The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists. The purpose of this publication is to keep our members updated on the NACNS headquarters news; connect our members with fast-breaking clinical news; and update clinical nurse specialists on state and federal legislative actions. If you have any questions or wish to advertise in this publication – please contact Jonathan Uitto at


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Featured Headlines

  1. NACNS at White House
  2. NACNS Alarm Fatigue Tool Kit – Available Now!
  3. Bylaws Vote for 2015

Headquarters News

  1. NACNS Board of Directors Approves 2015-2020 Mission and Goals
  2. NACNS Concerned About ANCC’s Discontinuation of the Pediatric Certification Exam
  3. Call for Volunteers – 2016 Annual Conference Planning Committee
  4. Nominating Committee Call for Candidates for Office
  5. NACNS Continues Efforts to Go Green – Complete Survey on Your Journal Preference – Hardcopy or Online
  6. Two New Task Forces Appointed
  7. Webinar last for 2014! 2014 NACNS Series Webinar:  Cutting Edge Information for the Clinical Nurse Specialist
  8. Win one of two free iPads – Clinical Nurse Specialist Census
  9. 2015 – NACNS Anniversary and Annual Conference
  10. Affiliate Conference Calls

Association News

  1. AACN Releases Findings from a National Study on Academic Nursing’s Progress in Transitioning to the Practice Doctorate  
  2. NSO/CNA Malpractice Insurance Announcement
  3. NACNS Participated in ACC’s Team-Based Care Forum

Clinical News

  1. National Cost of Motor Vehicle Accidents
  2. Cikungungya Virus

Federal and State Policy News

  1. CMS Issues Final Rule for Home Health, Including CNS Performing Face-to-Face Encounter for Home Health Services
  2. CMS Issues Final Rule for Physician Fee Schedule, Including Chronic Care Management Services

Featured Headlines

white house1. NACNS Invited to the White House

On October 30, 2014, NACNS was part of a small group of nursing, emergency preparedness and other healthcare organizations that were invited to the White House to hear President Obama speak about in Ebola epidemic and express his views on the commitment nurses, doctors and other healthcare providers have had to the Ebola patients that have been treated in the United States. He stressed the importance of stopping the spread of Ebola at the source, the nations in Western Africa, where the disease has spread rapidly through villages and towns. President Obama added his thanks to the Public Health Service officers and military deployees who have been assigned to travel to Africa to work in the Ebola zone.


2. NACNS Announces New Member Resource – Alarm Fatigue Toolkit is Now Online

NACNS’ Alarm Fatigue Task Force has been focused on assessing and providing tools for the clinical nurse specialist to deal with the issue of alarm fatigue. They held a well-attended meeting at the 2014 Annual Conference, hosted one webinar and will host a second in December 2014, have submitted an article for publication in the NACNS journal and have developed an extensive alarm fatigue online tool kit for members to use to gather information for their specific needs.

The tool kit can be found here on the NACNS web site.

white house

NACNS’ Board of Directors appointed the Alarm Fatigue Task Force because nurses in many settings run the risk of being overwhelmed by the sensory input of mechanical alarms. CNSs are in a unique position to effect change to improve patient safety. This is an issue of importance to the Joint Commission as well as the U.S. Food and Drug Administration (FDA). In one 4–year period, before increase attention was given to this issue, the FDA reports that there were more than 560 alarm-related deaths in a four year period.

3. NACNS Board of Directors Votes to Take Proposed Bylaws Changes to the NACNS Members

At the November 4, 2014 board meeting, the NACNS Board of Directors approved a proposal by the 2014 Bylaws Committee to bring a set of proposed bylaws changes to the NACNS membership for consideration and vote. According to the NACNS Bylaws, the membership must be made aware of the intention of the Board to have a bylaws related vote 30 days prior to the Annual Business meeting. The Annual Membership Business meeting is held every year at the NACNS Annual Conference, and will be held this year at the Annual Conference on March 6, 2014.

