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San Francisco Marin Medical Society Blog

VA Issues Final Rule that Allows Advaned Practice Registered Nurses to Practice Independently



The American Medical Association (AMA) is disappointed by the Department of Veterans Affairs’ (VA) decision today to allow most advanced practice nurses (APRN) within the VA to practice independently of a physician’s clinical oversight, regardless of individual state law. While we acknowledged the VA for its decision to carve-out nurse anesthetists from the rule and for clarifying that only individuals with credentials in radiology can perform radiology studies, the new APRN policy rewinds the clock to an outdated model of care delivery that is not consistent with the current direction of the healthcare system.

AMA officials met with the VA on a couple of occasions to discuss our concerns with this policy.  We also submitted comments on the proposed rule.  We emphasized that providing coordinated, physician-led, patient-centered, team-based care is the best approach to improving quality care for our country’s veterans, especially given the highly-complex medical care that veterans often require.  The AMA will monitor the implementation of this policy and we will engage the VA if issues arise.  The final rule is available here.

AMA statement on VA rule on advanced practice nurses

Statement attributable to Andrew W. Gurman, MD, President, American Medical Association

“The American Medical Association (AMA) is pleased that the Department of Veterans Affairs’ (VA) final rule continues to recognize the critical need for collaboration among physicians and nurse anesthetists to ensure patient safety when delivering anesthesia care.

“At the same time, we are disappointed by the VA’s decision today to allow most advanced practice nurses within the VA to practice independently of a physician’s clinical oversight, regardless of individual state law. This part of the VA’s final rule will rewind the clock to an outdated model of care delivery that is not consistent with the current direction of the healthcare system.

“Providing coordinated, physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country’s veterans, especially given the highly-complex medical care that veterans often require. The nation’s top health care systems rely on these 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.

“We would also like to acknowledge the VA for clarifying that radiology studies can only be performed and read by individuals who are credentialed in radiology. 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, in addition to the valuable care provided by advanced practice nurses and other primary care clinicians that are part of the care team."




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