ASA has long been the leading medical specialty society in warning of the dangers to the health and safety of patients that may occur when non-physician health care practitioners seek scope-of-practice expansion for which they are ill-prepared by education, training or experience.
For many years, ASA’s warnings seemed to fall upon deaf ears as other specialties thought, “that is your problem.” Fortunately, this appears to no longer be the case, as other specialties, particularly through the American Academy of Family Physicians (AAFP), have become aware that many advanced practice nurses (APNs) in their disciplines are now prepared to seek scope expansion that would allow them to practice independent of physician direction. The problem was brought to the forefront when ASA discovered (and publicized) that the Veterans Health Administration (VHA) was considering a mandate that all APN’s within the VHA be designated as independent providers, without regard to the state practice acts. The draft proposed would effectively eliminate physician-led, team-based care within the VHA system.
The proposed VHA policy and efforts by the American Association of Nurse Anesthetists (AANA) and other APN national organizations are in direct opposition to the physician-led care team model long endorsed by ASA and the physician-led, patient-centered, team-based care models that are the heart of the new models of care delivery such as accountable care organizations and patient-centered medical homes, a model of care strongly endorsed by primary care medical specialties.
With scope-of-practice battles looming on the horizon when state legislatures convene in early 2014, ASA has an effective ally in a resource little-known to most of our members: the Scope of Practice Partnership (SOPP) of the AMA.
The SOPP was created in January 2006 as a collaborative effort within the Federation of Medicine to focus the resources of organized medicine to oppose scope-of-practice expansion by non-physician providers that threatened the health and safety of patients. The SOPP is ably staffed by two attorneys from the Advocacy Resource Center of the AMA, Ms. Kristin Schleiter and Ms. Michaela (Kai) Sternstein. It is funded by dues of the member societies: 13 national medical specialty societies, two national medical associations, 32 state osteopathic chapters, and 49 state medical associations and the District of Columbia. The SOPP seeks to achieve its goals through a combination of legislative and regulatory activities, judicial advocacy and programs of information, research and education.
The SOPP is governed by a steering committee, which has included ASA since its inception. The SOPP supports and, in fact, created many of the core advocacy resources states and specialty societies utilize, including a Geographic Mapping Initiative that largely disproves that APNs are more likely than physicians to practice in underserved rural areas, data series modules that document both the number and practice locations of various types of practitioners, and “know-your-doctor” volvelles (a wheel-based advocacy tool comparing physician and non-physician education and training) that have proven to be very effective in educating legislators and regulators.
In addition, since 2007 the SOPP has awarded more than $825,000 to more than 97 national, state and specialty medical and osteopathic societies. These grants have helped defeat inappropriate scope-of-practice legislation and enact proactive truth in advertising legislation. A recent SOPP activity of great importance is a strong letter to the VHA objecting to its previously mentioned proposal to mandate that its APNs be designated as independent providers and instead highlighting the importance of physician leadership of health care teams. The letter was signed by the AMA and 22 national medical specialty societies and 43 state medical societies.
As ASA moves from a defensive posture to a proactive, positive approach with its “When Seconds Count” educational endeavor to highlight the value of physician-directed anesthesia care, the SOPP will be a strong and valued resource at the state and national level.
ASA’s Director of State Affairs, Jason Hansen, M.S., J.D., said it best: “The SOPP is the crown jewel of the AMA. Its staff and related materials have been instrumental in a number of our state-level advocacy successes.”
Your delegation to the AMA urges every member to be alert to scope expansion efforts and to be prepared to assist your state anesthesia society and state medical association to protect physician-led team care.