The bylaws changes seek to update the NACNS bylaws and streamline language throughout the document. Generally, the proposed changes in the bylaws recommend:

  • Removal of policy-oriented text and the transfer of this from bylaws into NACNS policy.
  • Consolidation of the Secretary and Treasurer Board positions to a single position – Secretary/Treasurer.  An additional board member – at large would be added so that the board remains the same size.
  • Consolidation of the Vice-President and the President-Elect positions to a single position. The President-Elect will pick up the duties of the Vice-President. An additional board member – at large would be added so that the board remains the same size.
  • Addition of criteria to the full member category that would allow someone who has previously worked in a CNS role to be a full member.
  • Addition of two new membership roles – Legacy member – for individuals who have 20 years or more membership in NACNS and an Associate member – a member who does not meet the requirements of the full member, retired member, student member, and/or the legacy member and is supportive of the CNS role.
  • Deletion of the two membership categories that have been unused for a significant number of years – honorary member and corporate member. These two membership categories are recommended to be discontinued and we will provide the opportunity to meet these relationship needs through policy rather than bylaws.
  • Change of the NACNS fiscal year from January 1 – December 31 to July 1 – June 30. This change would be made in order to do improved fiscal tracking based on the timing of the NACNS Annual Conference.

A detailed – side-by side – comparison of the current and proposed bylaws is currently being prepared. This document will be posted on the member’s only side of the NACNS web site on or before November 30, 2014. NACNS members will receive a blast email when this document is available. Additionally, NACNS is planning on hosting open forum member calls on January 22 & 29, 2015 to review the bylaws changes and allow membership to ask questions and seek clarification. Please RSVP here.The final vote will be held at the NACNS Business meeting. This vote is in conjunction with an electronic vote in order to attempt to receive a vote from all interested NACNS members.

Headquarters News

4. NACNS Board of Directors Approves 2015-2020 Mission and Goals

On the November 4, 2014 NACNS Annual Meeting, the NACNS Board of Directors approved the 2015-2020 Mission and Goals. Please see below:

NACNS Mission - To advance the unique expertise and value the clinical nurse specialist contributes to health care.

  • Increase the visibility and influence of CNSs.
  • Serve as the national leader for CNS education.
  • Promote the benefit the CNS brings to evidence-based quality, patient safety, and cost of healthcare delivery.
  • Enhance professional leadership qualities among NACNS members.
  • Be the authority for advancing the full scope of practice for the CNS.
  • Promote CNS research in order to further define the value of CNS interventions.

5. NACNS Concerned about ANCC’s Discontinuation of the Pediatric CNS Exam

1NACNS’ Board of Directors has expressed our concern at the discontinuation of the pediatric CNS exam directly to ANCC in a recent letter.  In this letter we expressed our concern that the American Nurses Credentialing Center’s (ANCC) decision to retire the certification exam for pediatric clinical nurse specialists (CNSs) in 2015. This decision will have a direct negative effect on pediatric CNSs’ employability and employment at a time when we need highly qualified nurses managing health care more than ever. 

Many states have adopted new requirements for CNS education and certification and nursing schools in those states have changed their curricula to meet those requirements, in many cases gearing curricula toward ANCC’s certification exams. In those cases, pediatric CNS students who have been preparing for the ANCC’s exam will now be faced with a different exam for which they may not be properly prepared.

NACNS’ President, Les Rodriguez, has had a conversation with ANCC leadership and will work to make arrangements for students currently enrolled in programs based on the ANCC pediatric CNS exam criteria to take the exam upon their graduation from their CNS program. No specific plan is in place at this time.

6. 2016 Annual Conference Planning Committee – Call for Volunteers

NACNS is working to lengthen our planning window for our Annual Conference. As a result, we are interested in appointing our 2016 Annual Conference Planning Committee in December 2014. The 2016 Annual Conference will be held in Philadelphia, PA from March 3 – 5, 2016. If you are interested in volunteering for this important committee – please send your C.V. or resume to Please include the phrase “2016 Annual Conference” in the subject line. Additionally, please include a brief paragraph or two addressing why you are interested in volunteering for this committee.

