Our colleagues who have chosen to work within the nation's public sector are overwhelmingly dedicated to fulfilling a higher mission, that of serving society. The Presidential term of Tim Carmody was very nicely highlighted at our Denver convention. The presentation of the Harold M. Hildreth Award was particularly moving, honoring long time APA staff Randy Phelps for his decades of support for those working within the Department of Veterans Affairs (VA) and the entire public sector. President-Elect Tony Puente and former Division President Femina Varghese spoke glowingly of the Division's appreciation. Most of us were not aware that APA does not have an office of Veterans or Military Affairs, even though one in 10 adults is a Veteran and one in six Americans is either a military service member, Veteran, or their dependent. A high priority of President Obama's Patient Protection and Affordable Care Act (ACA) is the development of interdisciplinary team-based care. This, of course, has long been the strength of the public sector.
This summer the VA formally proposed to amend its regulations to permit full practice authority for its Advanced Practice Registered Nurses (APRNs) when they are acting within the scope of their VA employment. Relying upon its federal supremacy authority, the new regulations would preempt individual State nursing licensure laws to the extent to which they would conflict with full practice authority. By the close of the public commentary period, an extraordinary 223,000 comments had been received approximately 60% supportive.
Under the leadership of APA immediate Past-President Barry Anton and President-Elect Tony Puente, 16 former APA Presidents submitted a letter in support of the VA's proposal. The APA Practice Organization signed on to a similar statement as a member of the Coalition for Patients' Rights, along with the American Physical Therapy Association and a number of nursing organizations. "Our coalition exists because of barriers our members face in providing the care they are trained and certified to deliver…. Efforts to limit scope of practice are unnecessary and impede, rather than enhance, patient access to quality care." The American Association of Colleges of Pharmacy also submitted highly supportive comments. The AMA urged the VA: "to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes." One political pundit opined that the AMA had as much credibility on this issue as the NRA did on gun control.
The Federal Trade Commission (FTC): "FTC staff support the Department's initiative to maximize its staff capabilities. Our prior examination of the impact of nursing regulations on health care competition reinforce the VA's view that the Proposed Rule would: * increase the Veterans Health Administration's ('VHA') ability to provide timely, efficient, and effective primary care services, among others; and * increase veteran access to needed health care, particularly in medically underserved areas, as well as decrease the amount of time veterans spend waiting for patient appointments. These changes in VA policy may also benefit health care consumers in private markets…."
"FTC staff recognize the critical importance of patient health and safety, and we defer to federal and state legislators to determine the best balance of policy priorities and to define the appropriate scope of practice for APRNs and other health care professionals. But even well-intentioned laws and regulations may include unnecessary or overbroad restrictions that limit competition. Undue regulatory restrictions on APRN practice can harm patients, institutional health care providers such as the VHA, and both public and private third-party payors. The [FTC] Policy Paper observes, in particular, that state-mandated supervision of APRN practice raises competitive concerns, may impede access to care, and may frustrate the development of innovative and effective models of team-based health care."
"Expert bodies, including the Institute of Medicine ('IOM'), have determined that APRNs are 'safe and effective as independent providers of many health care services within the scope of their training, licensure, certification and current practice.' FTC staff have recommended, therefore, that policy makers carefully examine purported safety justifications for restrictions on APRN practice in light of the pertinent evidence, evaluate whether such justifications are well founded, and consider whether less restrictive alternatives would protect patients without imposing undue burdens on competition and undue limits on patients' access to basic health care services."
"FTC staff urge the VA to apply a similar analytical framework. Granting full practice authority to VA-employed APRNs would benefit both the VA and the patients it serves, consistent with the goals expressed in the Proposed Rule. APRNs should be able, for example, to evaluate VA patients, order diagnostic tests for them, and manage their treatments without physician involvement or approval as long as they do so within the limits of their education and training. Furthermore, the VA's actions and leadership on this issue may send an important signal (and generate useful data) regarding the likely benefits of full practice authority for APRNs. This, in turn, could influence broader policy considerations, as well as provider market entry outside the VA system, both of which may help to bring the benefits of increased health care competition to an even larger number of U.S. citizens and permanent residents…. We strongly believe that full APRN practice authority can benefit the VA's patients and the institution itself, by improving access to care, containing costs, and expanding innovation in health care delivery. To the extent that the VA's actions would spur additional competition among health care providers and generate additional data in support of safe APRN practice, we believe those benefits could spill over into the private health care market as well."
Reflections from Senior Visionaries: Over the past several conventions, the Division has sponsored a panel focusing upon "Meaningful Retirement." Each year the audience has steadily increased, and this year we had 75-80 attendees on a Sunday morning. Long time VA psychologist and most recently fiction book author, Rod Baker, has been a regular. He reports: "One lament I hear from some who have retired is that they can no longer have Sunday brunch with long-time virtual friends from around the nation. I have two thoughts. Those past relationships can still be relevant if you put some time and energy into those friendships, but not if the association is restricted to an annual Christmas card/letter. Pining for lost relationships will get you nowhere. If you miss those past contacts, you have to ask yourself what you have done to maintain them or what you can do to re-ignite them as relevant to your new life. For psychologists who were active in APA, attending a meeting of APA or its Divisions and inviting others to join you to get together to renew friendships might work. I value, for example, the past presidents' breakfasts held by Division 18 for the past three APAs. My second thought is that maybe the focus should be on developing/maintaining and putting new friends and opportunities in your life with those in proximity. That will still take time and effort. The decision is yours."
Bruce Overmier, friend and colleague from APA governance days. "I also like you sense that we must integrate all levels of care. To me, this also speaks to APA getting back to recognizing MAs as a valid and appropriate and respected part of the psychological practice (and psychological science) spectrum. Physicians are finally managing to work with 'physician assistants,' maybe we could find it so for our MAs. I think psychology and APA would be stronger if we did so. Ah, well; perhaps that is just a foolish hope. Fighting vested interests is terribly challenging as you well know." Aloha,
Pat DeLeon, former APA President – Division 18 – September, 2016
Sent from my iPhone
