AORN endorses lower EO exposure limit proposed by OSHA

rn AORN has written the government en- dorsing a lower exposure limit for ethylene oxide. The new standard should be phased in over six months to one year to allow hospitals time to modify their current systems, the Asso- ciation suggested.

A new proposed standard of 1 part per mil- lion (ppm) averaged over an eight-hour period was issued by the Occupational Safety and Health Administration (OSHA) on April 21. The current standard is 50 ppm.

Experts agree the current standard is too high. In the past several years, new studies have indicated correlations between EO expo- sure and cancer, genetic mutations, and spon- taneous abortions.

The difficulty is in settling on a standard that is safe for employees yet practical for hospitals to achieve and monitor. AORN has been con- cerned that too low a standard might force some hospitals to abandon EO sterilization. Consequences might be inability to use certain equipment, greater use of high-level disinfec- tion perhaps with higher infection rates, and higher costs because of a shorter life and higher inventories for delicate and expensive equipment.

AORN believes that hospitals might be able to find solutions to these problems if they were given time in which to meet the new standard. The Association also recommended that more research be done to establish more clearly the relationship between EO and health risks.

Legislation &m -?

rn By now, you have probably heard the three little words that are going to change your hospital’s way of doing business-diagnostic- related groups (DRGs). Regulations are due this month to carry out a law signed by the President in April.

The law sets forth a new system, called pro- spective reimbursement, which the govern- ment will use in paying hospitals for the care of Medicare and Medicaid patients. A hospital will receive a flat payment per case, based on the patient’s diagnosis. DRGs are the 467 categories of diagnoses on which payments will be based. If a hospital can treat patients for less, it may keep the difference.

Major features of the law are: 0 It applies only to inpatient services.

(Physicians’ fees may be covered later.) Cer- tain types of facilities, such as psychiatric and children’s hospitals, are excluded.

0 Because hospitals differ, 20 DRG rates will be set up. The country will be divided into nine regions, each with an urban and rural DRG rate. There will also be national urban and rural rates.

0 Beginning in October, the law will be phased in over four years. Each year, the per- centage of costs reimbursed according to DRGs will increase.

0 DRG rates will be adjusted each year and recalibrated every four years, beginning in 1986.

0 Hospitals must have a peer review or- ganization (PRO) to review its diagnostic in- formation, admissions, and care given.

0 A national commission will monitor the setting of DRG rates. Nurses are supposed to be among its members.

0 Capital and medical education direct costs are excluded for the time being.

288 AORN Journal, August 1983, Vol38, Ni, 2

0 States may apply for waivers from the new system if they have a rate-setting system of their own.

The government’s goal is to bring health care costs under control by providing hospitals with an incentive to economize. At the same time, officials hope the system will enable them to budget more closely for health care, be- cause they will know in advance approximately what the care will cost.

In contrast, the current system allows hospi- tals to be paid whatever they say it costs them to care for Medicare and Medicaid patients. The costs have gotten out of hand, with health care costs rising about three times the national inflation rate in 1982. Congress and the Presi- dent had given up on the old system.

The new law is the first major change in Medicare and Medicaid reimbursement since the programs began in 1966. Because the law applies only to the government programs, a major concern is that hospitals will shift their expenses over to patients covered by private insurance. Regardless of the many unan- swered questions, the system is one we are likely to be living with for some time.

rn How will the DRG system affect nurs- ing? Will RNs be given more responsibility as hospital administrators seek their aid in cutting costs? Or will hospitals find their services too expensive, hiring more technicians and aides? Nursing leaders see the future differently, according to an article in Modern Healthcare.

Carolyne K Davis, RN, who administers Medicare and Medicaid as head of the Health Care Financing Administration, sees a more important role for nurses, especially head nurses. She believes they are in a key position to spot both complications and candidates for early discharge, which would affect a hospi- tal’s costs.

Because administrators see nursing as such a large share of the budget, they may be tempt- ed to cut the RN staff rather than give it more responsibility. That is the view of Virginia Jar- ratt, RN, president of the National League for Nursing. Nurses might be replaced by lesser- paid personnel. On the other hand, the new system might free nurses from nonnursing tasks, which could be assigned to other work- ers, she says.

Nurses should be a part of budgetary deci-

sions because they often are “balancers or buffers between administrators and doctors,” said Eunice Cole, RN, president of the Ameri- can Nurses’ Association (ANA).

ANA has applied to the government for a grant to aid in refining the DRGs. ANA would classify the DRGs according to nursing diag- noses with the aim of reflecting patient care outcomes from nursing services.

rn At last someone is trying to do some- thing about hospital-based child care for staff. Sen Paula Hawkins (R-Fla) and Rep Paul Simon (D-Ill) have introduced a federal bill that would provide grants to medical facilities to set up dependent care centers, the ANA Washing- ton office reports.

”One-fourth of the nation’s registered nurses have youngsters under the age of five,” Rep Simon said. “And research has shown that nurses tend to drop out of the work force to care for their children and reenter once their children reach school age. With convenient care for young or elderly dependents, many nurses could return to work.”

Sen Hawkins and Rep Simon are seeking sponsors to give their bill momentum. You can help by writing your senators and representat- ive, asking that they cosponsor Senate bill 241 and House bill 2036.

rn Nurse specialists in Montana will be eli- gible for reimbursement under disability insur- ance policies, according to a law passed in April. The law applies to nurse practitioners, nurse anesthetists, and nurse midwives.

A new report by ANA, described in the American Nurse, says that 13 states now provide for direct payment of nurses or nurse specialists.

Patricia Patterson Legislative consultant

AORN Journal, August 1983, Vol38, No 2 289