Jun 12, 2016

VA Official Defends Proposed Scope of Practice Change

(CHICAGO) - The Department of Veterans Affairs’ plan to allow advance practice nurses (APRNs) to practice independently within the VA is “all about access,” a top official in the VA health care system told Texas physicians today.

"When we say independent practice for nurse practitioners, that's in the context of team-based care," a senior VA health official told the Texas Delegation to the American Medical Association. "I don't even know what an independent practitioner in the VA system would mean."

The official said VA “bet the farm around 2010 on the patient-centered medical home model” and depends on APRNs to help meet veterans’ growing demand for care within the VA system.

The Texas physicians, which included a number of military veterans, peppered the official with tough questions.

"Veterans deserve the highest and best care,” said Beaumont anesthesiologist Ray Callas, MD, a decorated U.S. Navy veteran of Operation Desert Storm. “In the most complicated cases, anesthesiologists should be in the lead."

Last month, the VA published a proposed rule that would allow APRNs — nurse anesthetists, nurse practitioners, nurse midwives, and clinical nurse specialists — to practice independently within the VA health system. While this doesn't change state scope-of-practice laws for APRNs working outside the VA system, it overrides those laws for care being provided inside the VA.

Veterans' service organizations and more than 90 members of Congress are opposing this change on the grounds it jeopardizes veterans' safety. Comments on the draft rule are due July 25. TMA, the American Medical Association, the Coalition of State Medical Societies, and other medical societies will file formal comments in strong opposition.

The draft rule has stirred a storm of protest, particularly from anesthesiologists. The official said the VA already has received about 20,000 comments on the proposal, more than it has ever received on a proposed rule.

TMA urges Texas doctors to take a few minutes to tell VA officials what they think of the plan. Submit comments on the government's rulemaking website or through the American Society of Anesthesiologists' Safe VA Care website.

Despite the official's talk of team-based care, Fort Worth pediatrician Gary Floyd, MD, said an important phrase is missing in the VA’s draft rule. “It needs to be ‘physician-led,’” he said. “Please put that language back in.”

If the VA adopts the rule as written, Dr. Floyd said, groups like TMA will find it more difficult to protect physician-led team-based care in state legislatures.

“It needs to be a physician-led team, whether it's CRNAs or primary care,” he said. “That is the hallmark of quality care.”

1 comment:

Bhaskar said...

"I don't even know what an independent practitioner in the VA system would mean." I am not sure with what face she claims that it's all part of team play. Read the provisions in the proposal; they eliminate in crystal clear terms any references to a care team or even a mention of a physician.