Academy Objects to Scope Overreach by Veterans Affairs

The lack of proper oversight that the policy condones preempts states' scope-of-practice laws and "threatens the health and safety of veterans and their families," added the June 24 letter to Veterans Affairs Secretary Robert Wilkie, J.D.

The VA's memorandum on health care professional practice and the underlying Directive 1899, issued April 21, allows certified registered nurse anesthetists at VA medical facilities to practice without physician oversight during the national health emergency. It also lets VA health care professionals practice across state lines "within the full scope of their license, registration or certification."

"This combination in effect circumvents state scope-of-practice laws" for the 32 health care professions defined in the directive, the letter said. "Such a far-reaching expansion is overly broad, unnecessary and threatens the health and safety of patients within the VA system."

The AAFP and more than 80 physician and specialty groups -- including the AMA, the American College of Physicians and 45 state medical societies -- called on Wilkie to rescind the directive's move regarding CRNAs and amend its scope-of-practice measure to defer to state laws. An appendix to the directive, the groups reminded the secretary, already contains such an amendment for psychologists.

The letter also pointed out that at least one state has restored previous guidance after relaxing scope-of-practice laws to fight the pandemic at the urging of HHS Secretary Alex Azar. The Academy and its co-signatories cited West Virginia Gov. Jim Justice's Executive Order No. 12-20, issued in late March to reinstate physician supervision of CRNAs during the public health emergency.

The current push to remove such physician oversight, said the groups, "is overly broad, inconsistent with the situation as it is unfolding outside of the VA and unnecessary to address the immediate needs raised during the COVID-19 pandemic."

The Academy and scores of other medical groups similarly sought to safeguard the role of physicians as leaders of interdisciplinary care teams with a June 11 letter to CMS Administrator Seema Verma, M.P.H. That correspondence objected to a proposed rule that would allow nonphysician practitioners to perform services at inpatient rehabilitation facilities that today can be done only by physicians.

"Throughout the coronavirus pandemic, physicians, nurses and the entire health care community have been working side by side caring for patients and saving lives," the June 24 letter said. "Now more than ever, we need health care professionals working together as part of physician-led health care teams -- not in silos. Therefore, it is deeply troubling that the VA is directing all VA medical facilities to amend their bylaws to allow CRNAs to practice without physician oversight."