Washington Watch

By Connie Helmlinger and Stephanie Reed

Managed Care Legislation: ANA Testifies in Federal-State Hearing

At the invitation of Representative Patrick Kennedy (D-RI), ANA President Beverly L. Malone, PhD, RN, FAAN, testified April 2 at a joint federal-state hearing on managed care reform and liability legislation. The focus of the hearing, held at the State House in Providence, Rhode Island, was the contentious issue of accountability for treatment decisions in health care. Health plans have maintained that they have no responsibility for adverse consequences of their payment denials, on the grounds that they make judgments only on the terms of policy coverage, not treatments.

"It is a cruel distinction," Malone said of this argument, "because its effect is to deny treatment to the patients for whom we as nurses advocate, and to deny redress for the harm that the denial causes. Clearly, coverage predicated on `medical necessity' means that health plans are making treatment decisions."

Malone also addressed other managed care issues in her testimony, including

• the right to access health care services along the full continuum of care, with specific emphasis on legislation that would assure access to emergency services without preauthorization and under a "prudent layperson" definition of an emergency;
  
• the right of consumers to be empowered partners in making health care decisions and to have full information about staffing levels, clinical outcomes, and quality outcomes for institutional providers who contract with health plans;
  
• the provision of quality health care services in an interdisciplinary, collaborative manner with registered nurses retaining their essential role in providing and directing health care in all settings. Malone spoke to the importance of legislative prohibitions on discrimination against health care professionals on the basis of the type of license they hold, saying that such a prohibition is "crucial in ensuring that the first concern is that the patient have access to appropriate, quality services, not on the license held by the provider."

Malone's testimony was drawn from the principles of Managed Care: Nursing's Blueprint for Action, which was developed by the ANA's Managed Care Task Force and recently adopted by the Board of Directors. (See Issues Update, below, for more on the principles.)

"I would like to reiterate three issues that should be included in any comprehensive managed care legislation," Malone concluded. "First, nurses must be able to advocate for their patients without fear of retribution. Second, health care consumers have a right to full and comparable information about staffing and outcomes in health care institutions.

"And, finally, consumers must have access to a full range of health care providers, without the interference of artificial barriers to practice for practitioners they may choose," Malone said.

Following her testimony, Malone and representatives of the Rhode Island State Nurses Association joined the nursing staff at the Miriam Hospital in Providence at a reception to celebrate its recent award of Magnet Hospital status by the American Nurses Credentialing Center.

International News

Malone Appointed to World Health Assembly

Continuing the ANA's growing tradition of international involvement, ANA President Beverly Malone, PhD, RN, FAAN, was one of several individuals appointed by President Clinton to attend the 51st World Health Assembly, May 11-16, in Geneva, Switzerland.

"I am truly honored to have been selected to represent my nursing colleagues to our health care comrades around the world," Malone said. "Our participation in this international forum will only serve to advance the nursing profession worldwide."

Sponsored by the World Health Organization (WHO), the World Health Assembly provides an annual opportunity for health care professionals from around the globe to come together to develop solutions for health care concerns common to all nations. The nursing profession has enjoyed a growing prominence at the meeting each year, and was called in a 1993 resolution on occupational health "the bulk and backbone of health services in developing and developed countries alike."

"During the International Council of Nurses meeting last summer, I truly came to appreciate how much other countries have to offer us in our own healing and problem solving," Malone said. "Participation in the international community will not only move us into the next century but could prove beneficial in dealing with problems that nurses are facing today."

Held in May of each year, the World Health Assembly is attended by delegations from member states of WHO. ANA immediate past president Virginia Trotter Betts, JD, MSN, RN, FAAN, represented nursing's interests on the U.S. delegation in 1993 and 1996.

In addition to budget approval and discussion of key policy issues, celebration will be a predominant theme of this year's World Health Assembly as WHO turns 50. During its existence, WHO-led coalitions succeeded in eradicating smallpox and other deadly diseases, developed standards for health care worldwide, and raised international awareness of environmental health.

In addition, during WHO's half-century, human longevity worldwide has increased by more than 40%. The average life expectancy at birth has risen from around 46 years in the early 1950s to almost 65 years by 1996, according to WHO.

Connie Helmlinger is periodicals manager, and Stephanie Reed is associate director of federal government relations, at the American Nurses Association.