A O R N J O U R N A L JUNE 1984, VOL 39. NO 7

T 7 . * Legislation

Drape flammability proposal in legislative limbo

0 Did you know that the Consumer Product Safety Commission, a federal agency, has flammability standards for infant sleepwear, children’s sleepwear, and adult clothing-but none for surgical drapes? Nor does a voluntary standard exist.

The US Congress has been considering an amendment to the Flammable Fabrics Act that would require the commission to write a standard within one year of its passage. The amendment does not specify what the standard would be, but it would cover both reusables and disposables.

A moving force behind the amendment is Ralph A Milliken, MD, associate professor of anesthesiology, New York Medical College, New York City, and chairman of the Operating Room Safety Committee of the New York State Society of Anesthesiologists.

Dr Milliken believes drape fires to be a serious problem. “It’s true we have removed flammable anesthetic agents from the operating room,” he remarked, “but we have added a number of high-energy devices-such as lasers, arthro- scopes with high-intensity lamps, and hot-wire cauteries-that can ignite drapes.

“Moreover, most physicians and nurses are not aware that drapes are flammable.

“We believe the anesthetized patient is at greater risk than the sleeping infant. ”

The problem now is political. The amend- ment, which has been hanging in limbo, is part of an overall reauthorization bill for the commis- sion, which comes up every three to five years. The House has passed its bill, including the amendment. The Senate, however, passed a dif-

ferent version without the amendment. The two houses must now resolve their differ-

ences. First, a conference committee with mem- bers from both houses must be appointed. That process was stalled in mid-March. The commit- tee must then adopt a compromise including the amendment. Since the two bills are substantially different, that could be a problem.

You can help by writing to your senator, en- couraging him or her to adopt a Consumer Prod- uct Safety Act that includes the amendment for drape flammability standards.

0 Medicare’s new hospital payment system based on diagnosis-related groups (DRGs) is barely underway, and already serious questions are being asked. Is the system fair to hospitals or isn’t it? Will it save money or not?’ Will it save enough to keep Medicare from going broke? Should DRGs be expanded to cover other providers, such as nursing homes and physi- cians?

You may recall that Congress approved the new system just over a year ago. Legislators were persuaded that the government could save money on Medicare by paying hospitals a set amount in advance for patients’ diagnoses. Pre- viously, hospitals were paid whatever it cost to care for Medicare patients.

Hospitals have come under the system at the beginning of their 1984 fiscal year, and about half of them are now using DRGs.

In response to hospitals’ complaints that DRG rates do not fairly consider local wage rates and urban-rural differences, the government has al-

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ready decided to make some changes. Margaret Heckler, secretary of the US Department of Health and Human Services (HHS) announced the changes in late March. Revised rules are to be published this summer, with changes to take effect in 1985.

DRG rates are complex. Recognizing that hospitals would need time to adjust, Congress initially decided to phase the system in over four years. In the first year, only 25% of the Medicare payment is based on DRGs; the remaining 75% is a hospital-specific amount.

On top of that, Congress set up nine regional rates plus urban and rural rates, adjusted for wage variations. Over the next few years, the payment schedule will move toward one national urban and rural rate for each DRG.

Even with this many variations, hospitals found inequities. Some, who employ large num- bers of part-time workers, contended that the wage adjustment did not take this into account. The government now plans to do a survey for full-time and part-time workers.

Other hospitals, in areas classified by the 1980 census as ‘‘rural,’’ said their costs were as high as urban institutions, but that they were receiving a lower rate. The same was true for hospitals in different census areas within some metropolitan areas.

Heckler said the government would make minor corrections for these problems with its new rules, but could do little about the census designations.

There has been talk of expanding DRG pay- ments to physicians and skilled nursing facili- ties. In February, Sen Edward Kennedy (D- Mass) and Rep Richard Gephardt (D-Mo) an- nounced they would introduce a bill that would require states to regulate physicians’ fees. If the states failed to do so, the fees would be brought under prospective payment.

Although the HHS had intended to send Con- gress a plan for a DRG system covering skilled nursing facilities, it will be delayed, at least until the end of the year.

0. The Division of Nursing, a subunit of the US Department of Health and Human Services,

would be elevated to a new Bureau of Nursing under a bill to renew the Nurse Training Act. Sen Omn Hatch (R-Utah) announced in mid-March that he would introduce the legislation, which provides federal funding for nursing education.