7. Nominating Committee Announces Call for Candidates for Elected Office

NACNS invites you to become a volunteer leader in your professional organization. Opportunities for elected positions on the NACNS Board of Directors and Nominating Committee are available for the 2015-2016 year to all eligible full members. We hope you will consider candidacy yourself or nominating a peer!

Open Positions (individuals can run for 1 elected office):

  • President-Elect (1 open position, 3 year commitment, 1 Year President-Elect, 1 Year President, 1 Year Past President, requires a minimum 2 years of consecutive membership)
  • Treasurer (1 open position, 2 year term, requires a minimum 2 years of consecutive membership)
  • Board Director at Large (2 open positions, 2 year term, requires a minimum 2 years of consecutive membership)
  • Nominating Committee (3 open positions, 2 year term, must be a current member)

Officers and Board members are expected to participate in monthly board meetings via teleconferences as well as two face-to-face meetings per year. Elected Board Members are expected to attend the NACNS Annual Conference, March 5-7, 2015. Nominating Committee members are expected to participate in 4 conference calls per year. For detailed information on each position, please see attached for position descriptions.

Interested individuals should submit a Cover Letter articulating their interest in one of these positions and their qualifications along with an up to date Curriculum Vitae or Resume by Monday, November, 24. Materials should be submitted by email to Should you have additional questions about duties, responsibilities or qualifications please call 215-320-3881 or email

8. NACNS Continues Efforts to Go Green – Complete Survey on Your Journal Preference – Hardcopy or Online

NACNS’ Board of Directors is committed to observing efforts to make our association “more green.” In light of this, NACNS has recently sent a blast email asking members to let us know if you would be interested in a change in which format of the Journal you receive. Currently, the NACNS Journal, the Clinical Nurse Specialist - The International Journal of Advanced Practice Nursing is provided to all members in hardcopy and each member has the option to accessing the online journal. We want to know if some of our members are interested in just receiving the online journal. Please go to the NACNS homepage and access the survey on the headline along the right hand bar. Or click here to access the survey.

9. NACNS Appoints Two New Task Forces - Malnutrition and the Promotion of Optimal Nutritional Status and the Role of the Clinical Nurse Specialist in the Care of Patients with Chronic Conditions

The incidence of malnutrition and promotion of optimal nutritional status represents a significant challenge in the care of hospitalized patients. The NACNS Board of Directors, with the support of an educational grant from the Abbott Nutrition Health Institute, has established a task force to delineate the nursing role in assessing, treating and maintaining optimal nutritional status of patients. It is anticipated that they will consider the issues within the context of the hospitalized patient and with an eye to the unique concerns that may need to be identified during transitions from different levels of care and from the hospital setting.

The NACNS Board of Directors looks to this task force to recommend and develop activities and resources that the clinical nurse specialist needs in order to provide leadership on this important issue. In addition to developing a paper on this issue, the task force will work to delineate the role of the clinical nurse specialist and staff nurse in the risk assessment and the identification and treatment of malnutrition into their practice. The task force will critically consider the role of the CNS in coordinating a team-based response to this problem in order to promote and restore optimal nutritional health across all settings of care.

According to an article published in Preventing Chronic Disease, “Multiple Chronic Conditions Among U.S. Adults: A 2012 Update,” approximately half or 117 million of U.S. adults have at least one of the 10 identified chronic conditions. Furthermore, 1 in 4 adults has multiple chronic conditions (MCC). The complexity of patients in our health care system is increasing due to the co-morbities patient’s experience due to these chronic conditions. The NACNS Board of Directors has appointed a Task Force to provide recommendations to the NACNS Board of Directors on activities and resources that the clinical nurse specialist needs in order to provide leadership in the care of these patients from wellness to acute care, across the lifespan. In addition to identifying the needs of the CNS, the Task Force will be asked to develop a white paper on the issue that delineates the role of the clinical nurse specialist with this important population.

