December 16, 2016

VA Rule Denies Imaging Privileges for APRNs

Thanks to the advocacy activities of the American College of Radiology (ACR) and others, the Veterans Administration (VA) has decided against expanded imaging privileges for advanced practice registered nurses (APRNs)/ certified nurse practitioners (CNPs).

The VA removed language that would have allowed CNPs to “perform, supervise and interpret” imaging before posting its final rule Dec. 13 on the Federal Register Public Inspections page. The final rule limits the CNPs privileges to ordering imaging studies and integrating the results into clinical decision making.

In explaining its decision, the agency stated, “It is not VA’s intent to replace our highly qualified radiologists or radiological technologists. VA is committed to providing high quality health care for our nation’s veterans and is proud of the outstanding work performed by radiologists in our system. We note, however, that during the course of care, other health care providers may review radiology exams and make evaluations based upon the radiologist’s findings. These health care providers include providers in emergency departments, primary care clinics, and specialty clinics throughout the VA health care system. All radiology studies are formally performed and read by individuals who are credentialed in radiology. This rulemaking will not change this practice. In order to avoid confusion, we are amending § 17.415(d)(1)(i)(B) by removing performing, supervising, and interpreting imaging studies and replacing it with ‘Order laboratory and imaging studies and integrate the results into clinical decision making.’”

In its comments on the proposed rule, the ACR cautioned the VA that CNPs do not have the specialized education, experience or skills required to order, interpret, supervise or perform imaging studies. The College predicted that using CNPs to order, interpret, supervise or perform imaging studies will jeopardize quality of care and thwart the goal of the rulemaking to decrease wait times in the VA healthcare system. And it emphasized, “Extending APRN practice authority in the VA to encompass imaging is not consistent with the role of APRNs in the non-VA health care sector and contravenes VHA’s obligation to meet or exceed generally-accepted professional standards.”

The 60-day comment period on the VA’s proposed rule, which ended on July 25, 2016, generated 223,296 negative and positive comments.. The ACR thanks the more than 5,500 members who responded to the contributed responses to the proposed rule through the Radiology Action Network (RAN) Call to Action to oppose the proposal.