(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.”
“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:
"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.
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