These two task forces will begin their work in November and December 2014. We are pleased to have established a new methodology in appointing these task forces. All applicants for this work were appointed to either the task force or a review panel. The role of the task force review panel will be to serve as a sounding board for the task force and provide input into specific questions, issues and/or serve to provide comment on any resources the task force develops. NACNS is pleased to provide this new format in order to allow more NACNS volunteer members to engage in the work of the association.

10. 2014 NACNS Series Webinar: Cutting Edge Information for the Clinical Nurse Specialist - A final webinar for 2014!!

December 10, 2014 - CNS Competencies: Positioning Yourself to Close the Clinical Alarm Gap - 3:00 pm EST. 1.0 Contact hours* will be awarded for this webinar. The cost for this webinar is $45.00 for members and $60.00 for non-members.

This webinar is the second of two sessions on alarm fatigue, a commonly occurring condition in which alarms are ignored or silenced, placing the patient at risk. Each webinar stands on its own, so you can attend this second session and learn concepts and ideas that are different from the September webinar.

The clinical nurse specialist (CNS) is the ideal health care provider to identify and implement changes in the health care delivery system to address the potential negative impact of alarm fatigue. Clinical experts and members of the NACNS Board appointed Alarm Fatigue Task Force will address key considerations and resources for the CNS working to address this important patient safety issue. Participants on these webinars will be able to interact with the speakers through Q & A.

The first webinar will present the evidence base for addressing the problem, regulatory issues, and the technologic and commercial challenges clinical nurse specialists face related to alarm management. The second webinar on this topic, Clinical Nurse Specialist Competencies: Positioning Yourself to Close the Clinical Alarm Gap will focus on applying the CNS role competencies to risk assessment, gap analysis and proposing team and system based solutions within the clinical setting. An overview of a toolkit designed specifically to provide resources for the CNS to address this problem will also be presented.

Registration for individual sessions:
$45 per webinar for NACNS Members
$60 per webinar for Non-Members
$30 per webinar for Students (Student ID Required)

To register, visit or register online. Once you login (different credentials from your members-only login), click on “Online Store” on the left side of the page. Complete webinar descriptions are available online. If you prefer to register by phone, please call Jonathan Uitto at 215-320-3881.

Look for our announcement with our 2015 Webinar Series topics coming in January 2015!

* 1.0 Contact hours will be awarded for this session.

This continuing nursing education activity was approved by the PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Criteria for successful completion includes attendance at minimum, of one session during the NACNS Annual Meeting and submission of a completed CE tracker triplicate form to the registration desk prior to the end of the conference. The planning committee members and speakers have declared no conflict of interest. Approval of the continuing education activity does not imply endorsement by the provider, ANCC or PA State Nurses Association.

11. Clinical Nurse Specialist Census

NACNS has successfully launched the first 2014 CNS Census. The Census is designed to gather national-level data on all individuals that completed a CNS education programs. The individuals do NOT need to be employed currently as a CNS. This Census is designed to be beyond the NACNS membership, and therefore relies on word-of-mouth to get a large number of CNSs to respond. This Survey monkey-style tool is designed to capture demographic, practice and education data on those that complete the survey.

We need your help to get the word out. Please tell a friend!

Results of the CNS Census will be published in the Clinical Nurse Specialist: The International Journal for Advanced Nursing Practice. The survey will be open until December 31, 2014. NACNS is pleased to announce that the Journal and a member of the NACNS Board have each offered an iPad for a drawing. A drawing for 2 iPads will happen at the end of the census! To take the survey go to: and look for the button on the left side of the homepage.

