[Congressional Record (Bound Edition), Volume 147 (2001), Part 2]
[Extensions of Remarks]
[Page 2734]
[From the U.S. Government Publishing Office, www.gpo.gov]



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

                                 ______
                                 

                            HON. MAC COLLINS

                               of georgia

                    in the house of representatives

                        Thursday, March 1, 2001

  Mr. COLLINS. Mr. Speaker, today, I am pleased to introduce the 
Medicare Certified Registered Nurse First Assistant (CRNFA) Direct 
Reimbursement Act of 2001, which will provide equity in reimbursement 
for certified registered nurse first assistants who provide surgical 
first assisting services to Medicare patients. I introduced this 
legislation in the 106th Congress and am grateful that, last year, the 
Congress asked the General Accounting Office to study the issue and 
report within a year on the quality of care and cost effectiveness 
provided by CRNFAs. While I deeply appreciate this support, I also 
believe it is important to continue this effort on behalf of CRNFAs and 
am grateful for the fifteen colleagues that have agreed to rejoin me in 
this effort as original cosponsors of this legislation.
  Having received more advanced education and training in first 
assisting than any other nonphysician 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, Brenda C. Ulmer, RN, MN, CNOR, in bringing this issue 
forward. I also thank the nurses of AORN for contacting their 
Representatives regarding this important bill; their help has been 
indispensable. 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 Medicare Certified Registered Nurse 
First Assistant Direct Reimbursement Act of 2001.

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