It is my great pleasure to inform you that the efforts you made to alert the Veterans Administration to problems with the agency's rule expanding the authority for APRNs has met with success. Tomorrow, the VA will publish the final personnel regulations in the Federal Register.
We have successfully convinced the VA to adjust the language to better protect patients while expanding access to care for our nation’s veterans. Further, the VA calls out the "crucial role" laboratorians play in the care of VA patients. The key language explaining this change is below (with emphasis added by me).
“Several commenters stated that they were concerned with proposed§ 17.415(d)(1)(i)(B), where we stated that a Certified Nurse Practitioner (CNP) mayorder, perform, or supervise laboratory studies. The commenters stated that theproposed language does not “adequately appreciate the levels of complexity involved inlaboratory testing” and that there are rigid standards for laboratory tests that requirerigorous academic and practical training, which are not part of the training for APRNs.Another commenter stated, “While the VHA uses the word ‘interpret’ in reference tolaboratory and imaging studies,” the commenter “…infers that the VA’s intent is to grantthe ability for CNPs to interpret laboratory and imaging results, not to interpret or reportraw images or data.” The commenter suggested that VA amend the term “‘interpret’and recommends instead to use ‘integrate results into clinical decision making,’ or someother phrase” in order to avoid confusion between the duties of an APRN and those of alaboratory specialist. We agree with the commenter in that the proposed languagemight be construed as allowing CNPs the ability to perform laboratory studies. It is notVA’s intent to have APRNs take over the role of laboratory specialists. Thesespecialists perform a crucial role at VA medical facilities and are skillfully trained inperforming the various testing techniques that allow health care professionals toproperly treat a veteran’s medical condition. We are amending proposed§ 17.415(d)(1)(i)(B) to now state that a CNP may be granted full practice authority to‘Order laboratory and imaging studies and integrate the results into clinical decisionmaking.’”
The draft final rule can be found at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-29950.pdf
Congratulations to everyone who worked so hard and with so much passion to address this issue!
------------------------------Jim Flanigan, CAEExecutive Vice PresidentAmerican Society for Clinical Laboratory Science (ASCLS)1861 International Drive, #200 McLean, VA 22102o: 571-748-3746 | m: email@example.com | @jimflanigancae------------------------------
Very good news. Now-- where does CMS stand?
The issues with CMS, similar in that those regulations potentially put nurses in inappropriate positions best handled by laboratorians, are unique and will take longer to resolve. CMS has allowed nurses to take on laboratorian roles for years, but it was not widely known. New administrators at CMS wanted to make the "internal policy" transparent to their surveyors. That is what occurred on April 1.
CMS is beginning the process of updating the decades old personnel regulations, of which this is part. ASCLS will be working closely with administrators at CMS to push for upgrades to the regulations.
In my interactions with CMS, I've found the administrators to be very open to hearing our concerns.
In the case of the VA, we were fighting a rule before it was in place, which is much easier process. Changing an existing rule takes far more time.
This will be one of ASCLS's top priorities in the coming Congress and with the new administration.
This is an exciting success! Thanks to Jim and the team for amazing work on this. A holiday gift for all laboratorians!
Kathy Doig, PhD, MLS(ASCP)CMSHCM
Professor Emeritus, Biomedical Laboratory Diagnostics
Michigan State University
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