12. Celebrate the NACNS 20th Anniversary in 2015

Yes, it has been 20 years! And the NACNS Board of Directors is planning on recognizing and celebrating our history and success throughout the 2015, but specifically at the NACNS 2015 Annual Conference. The theme for this meeting is, “The Clinical Nurse Specialists: The Essence of Transitional Health Care.”  This meeting is being held at the Loews Coronado Bay Resort in San Diego, California. This meeting hotel will allow for an excellent educational experience as well as relaxation and exploration of beautiful Southern California. The hotel offers three pools, a sand beach and a spa. So plan now for a 20th anniversary celebration that will allow you to take care of your mind and body! The Loews Coronado Bay Resort caters to relaxation and will allow all of us to learn, network and relax. Coronado Island is a 10 minute cab ride from downtown San Diego. This will give everyone the best of both worlds – shopping and restaurants in San Diego and pampering and beautiful views on Coronado Island.  Do consider extending your trip by a day to appreciate the beauty of this area.

Visit the NACNS website for information the conference. Expect to receive a mini brochure from us before Thanksgiving that will give you a general overview of the meeting. Begin to make your plans!

13. Affiliate Conference Calls
NACNS president Les Rodriguez hosted a series of two conference calls with Affiliate leaders in October 2014. The goal of these calls was to update the Affiliates on NACNS activities and to provide the Affiliates an opportunity to update NACNS and other Affiliates on their activities. Both calls were successful.

The topics of discussion included plans for the 2015 state legislative sessions, key concerns with NACNS and Affiliate membership and communication strategies for Affiliates. The rich dialogue on each of these calls demonstrated the importance of keeping the channels of communication open between NACNS and the Affiliate leaders. NACNS will be holding additional calls on January 14 and 21, 2015 at 6:00pm Eastern. Stay tuned for emails announcing  these calls.

Association News

14. AACN Releases Findings from a National Study on Academic Nursing’s Progress in Transitioning to the Practice Doctorate

On October 28, 2014, the American Association of Colleges of Nursing (AACN) released findings from a national study conducted by the RAND Corporation, which examined the progress made by nursing schools in transitioning to the practice doctorate – a solution advanced 10 years ago to better meet the healthcare needs of the nation. The report authors found near universal agreement among nurse educators about the value of the Doctor of Nursing Practice (DNP) degree in preparing individuals for advanced nursing practice. Though many schools are moving to transition from the master’s degree to the doctorate for select nursing roles, many schools are facing barriers to full adoption of the DNP.

In 2004, member schools affiliated with AACN voted to endorse the Position Statement on the Practice Doctorate in Nursing, which called for moving the level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate by the target year of 2015. Even though schools have moved rapidly to offer the DNP, AACN acknowledges that all schools will not be able to fully transition their master’s-level programs to the practice doctorate by next year and that many schools are electing to maintain both master’s and DNP options to prepare Advanced Practice Registered Nurses (APRNs).

To better understand the issues facing schools moving to the DNP, the AACN Board of Directors commissioned the RAND Corporation to conduct a national survey of nursing schools with APRN programs to identify the barriers and facilitators to offering a post-baccalaureate DNP. Key findings from the report include:

  • DNP programs – either at the post-baccalaureate (BSN-DNP) or post-master’s (MSN-DNP) level – are now offered at more than 250 schools nationwide.
  • The study authors found near “universal agreement” among nursing’s academic leaders regarding the value of DNP education in preparing nurses to serve in one of the four APRN roles, specifically Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and Certified Nurse-Midwives.
  • Though the master’s degree remains the dominant route into APRN practice at this point in time, the educational landscape is changing. Approximately 30% of nursing schools with APRN programs now offer the BSN-DNP, and this proportion will climb to greater than 50% within the next few years.
  • The national movement toward offering the BSN-DNP and closing master’s level APRN programs is expected to accelerate. Currently, up to 14% of schools with APRNs programs only offer the BSN-DNP as their entry-level option into advanced practice. An additional 27% of schools with or planning a BSN-DNP intend to close their master’s level APRN programs within the next few years.
  • Student demand is strong for all types of programs – BSN-DNP, MSN-DNP, and the MSN – that prepare APRNs. Approximately 65% of schools with BSN-DNP programs also offer master’s level APRN programs.
  • Many employers are unclear about the differences between master’s-prepared and DNP-prepared APRNs and could benefit from information on outcomes connected to DNP practice as well as exemplars from practice settings that capitalize on the capabilities of DNPs.
  • Barriers identified by schools transitioning to the BSN-DNP include a lack of faculty, costs and budgetary concerns, insufficient clinical sites, and resource challenges associated with overseeing DNP scholarly projects. The requirement of the DNP for certification and accreditation is an important factor in a school’s decision to transition fully to the BSN-DNP.

