The House Committee on Veterans' Affairs and the Senate Committee on Veterans' Affairs exercise jurisdiction over legislation related to veterans' health care and provide oversight on the role of the Veterans Health Administration, Department of Veterans Affairs. H.R. 1302, a bill to amend title 38, United States Code, to establish the position of Director of Physician Assistant Services within the office of the Under Secretary of Veterans Affairs for Health, was introduced by Representatives Phil Hare (D-IL) and Jerry Moran (R-KS) on March 4, 2009. Original cosponsors included Representatives Boozman (R-AR), Brown (D-FL), Buyer (R-IN), Filner (D-CA), Grijalva (D-AZ), Holden (D-PA), Michaud (D-ME), and Rodriguez (D-TX). On May 21, 2009, S. 1155, a Senate companion bill, was introduced by Senator Susan Collins (R-ME) and Senator Daniel Inouye (D-HI).
On July 27, 2009, the U.S. House of Representatives passed bipartisan legislation to establish a full-time Director of Physician Assistant Services at the Veterans Health Administration. Originally introduced as HR 1302 by Reps. Phil Hare (D-IL) and Jerry Moran (R-KS), the provisions were incorporated into HR 3219,the Veterans' Insurance and Health Care Improvements Act of 2009, which was passed by voice vote. The establishment of the Director of PA Services was supported by the chairmen and ranking members of the Health Subcommittee and Committee on Veterans Affairs, including Reps. Mike Michaud (D-ME), Henry Brown (R-SC), Bob Filner (D-CA), and Steve Buyer ( R-IN).
Background
The first graduates of PA educational programs were veterans, former medical corpsmen who served in Vietnam and wanted to use their medical knowledge and experience in civilian life. The veteran/PA connection continues today. PA programs currently recruit medics who have served in Afghanistan and Iraq to be educated as PAs. PAs provide essential medical care in Iraq and Afghanistan as active duty members of the Armed Services, National Guard, and Army Reserves. The Department of Veterans Affairs is the single largest employer of physician assistants.
P.L. 106-419 required the VA to establish a PA Advisor to the VA's Under Secretary for Health. Prior to the enactment of the law in 2000, the VA had never had a PA within the Veterans Health Administration to advise on such issues as PAs' education, qualifications, clinical privileges, scope of practice, or third party reimbursement for services provided by PAs. The absence of a knowledgeable resource in the VA to advise on these issues resulted in unnecessary restrictions on PAs' ability to provide medical care to the veteran population.
The VA chose to implement the PA Advisor provision within P.L. 106-419 as a part-time, field position, with a very limited travel budget. Although the PAs who have served in the position have made progress on the utilization of PAs within the agency, there continues to be inconsistency in the way that local medical facilities utilize PAs. In one instance, the AAPA was informed that a local facility determined that a PA could not write outpatient prescriptions, despite licensure in the state allowing prescriptive authority. Other PAs report that VA medical facilities will not hire PAs.
Recommendation
The American Academy of Physician Assistants seeks the assistance of the 111th Congress to enact legislation to elevate the PA Advisor to the VA’s Under Secretary for Health to a full-time director, located in the VA’s central office.
Justification
In the years since the PA Advisor position was put into place, the VA PA population grew from 1,195 PAs to nearly 1,800 PAs - a 34% increase. Also, in the years since the PA Advisor was created, the Senate Appropriations Committee report on the Department of Veterans has included language recommending that the position be strengthened. In the 2002 report, the Senate expressed concern about the VHA limitation of the PA Advisor to a part-time position and encouraged the VHA to implement a full-time PA Advisor position in or near Washington D.C. Additionally, the Senate report urged the VHA to provide sufficient funding to support the PA Advisor position.
Inefficient utilization of PAs employed by the VA and unnecessary restrictions on the care provided by PAs limits veterans' access to quality medical care. The AAPA believes that the VA PA Advisor must be elevated to a full-time director in the VA's central office to address patient care issues and the full utilization of the PA workforce employed by the VA.
For further information, please contact:
Sandy Harding, Director of Federal Affairs
American Academy of Physician Assistants
Telephone: 703-836-2272, ext. 3205
E-mail:
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Kim Beer, Assistant Director of Federal Affairs
American Academy of Physician Assistants
Telephone: 703-836-2272, ext. 3204
E-mail:
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