AMA says VA proposal to give APRNs "full authority" would undermine patient care – physicians urged to comment

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The American Medical Association (AMA) reports that the Veterans Health Administration has published a proposed rule that “would give full authority to four categories of APRNs: Certified Nurse practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), or Certified Nurse-Midwife (CNM).”

AMA also notes that “the proposed rule defines ‘full practice authority’ to mean that an APRN working within the scope of VA employment would be authorized to provide services without the clinical oversight of a physician, regardless of state or local law restrictions on that authority. APRNs working outside of VA facilities would remain subject to state laws on APRN scope of practice. Federal preemption will be used to side-step state medical licensure laws such that APRNs who work for the VA will have full authority inside the VA.”

AMA Board Chair Stephen R. Permut, M.D., J.D., responded with a statement that says that…

The American Medical Association is disappointed by the Department of Veterans Affairs’ unprecedented proposal to allow advanced practice nurses within the VA to practice independently of a physician’s clinical oversight, regardless of individual state law.

While the AMA supports the VA in addressing the challenges that exist within the VA health system, we believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country’s veterans. We feel this proposal will significantly undermine the delivery of care within the VA. With over 10,000 hours of education and training, physicians bring tremendous value to the health care team. All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine.

There are many examples from across the nation demonstrating that physician-led team-based care results in improved access to high-quality, cost-effective health care. From patient-centered medical homes to some of the nation’s largest health care systems, physician-led inter-professional team-based health care has proven to be a successful model in the delivery of health care. The nation’s top health care systems rely on physician-led teams to achieve improved care and patient health, while reducing costs. We expect the same for our country’s veterans, and look to these systems as evidence that physician-led, team-based models of care are the future of American health care.

The AMA urges the VA to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes.

Click for proposed rule

In addition to AMA, the Medical Association of Georgia, the American Society of Anesthesiology (ASA), and the Georgia Society of Anesthesiology are among the groups that are urging physicians to submit comments to oppose the proposed rule.

ASA says that it has “worked extensively to challenge the [proposed rule] because the Veterans Health System would then not comply with best practices nor with state law. State codes on nursing practice, specific to diagnosis, would be void in the Veterans Health system.”

ASA has created a web portal to streamline the process for submitting comments to address the proposed rule. The deadline to submit comments on the proposed rule is July 25.

Click to submit comments on proposed rule (i.e., ASA portal)