Much of the work of Visiting Nurse Associations (VNAs) happens quietly, in homes, clinics, and even disaster sites. For that vital work to continue, VNAs must be heard loud and clear in Washington. For 25 years, the Visiting Nurse Associations of America (VNAA) has taken an active role in lobbying around legislative and regulatory issues affecting VNAs and their patients. Over the past 10 years, we have dramatically increased our presence in the Capital by creating a public affairs staff, retaining well-connected healthcare consultants, and building coalitions with other leading national advocacy organizations and members of the federal government.

This year our Washington-based National Affairs Office will be fighting cuts to VNAs' Medicare reimbursement. The VNAs' rate is in danger because Congress must find funds to pay for the repeal of a 4.4% reduction in physician reimbursement. Our legislative efforts will be lead by VNAA's senior lobbyist, Kathy Thompson, who was named by the D.C. publication The Hill as one of the "top healthcare lobbyists on the Hill."

VNAA is also advocating for regulatory reforms. Medicare's home health prospective payment system must better align payments with the actual cost of providing care, thus reducing the incentive for providers to "cherry pick" patients on the basis of payment premiums. As Medicare implements a pay-for-performance system, we are promoting the use of measurements that are tested, meaningful, and fair. Finally, we will strive to influence any restructuring of the Medicare post-acute benefit to increase opportunities for home care on the basis of reliable comparisons of cost-effectiveness and quality outcomes.

Robert Wardwell spearheads these initiatives as vice president for regulatory affairs, a position created as the VNAA moved to increase its influence in Washington. Bob came to VNAA from the Centers for Medicare and Medicaid Services (CMS), where he was one of Medicare's top home health policy experts. He is adept at influencing the system and at advising our members on regulatory issues. Wardwell also leads the VNAA's Financial Managers Group, a monthly teleconference for CFOs and senior financial managers to discuss regulatory and financial matters.

Any effort to influence national policy must overcome competing voices demanding the same finite resources, but we are optimistic on the basis of the strength of our team and the key successes we have achieved in the past 10 years. We persuaded Medicare to reverse the painful cuts of the Interim Payment System. We also influenced the reform of Outcome and Assessment Information Set (OASIS) and Outcome-Based Quality Improvement initiatives to reduce the burden on VNAs and focus measures on more relevant aspects of home care.

VNAA's National Affairs Office has established the association as the voice of home healthcare, a respected player advising Congressional committees and staff. It is a major commitment to maintain an office in the heart of Capitol Hill with a full-time staff and a team of consultants. But policymakers must be helped to understand the unique role and value of VNAs in providing healthcare, particularly to the most vulnerable Americans. We educate Washington every day about our members' mission to bring healthcare wherever it is needed. We also provide advocacy tools for member agencies to use with their individual representatives. To find our grassroots lobbying tools or the latest information on federal policy that influences home care, please visit our Web site at http://www.vnaa.org.