The Bureau would have three divisions 0 the Division of Nurse Educational Support

to preside over financial assistance 0 the Center for Nursing Research 0 the Division of Advanced Nurse Education. The proposed funding level was $54 million,

including $2 million to start up the new bureau and $10 million for the research center.

Through the creation of the research center, Senator Hatch said he hopes that “many more nurses will become interested in and seek re- search career opportunities. ”

Nursing groups, however, would prefer to see the research effort placed in the National Insti- tutes of Health (NIH). At a March hearing before the Senate Labor and Human Resources Com- mittee, representatives of the American Nurses ’ Association, the National League for Nursing, and the American Association of Colleges of Nursing (known as the Tri-Council for Nursing) testified. They reiterated support for a separate National Institute of Nursing in NIH as a home for nursing research. A bill establishing the Insti- tute has passed the House and Sen Daniel Inouye (D-Hawaii) had offered to sponsor a similar measure in the Senate.

Impetus for the Institute came from a study completed last year by the prestigious Institute of Medicine, part of the National Academy of Sci- ences.

In its report, the Institute of Medicine said that “the nursing profession’s capacity to undertake research is hampered by insufficient support both for the education of qualified researchers and for current work in research.” Its recom- mendation was to set up an “organizational en- tity to place nursing research in the mainstream of scientific investigation. ”

The Tri-Council for Nursing says that NIH is the only place for a nursing research program with a high level of visibility. In NIH, nurse researchers would have an opportunity for close interaction with other professions doing health

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care research. Tri-Council representatives have asked the Senate committee to seriously consider creating a nursing institute in NIH.

0 As the government attempts to put the brakes on rising Medicare costs, the patient is bearing more of the burden.

The government’s health program for the el- derly is now paying less than half of an individu-

al’s health costs. An older person will spend about 15% of his or her income on health care this year.

These figures were reported by Karen Davis, chairman of the Department of Health Policy and Management at Johns Hopkins University, Baltimore, an expert on health policy.

PATRICIA PATTERSON LEGISLATIVE COLUMNIST

Minority Fellowships for Nursing Students Two scholarship programs provide graduate scholarship assistance for minority registered nurses interested in pursuing doctoral degrees. The programs are sponsored by the American Nurses’ Association and are designed to increase the number of doctorally degreed minority nurses in mental health professions, behavioral science research, and clinical psychiatric nursing.

The registered nurse fellowship program for minorities was established in 1974 to support candidates in behavioral science doctoral studies who have an interest in continuing research relative to racial and cultural influences on mental health and health care delivery systems in ethnic minority communities.

program, was established in 1977 and designed for nurses interested in pursuing doctoral studies in psychiatric and mental health nursing. The program prepares nurses to provide, supervise, and consult in the delivery of psychiatric and mental health nursing, and particularly to ethnic and racial minority groups.

The purposes of the nursing scholarship programs, headed by Hattie Bessent, RN, EdD, are

to increase the recruitment of nurses from minority groups into the field through educational support

0 provide counseling on curriculum to

A second project, the clinical fellowship

fellows preparing to become nurse researchers or clinicians, and to facilitate the placement of graduates in clinical or research settings.

The programs are directed to Afro-Americans, Asian Americans, native AmericandAlaskans, and Hispanic Americans. Citizenship or a permanent visa is also required. Persons enrolled in or who plan to pursue a full-time accredited PhD program in the behavioral sciences are eligible to apply for the registered nurse fellowship program. The programs are funded by grants from the National Institute of Mental Health, Center for Minority Group Mental Health Programs.

Annual awards include a stipend, tuition and fees, and education expenses, books, supplies, etc. The stipend is to help defray monthly expenses and is paid directly to the fellow.

Applications may be obtained by contacting the Director, EthnidRacial Minority Fellowship Programs, American Nurses’ Association, 2420 Pershing Rd, Kansas City, Mo 64108, (816) 474-5720, or 1030 15th St NW, Suite 716, Washington, DC 20005, (202) 789-1334.

All graduate applications are reviewed by an advisory committee of nurses who are outstanding leaders in mental health, research, health education and nursing, behavioral science, and related areas.

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