Ep 79: The Path to Direct Reimbursement with Dick & Sandy Ouellette, CRNA.

You can argue that the passage of direct reimbursement in 1986 was one of the most significant lobbying achievements in healthcare. This process took much of the decade and spanned seven AANA presidents, including Dick and Sandy Ouellette, CRNA. We revisit those momentous years and learn more about all the hard work that went into getting direct reimbursement.

Click the timestamps below to help you navigate through the many topics we discussed.

On This Episode:

The CRNA profession has never been healthier but it’s taken a lot of work to get to this point. We’ve been telling some of the stories from past leaders, but it’s time now to get a history lesson on direct reimbursement.

Many people would make the argument that this was one the greatest lobbying achievements in healthcare and it changed the entire nursing profession. What makes it even more incredible is looking back on how much time and how many people it took to get this across the finish line.

This process took most of the 1980s, concluding in 1989, and happened over the course of seven AANA presidents. Two of those presidents were Dick Ouellette, CRNA, from 1985-86 and Sandy Ouellette, CRNA, from 1988-89. While everyone involved played a major role, these two were around when it was passed by Congress and when it was finally implemented.

So we want to learn as much as we can about how and why direct reimbursement came into effect. We’ll get a complete background on events that led up to this decision and what pushed the effort forward. Plus they’ll tell us what it was like to be there when the announcement was made that President Reagan signed the legislation.

But things didn’t end there. The next few years were very difficult as everything was getting implemented and Sandy shares the first-hand experience of that process.

Also, make sure you go back to episode 56 to hear more details from Dick Ouellette’s year as president.

Check it out at the top of the page and use the timestamps to help you navigate through the many topics we discussed.

[1:44] – We have a couple of our favorites with us today.

[3:20] – Let’s get some background on this great lobbying achievement.

[5:30] – What happened when the regulators tried to fix this reimbursement problem?

[9:10] – The unintended consequences of TEFRA Seven Steps

[11:22] – Healthcare costs over $3 trillion today.

[11:50] – PPS and DRGs

[15:25] – What we brought to legislatures when we first started pushing direct reimbursement.

[17:27] – Things can change quickly.

[19:38] – Difficulty understanding the numbers.

[20:55] – What was the plan for economic survival?

[24:25] – Direct Reimbursement created some conflict.   

[26:17] – Let’s talk the actual road to reimbursement from 1983-89.

[31:53] – The passage finally happens and the announcement that followed.

[32:45] – It took the effort of all the members to make this happen.

[34:03] – What did they do back then without a DC office?

[35:42] – It was just as difficult in the years following direct reimbursement.

[40:55] – Did you think we’d still be dealing with issues three decades later?

[43:25] – A big victory for nursing as a whole.

[44:36] – Closing thoughts on how great of a time this is for CRNAs.


“What we’ve learned is that you have to be forever vigilant, engaged, not apathetic.”

-Sandy Ouellette, CRNA

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