To facilitate the continued transition to the DNP, the report authors recommend that AACN conduct outcome studies to assess the impact DNP graduates are having on patient care and health care; provide outreach and data to employers showing the value-added benefits of recruiting DNP-prepared nurses; showcase success strategies that can be used by schools to overcome challenges, including securing clinical sites; and provide greater clarity and guidance around the DNP final project.

The RAND study is titled The DNP by 2015: A Study of the Institutional, Political, and Professional Issues that Facilitate or Impede Establishing a Post-Baccalaureate Doctor of Nursing Practice Program.

15. Notice to NACNS Members Insured by NSO/CNA

As you know, NSO/CAN have an established and respected commitment those they insure to provide a long-term program that remains current with the needs of the profession. To do this, they make sure the insurance program is backed by a financially stable insurance carrier partner who understands the risks and exposures nurses face and that they remain expert in managing and resolving claims for our insured and your members.

CNA remains the insurance carrier partner on the NSO nurse program and has been supporting this business for over 35 years. They’ve earned an A (Excellent) rating by AM Best which affirms their financial strength and their ability to pay claims.

Relative to assessing their expertise at managing and resolving claims, CNA has implemented, a ‘claim satisfaction survey’ with the insured who have gone through the claim process – their current scores are as follows:

  • 100% affirmed that the CNA claims professional provided prompt communication / follow-up following notice of the claim
  • 94.5% graded their CNA claims experience as either meeting or exceeding their expectations
  • 94.4% would recommend NSO / CNA to a colleague based on the service they received during their claim process

Each year NSO assesess the financial performance of the program (expense dollars incurred versus premium generated) and the good news is that the nurses program has remained stable showing no need for country-wide rate action. However, the state of New Jersey has consistently shown significant rate need as follows:

Total Nurses Insured
Total Employed
Total Self-Employed
Nurse Firms
% of Total NJ
% of Total
Total NJ Nurses
NJ Employed
NJ Self-Employed
NJ Nurse Firms

Currently, NSO can not identify ‘why’ NJ experience is so different from the balance of the country but we do know the experience has been consistent over the last five years. Based on this, NSO has determined it is important to the stability of the program that if the rate need in NJ be addressed. it could continue to erode the overall performance of the nurses program and result in a country-wide rate action. To avoid this, NSO is recommended filing a 2015 rate action for NJ nurses only. We will increase the rate 25% as follows:

This filing will be implemented within a few weeks with the expectation of rates ‘turning-on’ in New Jersey in early 2015.  Your account manager will advise you of the exact turn-on dates for new business versus renewal business once the filings been implemented and our system programed.  If you have any questions on this, please feel free to reach out to NSO for further discussion. Also know that NSO will dedicate specific risk management efforts to their NJ nurses in an attempt to provide them with the tools they need to create a safer environment for themselves and their patients.

For context, our nurse insured and those impacted are as follows:

Employed FT
Employed PT*
Self-Employed FT
Self-Employed PT
CountryWide Rate
*Minimum premium countrywide is $106. This will remain the minimum for NJ.

Based on the above, NSO insures over 37,000 nurses in New Jersey and this represents 7% of all the nurses we insure in the country.

