Paved with good intentions: VA finds innovative solution, but goes about it the wrong way
One of the problems we hear from our clients is that getting to see a primary care physician takes too long. And when they do get to see a PCP, it’s a different doctor at every visit.
To help control wait times and improve continuity of care, the VA will now allow Nurse Practitioners at VA facilities to use their full range of practice privileges. This means that Nurse Practitioners can now assess, diagnose, and prescribe medications without the direct oversight of a physician.
In nearly half the states, Nurse Practitioners already have this unrestricted ability to independently provide primary medical care. Allowing this autonomy often helps provide access to healthcare in rural and underserved areas that have a shortage of physicians. It also helps to reduce healthcare costs as a result of increased competition in the marketplace.
The problem with the VA’s solution is that it completely disregards the laws in the other half of the states that still require Nurse Practitioners to have some level of oversight and supervision from a doctor. Rather than respecting the laws in those states that do not allow Nurse Practitioners full autonomy, the VA had to reach back into the 1990s and use a Clinton-era Executive Order to “preempt” those states’ laws.
So, not only has the VA gone about expanding the scope of practice for Nurse Practitioners without needing Congress to pass a law, but the VA’s actions—despite its good intentions—have nullified the laws in half the states, at least at VA hospitals and clinics.
Sadly, this is just more of that “ends-justifies-the-means” mentality that has gotten the VA into trouble before and reminds us of a variation on that old saying: The road to the VA is paved with good intentions.