As the Department of Veterans Affairs (VA) works to revise rules meant to expand medical care for veterans, the AAFP provided feedback on a variety of issues, including physician payment, prior authorization and scope of practice.
In a proposed rule published Jan. 17 in the Federal Register,(www.gpo.gov) the agency described changes to the Civilian Health and Medical Program of the VA (CHAMPVA) that could reduce wait times at VA facilities by expanding access to medical professionals who work outside these facilities.
If the program is to succeed, the AAFP said in a March 7 letter(5 page PDF) to VA Secretary David Shulkin, M.D., participating physicians must be paid appropriately.
"The AAFP strongly believes that CHAMPVA payment must be at or above Medicare levels to be effective in promoting access to primary care services for veterans, spouses, children, survivors and certain caregivers of veterans who meet eligibility criteria," the AAFP said in the letter, which was signed by Board Chair John Meigs, M.D., of Centreville, Ala. "Any public or private payer health plan contract that does not at least meet the Medicare payment rate will create an unmanageable financial drain for most medical practices that already operate on extremely thin margins."
Because it is important that patients are cared for by a physician-led team, the AAFP forcefully opposed the idea of granting full practice authority to nonphysicians outside of state laws and regulations governing such authority, an option that was included in the proposed rule.
"The VA should not supersede state laws and regulations regarding the authority of nonphysician providers," the Academy's letter stated. "The determination of a health professional's ability to practice must follow appropriate standards as determined by state governments, and states are divided regarding independent practice authority. In fact, most states do not believe it to be in the best interest of their citizens and do not allow it, citing concerns for patient safety."
The proposed rule also included a plan to reduce the administrative burden of prior authorization. The AAFP strongly encouraged the move and listed several principles the VA should apply as part of this process, including requiring that prior authorizations be justified in terms of factors such as administrative cost and workflow burden, eliminating prior authorizations in some cases, and adopting a standardized prior authorization form.
The AAFP also supports proposals to eliminate cost-sharing and deductibles for CHAMPVA beneficiaries for
- colorectal cancer screening,
- breast cancer screening,
- cervical cancer screening,
- prostate cancer screening,
- annual physical exams and
"We applaud the VA for expanding CHAMPVA-covered preventive services while eliminating the cost-share amounts and deductibles for these services," the letter stated. "We strongly encourage all VA health plans to cover all preventive services with grade A or B recommendations(www.uspreventiveservicestaskforce.org) from the U.S. Preventive Services Task Force."
Finally, the VA proposed making outpatient prescription smoking cessation pharmaceutical supplies available only through Medications by Mail, but the AAFP insisted that such materials should be available through more channels and went on to note that these supplies are most effective when combined with counseling.
"The AAFP calls on the VA to increase opportunities for family physicians and other health care clinicians to counsel patients about tobacco cessation," the letter stated. "Counseling reinforces pharmacotherapy use in the treatment of tobacco dependence and is an effective method to reduce smoking rates."
Related AAFP News Coverage
New Law Requires VA to Participate in State PDMPs
AAFP Had Urged Agency to Adopt Rule to Fight Opioid Crisis