We have no other plans for rate action for Nurses or Nurse Practitioners in 2015. We are confident that this action will ensure the stability of our nurses program and align rate action with the state that has been consistently driving rate need.

As always, we appreciate your continued support of our program. If you have any questions or would like to discuss the above action, please don’t hesitate to call…

16. NACNS Attends the American College of Cardiology Team-Based Care Forum

On February 7, 2014 NACNS member Linda Hoke, PhD, RN, AGCNS-BC, CCNS, CCRN, WCC from the University of Pennsylvania and Melinda Mercer Ray, MSN, RN, NACNS’s Executive Director attended the forum held by the American College of Cardiology to discuss key questions they had regarding the issue of team-based care in cardiology. ACC has a non-physician membership category since 2003 and the discussion was collegial and focused on how team-based care can best meet the needs of the patient. ACC’s team-based care writing team participated in the discussion and following the forum met separately to continue work on their position statement on this issue.

Clinical News

17. CDC Reports Motor Vehicle Crash Injuries are Frequent and Costly

Americans spend more than 1 million days in the hospital each year from crash injuries


Full impact of motor vehicle crashes.

Entire Infographic

More than 2.5 million people went to the emergency department (ED) – and nearly 200,000 of them were hospitalized – because of motor vehicle crash injuries in 2012, according to the latest Vital Signs report by the Centers for Disease Control and Prevention (CDC).

Lifetime medical costs for these crash injuries totaled $18 billion. This includes approximately $8 billion for those who were treated in the ED and released and $10 billion for those who were hospitalized. Lifetime work lost because of 2012 crash injuries cost an estimated $33 billion.

In 2012, nearly 7,000 people went to the emergency department every day due to car crash injuries.

Key findings include:

  • On average, each crash-related ED visit costs about $3,300 and each hospitalization costs about $57,000 over a person’s lifetime.
    • More than 75 percent of costs occur during the first 18 months following the crash injury.
  • Teens and young adults (15-29 years old) are at especially high risk for motor vehicle crash injuries, accounting for nearly 1 million crash injuries in 2012 (38 percent of all crash injuries that year).
  • One-third of adults older than 80 years old who were injured in car crashes were hospitalized – the highest of any age group.
  • There were almost 400,000 fewer ED visits and 5,700 fewer hospitalizations from motor vehicle crash injuries in 2012 compared to 2002. This equals $1.7 billion in avoided lifetime medical costs and $2.3 billion in avoided work loss costs.

For this Vital Signs report, CDC analyzed ED visits due to crash injuries in 2012 using the National Electronic Injury Surveillance System-All Injury Program and the Nationwide Inpatient Sample. The number and rate of all crash injury ED visits, treated and released visits, and hospitalized visits were estimated, as were the associated number of hospitalized days and lifetime medical costs.

“Motor vehicle crashes and related injuries are preventable,” said Gwen Bergen, PhD, MPH, MS, behavioral scientist in the Division of Unintentional Injury Prevention of the National Center for Injury Prevention and Control. “Although much has been done to help keep people safe on the road, no state has fully implemented all the interventions proven to increase the use of car seats, booster seats, and seat belts; reduce drinking and driving; and improve teen driver safety.”

State officials can consider taking the following actions to prevent motor vehicle crashes and related injuries:

  • Increasing seat belt use through primary enforcement seat belt laws that cover everyone in the car. 
  • Improving child passenger safety with restraint laws that require car seat or booster seat use for children age 8 and under or until 57 inches tall, the recommended height for proper seat belt fit.
  • Reducing drinking and driving by using sobriety checkpoints and requiring ignition interlock use for people convicted of drinking and driving, starting with their first conviction.
  • Improving teen driver safety through the use of comprehensive graduated driver licensing systems.
  • Supporting traffic safety laws with media campaigns and visible police presence, such as sobriety checkpoints.
  • Linking medical and crash data to better understand why crashes happen, the economic cost of those crashes, and how to prevent future crashes.

