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Running head: Advocacy Experience Self-Assessment
Legislation and Advocacy Experience a Self-Assessment
Thomas A. Kane
Ferris State University
Abstract
The ability to advocate for one’s profession is imperative to advance the content and scope of the profession, insure adequate reimbursement to perpetuate the profession and attract new persons to the profession. In order to advocate effectively, knowledge of and experience in the legislative process, ability to communicate fluently verbally and in writing regarding the issues to the individuals whom can improve or change the issue at hand and a thorough knowledge of the issues being advocated for is essential. There are many areas related to advocacy, which may include but are not limited to health care policy, legislative activities, issues related to health care delivery including reimbursement, access, health care organizations, cost control mechanisms, quality and ethics. This paper will explore the writer’s experiences and knowledge as well as goals for improving advocacy skills.
Legislation and Advocacy Experience a Self-Assessment
Purpose
The purpose of this paper is to examine knowledge and experiences that the writer has regarding health care policy, legislative activities and issues related to health care delivery including reimbursement, access, health care organizations, cost control mechanisms, quality and ethics. The paper will also address what outcomes the writer desires from the course (NURS 521) as well as how the course instructor and the writers peers can support the achievement of the outcomes.
History
My experience with advocacy and legislative efforts dates back to the mid 1980’s. At that time, I was not yet a RN but was a respiratory therapist. In an effort to improve the profession, I was a member of both the Michigan Society for Respiratory Care (MSRC) and the American Association for Respiratory Care (AARC). At that time, Respiratory Therapists were not licensed in Michigan and the MSRC was beginning grass root efforts to make legislators aware of the need for licensure for this discipline. I held several positions in the MSRC including two terms as president in 1995 and 2003 (Michiganrc.org, History 2015) during which time in conjunction with lobbyists, the society advocated for the profession in Michigan for licensure. During this time, I had the opportunity to meet personally with many legislators and legislative aids regarding this initiative, was invited to, attended three gubernatorial inaugurations, and had the opportunity to testify several times in front of each house as the president of the society. During this time, I also began liaisons’ with other professions in Michigan on behalf of the society who were fostering similar initiatives including speech and language pathologists, occupational therapists who had title registry but not licensure and radiology technologists. During the Republican administrations, we found that the administrations favored self-regulation by the professions in an effort to be economical with the taxpayer’s money. During these years, we attempted to have the licensure added as an amendment to many bills and continued to meet with many parties in an effort for passage. One of the most time consuming portions of this initiative was discussions with and keeping support from other licensed professions whose boards were formally asked if they supported the measure. During my second term as president, there was a change in the gubernatorial office to a governor that was amiable to licensure (also a Democrat). Many long hours were spent with attorneys and lobbyists to construct a bill acceptable to both houses and the governor and in February 2004 45 days after my term ended, the governor signed the bill into law (Michiganrc.org, 2015. Advocacy). The efforts encompassed components of patient safety as Michigan was one of the last to states to enact licensure and individuals that were not eligible to be licensed in other states flocked to Michigan as there were no criteria to practice. Access was addressed as there were adversaries to the bill that purported that the licensure would reduce patient access. The profession is currently facing deregulation and delicensure under the Snyder administration and efforts continue to protect respiratory care licensure in Michigan law (Michiganrc.org, (2015). Advocacy).
During my time as a licensed Nursing Home Administrator, I was a member of the Michigan Homes and Services for the Aging the advocate for the non-profit and denomination based nursing homes in Michigan. I was also a member of the Health Care Association of Michigan which is the advocate for the not for profit as well as the for profit nursing homes in Michigan. I was involved with both of these organizations on the patient advocacy and quality improvement areas as an administrator with a clinical background. We also did meet your legislator days for the Michigan House and Senate to advocate for continued Medicaid and Medicare reimbursement as well as to ask for improved communication and relationships from the state survey teams. There existed at the time a very adversarial relationship between the industry and the surveyors that resulted in high turnover of administrators and directors of nursing. The ongoing turnover adversely affected the ability to recruit and retain staff, primarily nurses that in turn affected the continuity of care and patient outcomes. From a political perspective, the nature of the relationship was driven by the long time Michigan Attorney General Frank Kelly. In addition to meeting with legislators, I was part of groups of advocates that met with the Director of the Michigan Department of Community and Industry Services in an effort to improve communications, solidify expectations and improve outcomes. On a national level, I was involved in grass root efforts to mold the change from a cost based payment system in the long-term care industry to the Relative Utilization Group Groupers (RUGs Groupers). This change had several iterations, which ultimately saved Medicare dollarsbut resulted in the closure of a significant number of nursing homes just as Diagnostic Related Groups (DRGs) had done to acute care hospitals when implemented.
