 by a vote of 38-12. The bill is in the House and assigned to the Courts and Criminal Code Committee.
Feb. 06--SOUTH BEND -- As one well-known ambulance service in Indiana is leaving St. Plus, inHealth would be open to private calls, directly from the customers, for patient transports. InHealth will be staffed to handle the work ahead, Donahue added. Even with the many workers from Prompt's South Bend location who have chosen to work for inHealth, the new company will do more hiring.
In a report released in 2016, the National Academies of Science, Engineering and Mathematics (NASEM) noted that as many as 30,000 deaths in 2014 could have been prevented if trauma care had been optimal. Included in a series of recommendations in the report was improved coordination and better integration of military and civilian trauma care.
On February 6, Rep. Michael Burgess, Chairman of the Health Subcommittee of the powerful House Energy and Commerce Committee reintroduced the Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act (MISSION ZERO Act) to address NASEM's recommendations. The MISSION ZERO Act (H.R. 880) would create a grant program to embed military trauma teams and providers, including emergency nurses, in civilian facilities. This will encourage the transfer of skills learned on the battlefield to civilian practice. Also, by allowing military trauma providers to work in civilian facilities, those providers are better able to keep their skills sharp while not deployed.
The Occupational Safety and Health Administration (OSHA) is seeking comments on a national standard to prevent workplace violence in healthcare and social service settings. As part of its request for information (RFI), members of the Emergency Nurses Association testified about workplace violence in the emergency department during an OSHA meeting on Jan. 10. The public meeting allowed employees, employers and other stakeholders to provide testimony describing their experiences with workplace violence. The meeting also included a discussion among stakeholders on strategies and tactics to prevent and respond to workplace violence.
Several major themes arose during the meeting: the culture of violence is pervasive and needs to change; workplace violence can happen to anyone, anytime, and anywhere; how workplace violence is defined is important; and better training is needed for staff at all levels. The comment period for the RFI is open until April 6. Submissions can be made electronically, by FAX or by regular mail. Go to https://www.federalregister.gov/documents/2016/12/07/2016-29197/prevention-of-workplace-violence-in-healthcare-and-social-assistance for more information.
In an effort to increase access to primary care and decrease waiting times for our nation's veterans, the Department of Veterans Affairs (VA) has granted veterans direct access to its estimated 5,000 advanced practice registered nurses (APRNs). In recent years, the VA has been mired by accusations of mismanagement, as it became know that some veterans had to wait days, weeks and even months for treatment and basic primary care. Health care organizations, like ENA, commented this summer in support of the rule providing advance practice nurses, such as nurse practitioners and clinical nurse specialists, with full practice authority at VA. These groups argued, successfully, that these professionals can help improve access to high-quality care for veterans.
"This rule-making increases veterans' access to VA healthcare by expanding the pool of qualified healthcare professionals who are authorized to provide primary healthcare and other related healthcare services to the full extent of their education, training, and certification, without the clinical supervision of physicians," the VA said in a summary of the final rule.
A report released by the U.S. Department of Health and Human Services (HHS) shows hospital-acquired conditions dropped 21 percent with 3 million fewer adverse events over a five-year period. According the report, approximately 125,000 fewer patients died due to hospital-acquired conditions and more than $28 billion in healthcare costs were saved from 2010 through 2015. Hospital-acquired conditions are those a patient develops while in the hospital being treated for something else. The data was compiled and analyzed by the Agency for Healthcare Research and Quality (AHRQ). These successes are the result of a nationwide effort to improve patient safety which includes programs stemming from the Affordable Care Act.
HHS selected specific conditions as focus areas because they occur frequently and appear to be largely preventable, based on existing evidence. Hospital-acquired conditions selected include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others.
The U.S. Congress, with the support of the incoming Trump Administration, has indicated they will move quickly in the 115th Congress to make major changes to the U.S. health care system, including the repeal and possible replacement of the Affordable Care Act. The Republican Party controls both the Senate and the House, thereby giving them control of the chairmanship of every congressional committee and the ability to set the legislative agenda in both chambers. They have stated that their top legislative priority is repeal of the ACA.
Depending on the replacement health plan that is passed, a repeal of the ACA could lead to more than 20 million Americans losing health insurance coverage. Many of these patients, especially those who gained coverage through the expansion of Medicaid, utilize emergency departments for many of their health care needs. In fact, in states that expanded Medicaid pursuant to the ACA, there was a 31 percent decrease in uninsured ED visits. There was a corresponding increase in Medicaid-paid ED visits in those states.
ENA recently submitted a letter to House and Senate leadership detailing ENA's position with respect to the possible changes to the U.S. health care system. It focuses on principles of importance to maintaining access to affordable, high-quality emergency care.
Indiana House Bill 1474 (regarding APRN Full Practice authority) is set to go to committee on Monday February 20, 2017, where proposed amendments may be made. This is the final chance for this bill to make it out of committee and on to the full house chamber.
No public testimony will be held on Monday, however there is still time to contact the committee members TODAY! Since the bill is likely open to compromise type amendments be specific in your message to the committee members. One amendment that might be on the table is a graduated collaborative practice where a novice APRN is required to operate in a collaborative practice for a few years before advancing to independent practice.
Email the committee members TODAY to support this bill
Rep. Cindy Kirchhofer (Chair) firstname.lastname@example.org
Rep. Ron Bacon (Vice Chair) email@example.com
Rep. Robert Behning firstname.lastname@example.org
Rep. Steve Davisson email@example.com
Rep. Dave Frizzell firstname.lastname@example.org
Rep. Don Lehe email@example.com
Rep. Hal Slager firstname.lastname@example.org
Rep. Dennis Zent email@example.com
Rep. Cindy Ziemke firstname.lastname@example.org
Rep. Robin Shackleford email@example.com
Rep. B. Patrick Bauer firstname.lastname@example.org
Rep. Charlie Brown email@example.com
Rep. Greg Porter firstname.lastname@example.org