The American Legion released a nationwide study today to elevate the voice of veterans as the Department of Veterans Affairs (VA) creates National Standards of Practice (NSP) for dozens of health-care specialties.
The survey release precedes a House Committee on Veterans’ Affairs Subcommittee on Health hearing on the NSP issue. The American Legion will be submitting a statement for the record at Tuesday’s hearing, “VA’s Federal Supremacy Initiative: Putting Veterans First?”
The Federal Supremacy Initiative was created to set national standards of practice for more than 50 clinical specialties. The standardized set of services means that all health care professionals in a given occupation can perform within VA, regardless of what is permitted by state licensure, certification or registration.
While many specialties have fairly uniform requirements across the country, the scope of practice for some highly specialized professions varies widely from state to state. The hearing will look at the transparency of the initiative’s process, what these standards could mean for patient care and more.
“Veterans service organizations, medical associations, and members of Congress have spoken to VA about NSP, but the stakeholders who have not been heard from are veterans,” said Chanin Nuntavong, The American Legion’s executive director of Government Affairs. “We felt it was our responsibility to gather non-anecdotal information and ask veterans about this topic. So, we had an independent third-party company handle the survey.”
Pierrepont Consulting & Analytics LLC conducted the survey of 1,400 veterans between February and April of this year. Survey respondents represented veterans of all ages and service branches.
The American Legion National Executive Committee passed Resolution No. 20, National Standards of Practice, in October 2022. The resolution calls for VA to ensure NSP providers are held to the same level of licensure and certification requirements as those in the majority of states, and that NSPs are consistent with providing the best care possible to veterans.
VA is creating standards for 50 occupations, but Nuntavong said the Legion wanted the survey to be more focused.
“There are many occupations that VA is considering for creating NSPs,” he said. “For the purpose of this survey, we selected the occupations we felt would be the most debated – anesthesiologists and nurse anesthetists.”
The survey showed veterans overwhelmingly prefer a physician over a nurse to provide anesthesia care during surgery.
In fact, 61% of respondents preferred a physician administer anesthesia care while only 4% chose a nurse. The remainder had no preference.
Additionally, 52% of veterans said they would seek care outside of VA if their only choice was to have a nurse administer anesthesia. Another question revealed that 71% of veterans believe VA will have a different standard of care if nurse anesthetists replace physician anesthesiologists.
Other results related to anesthesia included:
• Question: In your opinion, is it important that your anesthesia care during surgery be provided by a physician anesthesiologist?
Responses: 74% important, 18% not important and 8% don't know.
• Question: Surgery and anesthesia are inherently dangerous. Many VA patients have underlying medical conditions such as diabetes, high blood pressure, heart disease, arthritis, or chronic pain that put them at greater risk for surgical complications. Requiring physician involvement is a necessary safeguard.
Responses: 61% strongly agree, 31% somewhat agree and 8% somewhat disagree or strongly disagree.
• Question: Not one top-rated civilian hospital in the U.S. allows nurse-only anesthesia care. Veterans deserve the same level of high-quality care during surgery as non-veterans get at top-rated hospitals.
Responses: 64% strongly agree, 27% somewhat agree and 9% somewhat disagree or strongly disagree.
Among other key findings:
• Roughly nine in 10 veterans expect the same quality of health care as the top-rated non-VA hospitals.
• Just 6% of veterans in VA health care would not recommend it to fellow veterans.
• Veterans with Burn Pit exposure are 30% more likely to be enrolled in VA health care.
• 60% of veterans suffer from multiple health issues.