Another experience I had regarding interacting with the legislature was in the realm of hyperbaric medicine. During the operationalization of a center for wound healing and hyperbaric medicine in Alpena Michigan, the Fire Marshall from the Michigan Bureau of Fire Safety contended that the area in which the chamber was located did not meet hospital inpatient building criteria. The ruling meant that the center was closed to operation immediately. In conjunction with other members of the staff, we met with members of the Fire Marshalls office to review the structure of the center, previous occupancy and previous approvals from the State of Michigan Engineering office, the Bureau of Fire Safety and the Department of Community Health. As ongoing appeals were denied, a request was made to CMS for a ruling as to the ability to occupy the area and bill Medicare for services. At the same time, we appealed to our United States Representative and Senators. Senator Carl Levin became involved and I spent time advocating with Senator Levin who was also in the midst of opening the first NOAA freshwater sanctuary in the same area. Through many months of negotiation, I was able to reopen the center after making some conciliations the most major being putting a fire door on the dirty utility room. In another venue related to wound care and hyperbaric medicine, I was requested by Senator Levin to travel to American Samoa and advocate for a center there. As a nurse, I was keenly interested in the level of medicine and resources as well as the large percentage of the population with diabetic wounds resulting inn amputation. I travelled to American Samoa to visit the Lyndon Baines Johnson (LBJ) tropical hospital to advocate for the hospital and for the people of American Samoa in 2008 (Samoa News, 2012). During my stay there, I met with the United States Representative to the territory, the territorial governor as well as the tribal and talking chiefs of the villages on the island. The advocacy effort included determining the available physical resources and potential location in the hospital (i.e. each typhoon season part of the mountain behind the hospital would wash away into the open lobby of the hospital creating infection control and operational issues), revenue availability (US territories did not have the same reimbursement as US states), how to train, how to maintain competency and how to integrate an otherwise foreign treatment in to their culture (i.e. culturally they do not believe in the use of insulin). This initiative included components of local, federal and territorial law, advocating for a territory as well as a culture, financial components/constraints, resource constraints and brutal environmental conditions (being 3 degrees off the equator, everything equipment included is quickly claimed by the jungle) as well as patient access. In 2012 the center was opened (Samoa News, 2012) and I have been invited to return to expand the initiative.
I have had the opportunity to be the nurse executive for a Federally Qualified Health Center. Advocacy efforts with this organization of four primary care offices and two school based health centers (Hugo 2015), included developing grass root campaigns with patients who would have no access to health care without the clinics, which were in a remote rural area. Efforts were focused on the federal level for ongoing reimbursement/funding for the clinics directly meeting with United States Representatives and Senators as well as with Kathleen Sebelius Secretary of Health and Human Services. Another component of the advocacy I was involved with at this time was the Michigan Department of Education pilot program for school based health centers. When initially instituted there was a limited amount of time the granting was approved to the Department of Education for the demonstration project. The centers had an RN coordinator, a nurse practitioner, a MSW, a support nurse for the provider and a receptionist/billing coordinator. I spent a significant amount of time documenting need, improved access to a pediatric population (K-12), improvements in health to include, improved nutrition, vast improvement in vaccination rate, decrease in obesity and a ninety percent reduction in adolescent pregnancy for the school system we were embedded in. Interactions included; the local school board, the State Department of Education, the board of the FQHC sponsoring the School Based Health Center, presentations with the National Association of School Based Health Centers, project officers from the state of Michigan as well the federal government and grass root campaigns from parents and students to legislators to continue the funding for the center.
Involvement in local politics at the township level allowed me to experience both advocacy for my township as I was the fire chief (Greentownshipmi.org, 2005Fire) and was involved in efforts post 911 to bring the department to the new federal standards that included advocating on a federal level for volunteer departments to be eligible for federal Assistance to Firefighter grants. As the chair of the local planning board (Greentownshipmi.org, 2015Planning), I was the recipient of lobbying and advocacy efforts. These came in the form of residents advocating for or against enacting ordinances for blight, outdoor wood stoves, animal husbandry, adult erotic operations/businesses, road width and number and type of pets to name a few.
Outcomes and Support
The outcomes I hope to achieve related to this course are to become more aware of and involved in advocacy related to nursing issues and patient issues. As a student in the informatics track, I would be particularly interested in efforts or initiatives related to the improvement of patient care and outcomes in relation either to efficient use of an electronic health record, analytics that can be utilized for evidence based care or improved work flow activities that can improve the quality of work life for nurses and other clinicians. The instructor can support these outcomes by point me to initiatives or advocacy that will allow me to achieve these long-term goals. I do not consider organized labor to be an advocate for nursing as in my personal experience as a member, they advocate for the lowest common denominator in practice and improvement of the profession. My peers can assist by providing examples of experiences and avenues by which to get involved. I am anticipating that the diversity of this course’s students will be able to provide a significant amount information and direction for me.
References
Greentownshipmi.org, (2015).Planning Commission Green Township. Retrieved 18 January 2015, from
Greentownshipmi.org, (2015).Fire Dept Green Township. Retrieved 18 January 2015, from
Hugo Cubias, I. (2015).Thunder Bay Community Health Service - Clinic Sites.Tbchs.org. Retrieved 18 January 2015, from
Michiganrc.org, (2015).Advocacy Michigan Society for Respiratory Care. Retrieved 18 January 2015, from
Michiganrc.org, (2015).MSRC History Michigan Society for Respiratory Care. Retrieved 18 January 2015, from
Samoa News, (2012).LBJ unveils newest hospital equipment, a hyperbaric chamber. Retrieved 18 January 2015, from