Released in conjunction with this month’s Vital Signs is CDC’s new interactive calculator, called the Motor Vehicle PICCS (Prioritizing Interventions and Cost Calculator for States). This tool will help state decision makers prioritize and select from a suite of 12 effective motor vehicle injury prevention interventions. It is designed to calculate the expected number of injuries prevented and lives saved at the state level, as well as the costs of implementation, while taking into account the state’s available resources. A fact sheet for each intervention and a final report with methodologies and cost-effectiveness analyses are included.

18. Chikungunya Virus – A Relatively New Mosquito-Borne Virus

Providers should be aware of the growing concern over a new virus that has been seen in a number of other countries. Chikungunya (pronunciation: \chik-en-gun-ye) virus is transmitted to people by mosquitoes. The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. There is no vaccine to prevent or medicine to treat chikungunya virus infection.  The disease is rarely fatal. Joint pain caused by chikungunya can be severe and debilitating. Travelers who return from areas with chikungunya cases who have symptoms of the disease should seek medical care and inform their doctor about their recent trip. Most people get better in about a week. But, it is important to note that some people will have long-term joint pain as a result of the infection. The CDC believes that individuals who have been infected by the virus will have lifelong immunity against the disease.

Outbreaks have occurred in countries in Africa, Asia, Europe and the Indian and Pacific Oceans. In late 2003, chikungunya was found in the United States by infected travelers. Recently, outbreaks have been seen in the Americas on islands in the Caribbean. One of the primary ways to avoid this new virus and decrease the transmission of the virus is to prevent mosquito bites. Use of mosquito repellants, mosquito netting, screens and air conditioning should be considered when traveling as well as the use of clothes that cover the skin areas.

Federal and State Policy

19. CMS Issues Final Rule for Home Health, Including CNS Performing Face-to-Face Encounter for Home Health Services

3On November 6, CMS issued the final rule that implements changes to simplify the face-to-face encounter regulatory requirements for home health services. This rule also updates the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015.

The Affordable Care Act mandated that prior to a physician certifying the need for home health services, the physician or an allowed non-physician practitioner (NPP), including a CNS, must perform a face-to-face encounter. The face-to-face encounter must be related to the primary reason the patient requires home health services and occur no more than 90 days prior to the home health start of care date or within 30 days of the start of the home health care.

In addition, current regulations require that, as part of the certification of eligibility, the certifying physician must document the date of the encounter and include an explanation of why the clinical findings of such encounter support that the patient is homebound and in need of either intermittent skilled nursing services, physical therapy, or speech-language pathology services.

20. CMS Issues Final Rule for Physician Fee Schedule, Including Chronic Care Management Services

This final rule includes responses to NACNS’s comments to CMS on the proposed rule for the physician fee schedule. These include NACNS’s comment on the definition of CNS on the Physician Compare website and the physician centric approach in the website. The final rule also includes specific requirements for the delivery of chronic care services that can be provided by CNSs.

In CNS’s letter to CMS on the proposed rule, we requested that they use the definition recommended by NACNS, “The clinical nurse specialist is an individual prepared at the master's or doctoral level as a clinical nurse specialist from an accredited educational institution and/or holds an advanced degree in nursing from an accredited educational institution and is recognized by their state as a clinical nurse specialist.” CMS stated that they will take this under consideration in the future and will work with relevant stakeholders to update as appropriate.

NACNS also recommended to CMS that the Physician Compare website should allow the search function to be more inclusive of all qualified healthcare providers. CMS responded by saying that they will evaluate these recommendations for potential future inclusion.

The final rule contained the two HCPCS codes for chronic care management. These services can be provided by CNSs because they are considered qualified health care professionals. The codes are defined as follows.

  • HCPCS Code: 99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.
  • HCPCS Code:  99487 Complex chronic care management services, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; establishment or substantial revision of a comprehensive care plan; moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.
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