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FTC Backs VA 'Full Practice Authority' for APRNs

News  |  By HealthLeaders Media News  
   July 26, 2016

Under a Veterans Affairs proposal put forward this spring, advanced practice registered nurses would provide wider array of services without direct clinical oversight from a physician, and regardless of restrictions in state or local law.

Federal Trade Commission staff have issued written support for a Department of Veterans Affairs proposal that would grant advanced practice registered nurses a wider degree of authority and autonomy.

Staff of the FTC's Office of Policy Planning and its Bureaus of Competition and Economics responded to the VA's request for public comments and wrote that removing the remaining state law-based supervision restrictions for APRNs working within the Veterans Health Administration system could benefit VA patients nationwide "by improving access to care, containing costs, and expanding innovation in healthcare delivery," FTC said.

"To the extent that the VA's actions would spur additional competition among healthcare providers and generate additional data in support of safe APRN practice, we believe those benefits could spill over into the private healthcare market as well," FTC staff wrote.


Related: Evidence Trumps Politics When It Comes to APRNs


When the VA released the proposal in May, it said that full practice authority would expand the pool of qualified healthcare professionals authorized to provide primary healthcare and other related health care services to the full extent of their education, training, and certification to Veterans without the clinical supervision of a physician. 

The American Medical Association responded in May that " this proposal will significantly undermine the delivery of care within the VA" and urged the VA to maintain its physician-led model of care.

Under the new policy, APRNs would be able 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 professional education and training.

The four APRN roles are:

  • Certified Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registered Nurse Anesthetist
  • Certified Nurse Midwife

All VA APRNs are required to obtain and maintain current national certification. The VA recognizes that CNPs, the main category of primary care APRNs, already have full practice authority under the laws of more than 20 states and the District of Columbia.

"The purpose of this proposed regulation is to ensure VA has authority to address staffing shortages in the future," said VA Under Secretary for Health David J. Shulkin, MD. "Implementation of the final rule would be made through VHA policy, which would clarify whether and which of the four APRN roles would be granted full practice authority."

Shulkin stressed in May that the VA is not seeking to change its policy on the role of APRNs "at this time… but would consider a policy change in the future to utilize full practice authority when and if such conditions require such a change."

"This is good news for our APRNs, who will be able to perform functions that their colleagues in the private sector are already doing," he said.   

The President of the American Association of Nurse Practitioners, Cindy Cooke, DNP, FNP-C, FAANP, said in a statement Monday that AANP "is pleased that the FTC filed comments in support of the VA's proposed rule.  The FTC's comments recognize that granting veterans direct access to nurse practitioners at VA facilities across the nation will increase access to care and improve efficiencies in health care delivery."

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