RNFA Reimbursement Advocacy Opportunity

Publish Date: March 1, 2016


The IOM’s 2010 The Future of Nursing: Leading Change, Advancing Health report calls for more nurse involvement in the reform of our health care systems. One direct result of the report has been the formation of state action coalitions to implement the recommendations in the report at the state, local and regional level. The state action coalitions are charged with convening nurses and non-nurses across a state to implement the four key messages in the report:

  1. Nurses should practice to the full extent of their education and training (scope of practice)
  2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression
  3. Nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States
  4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

The state action coalitions present an opportune forum for states to formalize support for RNFA reimbursement initiatives. The coalitions bring together diverse groups of stakeholders, such as provider and payer groups, employers, consumer groups, and educators.

In 2012, New York’s state action coalition composed a letter to United States Senator Charles Schumer identifying Medicare’s continued refusal to recognize first assistant services provided by registered nurse first assistants (RNFAs) as eligible for reimbursement as a scope of practice barrier. The letter advises that recognition and resolution of this barrier is wholly consistent with the recommendations in the Future of Nursing report. New York’s governor signed an RNFA reimbursement bill into law in December 2015.

RNFAs are experienced operating room nurses who are well-qualified to practice as first assistants at surgery. RNFAs are needed to provide first assistant services across the country, especially in light of the shortage of physicians and residents available to first assist and the health care reform climate which requires the most cost-effective quality care in today’s operating rooms. In November 2012, the Texas state action coalition provided a similar letter identifying lack of reimbursement as a scope of practice barrier.

AORN government affairs and the AORN RNFA Specialty Assembly are encouraging RNFAs to seek similar support from their state action coalitions. The IOM Future of Nursing report is well-known and respected by legislators and staff. Multiple letters of this type from state action coalitions, if brought to the attention of various legislators, could serve to influence initiatives to change both Medicare and state insurance laws.

AORN members are encouraged to pursue similar action with their IOM state action coalition. Members and RNFAs should contact AORN’s director of legal and government affairs Amy Hader for advocacy support and assistance with a template letter.