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AMA: Physicians Must Lead VA Teams for Quality, Care Access

The American Medical Association responded to VA's proposal to expand veteran care access by saying their facilities should still be physician-led in order to ensure care quality.

By Sara Heath

Physicians must remain at the head of patient care teams in order to maintain the quality of services available to patients within the Department of Veterans Affairs, says the American Medical Association (AMA) in a public statement.

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In response to the VA’s proposal to allow advanced practice registered nurses to deliver care independently,  the AMA explained that this will not ensure that veterans receive the highest quality care.

Advanced practice registered nurses (APRNs) include certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse-midwives.

“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,” says AMA board chair Stephen R. Permut, MD, JD. “We feel this proposal will significantly undermine the delivery of care within the VA.”

Because of physicians’ extensive education – which, Permut says, often adds up to nearly 10,000 hours  of training – quality care at the VA relies on physician-led medicine. Access to this quality of care is a fundamental right for all patients, regardless of the kind of care they seek.

READ MORE: VA Launches Center for Patient-Centered Healthcare Innovation

“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,” Permut claims.

AMA says the VA should model their practice workflows off of the numerous healthcare facilities nationwide that utilize physician-led models and that reportedly continue to deliver timely and effective care to patients.

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 healthcare systems, physician-led interprofessional 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.

According to a document published in the Federal Register, APRNs are allowed to practice at this high level at civilian healthcare facilities as well, and the VA claims that giving APRNs more responsibility would not devalue the quality of care provided at VA facilities.

“This rule would permit VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA,” the proposal reads. “The proposed rulemaking would establish additional professional qualifications an individual must possess to be appointed as an APRN within VA.”

READ MORE: VA Deal Drives Patient Education on Mental Health Treatment

Responses to this proposal were not all negative. In a press release, the American Association of Colleges of Nursing (AACN) praised the VA’s proposal, saying that it represents a vital step forward in improving veteran access to healthcare.

"Supporting APRNs in the VHA to practice to their full scope demonstrates a strong commitment to improving care for those who serve our country," said AACN’s president and CEO Dr. Deborah Trautman. "Academic nursing applauds this visionary step taken by the VHA, and we stand ready to help advance this agenda for the well-being of our nation's Veterans."

While responses to the VA’s proposals may not be unanimous, data does show a clear need for better access to veteran care.

In April, a report from the Government Accountability Office (GAO) showed that wait times at the VA are still lengthy.

In a sampling of 180 newly-enrolled VA patients, 60 were completely unable to make an appointment with a primary care physician. Those who were able to obtain an appointment saw wait times between 22 and 71 days.

READ MORE: Inaccurate VA Wait Time Data Creates Healthcare Access Issues

GAO emphasized in its report the importance of mitigating this significant issue considering the fact that veterans prove to be a high-risk population with considerable health needs.

“Providing our nation’s veterans with timely access to primary care is a critical responsibility of VHA,” GAO concluded. “As primary care services are often the entry point to the VA health care system for newly enrolled veterans, the ability to access primary care and establish a relationship with a VHA provider can be instrumental in the ongoing management of a veteran’s overall health care needs.”

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