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   May 25, 2016

IMPORTANT

Please respond to protect safe anesthesia care for veterans, and the future of the specialty.

The Veterans Administration is publishing in the Federal Register today a proposal to require independent practice of nurse anesthetists, eliminate anesthesiologist supervision of nurse anesthetists, and over-ride any state rules requiring collaboration. A 60 comment period on the proposal will follow. If enough comments identify this proposal as unsafe, unneeded and unfounded, then the proposed rule will not be adopted.

Please review the information below, and respond to the proposed rule at safevacare.org. Please get five or more other people to respond. You can respond more than once with multiple comments. Numbers are important. You cannot rely on others to defeat this unsafe proposal.

The proposed rule is:

Unsafe for Veterans – would reduce their standard of care below community practice.

Anti-nurse anesthetist – most nurses want to practice in a care team model

Anti-anesthesiologist – care team model is widely shown to have highest quality

Submit your comments through safevacare.org.

 

News article in Modern Healthcare on the VA proposal.

VA will expand scope of nurse practice

By Virgil Dickson  | May 24, 2016

The U.S. Department of Veterans Affairs is expected to release a proposed policy Wednesday that expands the scope of practice for nurses.

The proposed rule, which the Office of Management and Budget sent back to the VA last month, is expected to, among other things, allow nurses to fill in for anesthesiologists during surgery.

The American Society of Anesthesiologists is opposing the measure, saying its unnecessary.

Expanding the scope of practice for nurses within the VA overall would address a shortage of some types of physicians, but the ASA argues that there is no such deficit of physician anesthesiologists

“This policy lowers veterans’ standard of care,” Dr. Jane C.K. Fitch, ASA’s past president and former nurse anesthetist says in a statement. “The change also directly conflicts with the VA’s core strategy to deliver high-quality, veteran-centered care and endangers the lives of those who served our country and deserve better.”

Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training. By comparison, nurse anesthetists have about half the education and almost 2,500 hours of clinical training according to the ASA.

A spokesperson for the American Association of Nurse Practitioners said the group is withholding comment until the proposed rule is actually released. The association previously has said it feels expanding nurse scope of practice within in the VA could be key to reducing the long wait time some veterans now face.

The agency is facing public criticism this week as VA Secretary Bob McDonald is apologizing for comments about the wait times he said were misinterpreted. In speaking about a problem that’s plagued the agency, McDonald said that the experience, not wait times, is what people remember at Disneyland.

ASA Press Release – May 24, 2016

Physician Anesthesiologists, Veterans and VA Anesthesia Chiefs Oppose VA Policy Replacing Physicians with Nurses for Anesthesia Care in Surgery

The American Society of Anesthesiologists (ASA) urges Americans to protect our nation’s Veterans by opposing a U.S. Department of Veterans Affairs (VA) proposed policy that removes physician anesthesiologists from surgery and replaces them with nurses, lowering the standard of care and jeopardizing Veterans’ lives.

The policy change is based on a shortage of some types of physicians in VA. However, there is no shortage of physician anesthesiologists and the change is not needed to improve access to anesthesia care in surgery. The policy would abandon a proven model of care where physician anesthesiologists and nurse anesthetists work together as a team to provide Veterans high-quality and safe anesthesia.

 

“Surgery and anesthesia are inherently dangerous requiring physician involvement, particularly for Veterans who are sicker and often have multiple medical conditions that put them at greater risk for complications,” said ASA President Daniel J. Cole, M.D.

“There are no issues with access to anesthesia care in VA – this policy lowers Veterans’ standard of care,” said Jane C.K. Fitch, M.D., ASA past president and former nurse anesthetist. “The change also directly conflicts with the VA’s core strategy to deliver high-quality, Veteran-centered care and endangers the lives of those who served our country and deserve better.”

The VA’s own internal evaluation of the relevant studies regarding health outcomes of patients receiving care from nurse anesthetists practicing independently concluded that the evidence was biased and insufficient to support making a policy change. VA’s Quality Enhancement Research Initiative (QUERI) could not discern “whether more complex surgeries can be safely managed by CRNAs, particularly in small or isolated VA hospitals where preoperative and postoperative health system factors may be less than optimal.”

The policy also conflicts with state laws that recognize the importance of physician involvement in the delivery of anesthesia. The leading experts on anesthesia care in the VA, the Chiefs of Anesthesiology, have twice expressed concern that the new policy “would directly compromise patient safety and limit our ability to provide quality care to Veterans.”  They received no response from the VA to their requests for meetings. Veterans membership organizations and a bipartisan group of more than 90 members of Congress also oppose the policy.

Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training to specialize in anesthesia care and pain control, with the necessary knowledge to understand and treat the entire human body.1 By comparison, nurse anesthetists have about half the education and almost 2,500 hours of clinical training.2

The proposed policy would have all advanced practice registered nurses (APRNs), including nurse anesthetists, practice without the collaboration, supervision or direction of a physician. Individual VA hospitals will not be permitted to keep the proven model of team-based anesthesia care that ensures patients have access to a physician anesthesiologist if an emergency or complication occurs. Under the new policy, Veterans will not have access to physician anesthesiologists.

 

The proposed policy change will be posted to the Federal Register May 25 and is open for public comment for 60 days. ASA urges every American who cares about safe VA care and the well-being of the nation’s Veterans to visit safevacare.org and post a comment to stop the VA from removing physician anesthesiologists from surgery.

 

More information about the proposed policy and physician anesthesiologists is available at safevacare.org.

 

WVSSA officers:

 

President
President-elect
Immed Past-Pres
Sect-Treas
Asst Sect-Treas
ASA Delegates

ASA Alt Delgs

ASA Res Delg
ASA Director
ASA Alt Dir
Legislative

Seth Crislip, MD (sethcrislip@gmail.com)
Matt Ellison, MD (ellisonma@wvumedicine.org)
Michael Panger, MD
Robert Johnstone, MD (johnstoner@wvumedicine.org)
Brian Grose, MD
Alex Skaff, MD
Brian Grose, MD
Matt Ellison, MD
Chad Sizemore, MD
John Bozek, MD
Robert Johnstone, MD
Alex Skaff, MD (ASkaff1Ace@aol.com)
Alex Skaff, MD

Robert Johnstone, MD, Newsletter Editor

 

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