[Congressional Record Volume 146, Number 32 (Tuesday, March 21, 2000)]
[Senate]
[Pages S1521-S1522]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself, Mr. Jeffords, and Mrs. 
        Hutchison):
  S. 2264. A bill to amend title 38, United States Code, to establish 
within the Veterans Health Administration the position of Advisor on 
Physician Assistants, and for other purposes; to the Committee on 
Veterans' Affairs.


   recognition of physician assistants in the department of veterans 
                          affairs act of 2000

 Mr. ROCKEFELLER. Mr. President, I am proud to introduce today 
the ``Recognition of Physician Assistants in the Department of Veterans 
Affairs Act of 2000,'' which I am delighted to cosponsor with Senators 
Jeffords and Hutchison. The bill before us would establish within the 
Veterans Health Administration an advisory position on physician 
assistants--an action long overdue.
  It is baffling to me that the VA--the largest single employer of 
physician assistants in the country--does not provide direct 
representation for physician assistants. VA has nearly 1,200 physician 
assistants working in hospitals and clinics, yet VA is the only federal 
health care agency that does not have a physician assistant in a 
leadership role. Skimming through the VA phone directory, we find much 
needed representation for social workers, dentists, audiologists and 
speech pathologists, nutritionists, recreational therapists, and 
nurses. Physician assistants, however, are hidden within the bailiwick 
of the Chief Consultant for Primary and Ambulatory Care.
  This lack of physician assistant leadership has translated into a 
lack of knowledge about the profession at the national level--which, in 
turn, has filtered down to the local level. For example, the scope of 
practice for physician assistants is not uniformly understood in all VA 
medical facilities and clinics. Practitioners in the field also report 
confusion regarding such issues as privileging, supervision, and 
physician countersignature. Some facilities unnecessarily restrict the 
ability of physician assistants to provide medical care, while others 
will not hire physician assistants. The unfortunate consequence of 
these restrictions is to limit veterans' access to quality medical 
care.
  In June 1997, the final report of a work group to explore internal 
practice barriers for Advanced Practice Nurses,

[[Page S1522]]

Clinical Pharmacy Specialists, and Physician Assistants was issued. To 
date, we have seen no response regarding what VA plans to do to 
implement the recommendations contained in the report.
  Although the work group's report does not contain a specific 
recommendation for an advisory position, the report clearly states that 
``many times unnecessary, inappropriate restrictions have been placed 
on their [PAs] practice.'' An advisor would be especially helpful in 
clarifying all issues associated with the profession, including 
education, qualifications, clinical privileges, and scope of practice. 
I firmly believe that such an advisor is the key to removing barriers 
to greater use of these valued health care professionals. I also 
encourage VA to move ahead with the other recommendations contained in 
the work group report.
  I personally understand the huge importance of physician assistants. 
My own state of West Virginia is highly dependent upon their expertise. 
We count on them to provide quality health care in a cost-effective 
way.
  In closing, I thank the Veterans Affairs Physician Assistants 
Association, which has always provided me with the most up-to-date 
information about the state of the physician assistant profession. I 
hope the Committee on Veterans' Affairs will work expeditiously to pass 
this bill out of committee. Physician assistants--and their patients--
are depending upon it.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2264

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Recognition of Physician 
     Assistants in the Department of Veterans Affairs Act of 
     2000''.

     SEC. 2. ESTABLISHMENT OF POSITION OF ADVISOR ON PHYSICIAN 
                   ASSISTANTS WITHIN OFFICE OF UNDERSECRETARY FOR 
                   HEALTH.

       (a) Establishment.--Subsection (a) of section 7306 of title 
     38, United States Code, is amended--
       (1) by redesignating paragraph (9) as paragraph (10); and
       (2) by inserting after paragraph (8) the following new 
     paragraph (9):
       ``(9) The Advisor on Physician Assistants, who shall carry 
     out the responsibilities set forth in subsection (f).''.
       (b) Responsibilities.--That section is further amended--
       (1) by redesignating subsection (f) as subsection (g); and
       (2) by inserting after subsection (e) the following new 
     subsection (f):
       ``(f) The Advisor on Physician Assistants under subsection 
     (a)(9) shall--
       ``(1) advise the Under Secretary for Health on matters 
     regarding the optimal utilization of physician assistants by 
     the Veterans Health Administration;
       ``(2) advise the Under Secretary for Health on the 
     feasibility and desirability of establishing clinical 
     privileges and practice areas for physician assistants in the 
     Administration;
       ``(3) develop initiatives to facilitate the utilization of 
     the full range of clinical capabilities of the physician 
     assistants employed by the Administration;
       ``(4) provide advice on policies affecting the employment 
     of physician assistants by the Administration, including 
     policies on educational requirements, national certification, 
     recruitment and retention, staff development, and the 
     availability of educational assistance (including 
     scholarship, tuition reimbursement, and loan repayment 
     assistance); and
       ``(5) carry out such other responsibilities as the Under 
     Secretary for Health shall specify.''.

  Mr. JEFFORDS. Mr. President, I am pleased to join Senators 
Rockefeller and Hutchison in the introduction of the Recognition of 
Physician Assistants in the Department of Veterans Affairs Act of 2000. 
This legislation will establish a position of advisor on physician 
assistants within the office of the Undersecretary of Health for 
Veterans Affairs.
  Physician assistant are very valuable members of the VA health care 
delivery team. But unlike most components of the team, physician 
assistants have no representative within the VA's Office of the 
Undersecretary for Health. As the largest employer of physician 
assistants in the country, the VA will be establishing important 
precedents as the role of physician assistants evolves over the coming 
decade. Physician assistants must be part of the discussion and 
represented at the level where key health care delivery decisions are 
made.
  An advisory position would be established by this legislation to 
inform the Undersecretary for Health on such matters as optimal 
utilization of physician assistants by the VA, the advisability of 
establishing clinical privileges and practice areas, the development of 
appropriate educational requirements and certification criteria, and 
other matters.
  This representation is critically important at this time. As the VA 
moves toward Medicare Subvention and the requisite billing expertise, 
questions will continually arise surrounding the role of physician 
assistants. There must be consistent input on these matters directly 
from physician assistants.
  I urge my colleagues to carefully consider this legislation and I 
hope it is quickly enacted into law.
                                 ______