Another reason why we can’t manage the US healthcare system

2014

The Veterans Administration is creating a flap because it is proposing a greater role for physician extenders (physician assistants, nurse practitioners, etc.).

Here is just a short excerpt from a recent WSJ article.

… the roles nonphysician health providers should play in medical care, with doctors in short supply in some areas and more Americans gaining health insurance. Physician assistants, nurse practitioners and other so-called physician-extenders are increasingly taking on duties once performed solely by doctors, but state scope-of-practice rules differ widely on how much autonomy they have.

Last month, the VHA issued new guidelines for its 2,200 physician assistants, lifting some restrictions and letting individual PAs and their “collaborating physicians”—previously called “supervising physicians”—determine how much autonomy the PA should have. The American Academy of Physician Assistants hailed the new directive as a “model of flexibility.”

I am not qualified to enter the debate from a clinical position, but I do know that greater roles for less costly forms of health care is essential. I also know that each side of the debate is protecting self-interest.

But here is the real point. Look at the section I have highlighted in bold above. Why in any logical world should each state have different rules for how health care is practiced? Do citizens of different states deserve better or poorer care, more or less costly care? Are regulators in California smarter than regulators in Virginia or is it that lobbying groups have more sway in one place?

Logic knows no bounds

While on vacation last summer in Massachuettes my wife needed short-term care for a wound. The local VNA could not provide the service because they could not accept orders from an out-of-state doctor. So to get this service ultimately required three office visits where the local doctor asked a few questions, signed the order and left. Medicare paid for those three office visits having no valid reason. A more efficient system would have allowed the VNA to contact our local doctor and proceed.

Gee, gross inefficiency and unnecessary cost and an insurance company had nothing to do with it. Extrapolate this event throughout the system and you know why we are light years away from changing the US health care system.