[Congressional Record (Bound Edition), Volume 146 (2000), Part 2]
[Extensions of Remarks]
[Page 2800]
[From the U.S. Government Publishing Office, www.gpo.gov]



IMPROVE THE QUALITY AND COST EFFICIENCY OF THE MEDICARE SYSTEM: SUPPORT 
     REIMBURSEMENT FOR CERTIFIED REGISTERED NURSE FIRST ASSISTANTS

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                            HON. MAC COLLINS

                               of georgia

                    in the house of representatives

                        Tuesday, March 14, 2000

  Mr. COLLINS. Mr. Speaker, today, I am pleased to introduce The 
Certified Registered Nurse First Assistant (CRNFA) Direct Reimbursement 
Act of 2000, which will provide equity in reimbursement for certified 
registered nurse first assistants who provide surgical first assisting 
services to Medicare patients.
  Having received more advanced education and training in first 
assisting than any other non-physician provider, CRNFAs serve a vital 
role, directly assisting physicians with surgical procedures. 
Additionally, CRNFAs and RNFAs are the only providers--aside from the 
rare physician making house calls--who sometimes provide post-operative 
care by actually visiting patients at home following surgery. Thus, not 
only do CRNFAs have more clinical experience and education than other 
non-physician providers, but they also provide continuity of care to 
patients enabling higher quality and better patient outcomes.
  CRNFAs also provide the additional benefit of cost efficiency. Health 
claims data from the Health Care Financing Administration (HCFA) reveal 
that physicians file more than 90% of the first assistant at surgery 
claims for Medicare reimbursement. Physicians receive 16 percent of the 
surgeon's fee for serving as a surgical first assistant. Under this 
legislation, CRNFAs will receive only 13.6 percent of the surgeon's fee 
for providing first assistant services. Furthermore, CRNFAs are equally 
as cost-effective as other non-physician first assisting providers who 
currently are reimbursed at 13.6 percent of the surgeon's fee for first 
assisting. Use of CRNFAs would, therefore, be a high quality yet cost-
effective alternative for the nation's health care delivery system, 
affording additional flexibility to surgeons, hospitals and ambulatory 
surgery centers.
  In closing, I would like to express my appreciation for the hard work 
of the Association of periOperative Registered Nurses (AORN) and its 
president, Patricia Seifert, RN, in bringing this issue forward. As a 
provider of health care, the CRNFA is a viable solution for controlling 
rising health care costs. Working in collaborative practice with 
surgeons, CRNFAs are cost-effective to the patient and to the health 
care delivery system. I urge my colleagues to join me in supporting 
equity for certified registered nurse first assistants by cosponsoring 
The Certified Registered Nurse First Assistant Direct Reimbursement Act 
of 2000.

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