Expanding Scope of Practice for Vascular Access Specialists Can Improve Quality Care

Part 2 of a two-part post.

The Affordable Care Act (ACA), more commonly known as Obamacare, is 906 pages long. But amidst all that detail are a few driving goals. One of those is something few would argue with: higher quality healthcare at lower cost. That’s also the focus of a new white paper on vascular access.

It’s no wonder the ACA’s authors made that a priority. The U.S. lags behind other industrialized countries on both sides of the quality/cost equation. We have the most expensive healthcare, by far, among industrialized nations, according to both the Organization for Economic Co-operation and Development (OECD) and the healthcare-focused Commonwealth Fund. The U.S. also ranks worse than many of these nations on some measures of quality, including safety.

That brings us to Leslie Schultz, RN, Ph.D., Director of the Safety Institute at Premier, Inc., a major healthcare group purchasing organization. As described on its website, the Safety Institute “coordinates safety-related activities among national organizations, Premier members, [Premier’s] business units, [Premier’s] contracted suppliers, and the community.” In line with that mission and the ACA both, Schultz has pointed to an elegant idea that addresses cost and quality simultaneously.

The idea is to have non-physician vascular access specialists (VAS’s) expand their role in IV line placement to include central venous catheters (CVCs) and arterial lines. These specialists can encompass RNs, respiratory therapists, physician assistants, and nurse practitioners. At most medical facilities, non-physician inserters already place peripheral IV lines, midline catheters, and PICC lines. Most states also allow non-physicians to place CVCs and arterial lines. (See this map for each state’s requirements.) But for a variety of reasons – some of which are strictly political – few facilities permit VAS’s to place the full range of lines that they are licensed to insert.

Why is expanding the role of VAS’s a good idea and how does it fit with the ACA’s goals of increasing quality and lowering cost? Start with the fact, Schultz says, that VAS’s expertise in IV line placement often exceeds the knowledge and experience of physicians. For instance, unlike physicians, specialists are usually trained in ultrasound guidance techniques. Ultrasound allows veins to be visualized during the placement procedure, which tends to reduce the number of insertion attempts and the associated complications, Schultz notes. This fact alone increases quality while reducing time- and treatment-related costs.

VAS’s also tend to be more available to place lines than doctors are. So a patient who needs a CVC or arterial line would be less likely to have to wait for it if a VAP was tasked to do it. Waiting is not just annoying. It also delays treatment, so it is a quality issue. Higher quality care in the form of fewer insertion attempts, fewer complications, and shorter wait times also increases patient satisfaction, Schultz points out. More satisfied patients then have an indirect effect on cost by raising a hospital’s stature in its competitive marketplace.

Consider also, Schultz says, that physicians are much more highly compensated than VAPs. If VAPs take over doctors’ CVC and arterial line duties, the doctors are more available to do other tasks that only they can do. So expanding the role of VAPs leads to a more productive, efficient, and cost-effective use of physician time.

Again, hospitals have been slow to expand VAS’s role, but how long can that continue? Hopefully, the ACA will provide some impetus for change. VAPs can also try to get the ball rolling themselves, Schultz suggests – for instance, by making cases like the ones above to their hospital’s chief financial officer (CFO).

“I think it’s an opportune time for vascular access professionals,” Schultz says, “because if you demonstrate that you have better outcomes and you are paid less than doctors, the CFO is going to be very interested in you. That’s especially true if the hospital is facing financial penalties under the Affordable Care Act.”

The genius of the ACA is that the same quality/cost solution that works for the hospital also works for the ACA itself. As Schultz puts it, “Where you have better outcomes, you have higher quality and lower cost. And higher quality at lower cost is what the Affordable Care Act is all about.”

To read a white paper and access other resources devoted to the scope-of-practice issue, click here.

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