AMA, Physician Groups Slam VA’s Planned Standards of Practice Changes

The American Medical Association (AMA) and dozens of physician groups are pushing back on the Department of Veterans Affairs’ plan to establish new national standards of practice, which would override current state practice and licensure laws and allow non-physicians to operate outside of their training.

“These back-of-the-envelope standards will have the unintended consequence of reducing the quality of health care for veterans, many of whom suffer from complex symptoms that require expertise from trained medical professionals,” said AMA President Gerald Harmon, MD, in a press release. “These new standards of practice are unlikely to encompass the complexity of modern medicine. They will supersede longstanding state regulations and laws and create confusion. This is a solution in search of a problem.”

In 2016, the VA proposed and later implemented a rule allowing advance-practice nurses within their medical system to practice at the top of their licenses without physician supervision, which also triggered a backlash.

In a July 29 letter to VA Secretary Denis McDonough, the groups expressed their “serious concerns” over the plan, part of what’s known as the Supremacy Project, and urged the VA to reconsider.

“In particular, we are dismayed that the VA has not provided a transparent process by which public stakeholders are provided an adequate opportunity to review and provide meaningful input into the standards of practice,” they wrote.

In addition to threatening patients’ safety and quality of care, the changes would leave state boards with their hands tied in terms of providing proper supervision to the providers they license, as well as disciplining healthcare professionals who provide inadequate care, the groups noted.

They pointed to several Government Accountability Office audits as evidence that “the VA is already doing an inadequate job of supervising and disciplining its NPPs [non-physician providers.]”

Reported issues included providers working without the appropriate qualifications, poor performance, and misconduct, they said.

“Unfortunately, the VA has been deficient in putting an end to this subpar care, in part due to poor VA reporting and oversight,” they wrote.

The physician groups also argued that the “VA’s approach to developing the standards of practice” for 48 types of healthcare professionals overlooked the entire concept of the healthcare team, “moving standards forward independent of one another.”

In the AMA press release, Harmon also noted that if physician groups had been asked about the planned changes, they would have requested that the VA “pause and consider the breadth of what it is doing. This is a monumental undertaking, not one to rush through between administrations. Physicians want to deliver superior care to veterans. These standards are likely to compromise care. That isn’t what the VA intends, but that’s the probable result.”

Lisa Gables, CPA, CEO of the American Academy of PAs (AAPA), disagreed.

“An efficient healthcare workforce requires that outdated practice laws and regulations be modernized to authorize every health professional to deliver care to the top of their education, clinical training, experience, and competencies … The PA profession’s longstanding commitment to ethical practice is paramount and will remain unchanged,” Gables wrote in an email to MedPage Today.

“Contrary to what has been suggested by certain organizations, assertions that strengthening PA practice would cause quality of care to suffer or legally grant regulatory authorities carte blanche to abdicate their responsibilities to assure patient safety or impose appropriate disciplinary action are not substantiated. We encourage the VA to utilize its authority established in this rule to grant full practice authority to the PA profession at the VA to ensure its PA workforce is in the strongest position to continue serving veterans and to expand access to high-quality care for our nation’s veterans,” she added.