Nov. 20, 2020: National Advocacy Update


A smooth transition of power, a central tenet of any well-functioning democracy, has never been more critical than it is at this moment. AAs the nation is currently experiencing a surge of COVID-19 cases, hospitalizations and deaths which the upcoming holiday season will likely exacerbate, organizations representing the nation's physicians, registered nurses, hospitals and health systems (the AMA, American Hospital Association and American Nurses Association) are urging the Trump Administration to work closely with the Biden transition team to share all critical information related to COVID-19. 

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Confronting the challenges of the pandemic is imperative to saving American lives. Real-time data and information on the supply of therapeutics, testing supplies, personal protective equipment, ventilators, hospital bed capacity and workforce availability to plan for further deployment of the nation's assets needs to be shared to save countless lives. All information about the capacity of the Strategic National Stockpile, the assets from Operation Warp Speed and plans for dissemination of therapeutics and vaccines needs to be shared as quickly as possible to ensure that there is continuity in strategic planning so that there is no lapse in care for patients.

On Nov. 12, the Department of Veterans Affairs (VA) published an Interim Final Rule (IFR) that reconfirms its authority to allow independent practice for advanced practice registered nurses (APRN). The VA's authority to allow independent APRN practice was first confirmed in a December 2016 Final Rule, entitled "Advanced Practice Registered Nurses." The current IFR also confirms the VA's authority to allow chiropractors, optometrists, physician assistants, audiologists, dietitians, physical therapists, pharmacists and other non-physician providers defined in the U.S. Code (38 U.S.C. 7401(1) or (3)) to practice independently if they adhere to the terms of their VA employment and are licensed to practice in one state. The IFR preempts state license, registration, certification, supervision or other requirements that unduly interfere with VA-employed health care professionals' ability to practice independently. The VA used the pandemic and the need to send health care professionals where the need is greatest, irrespective of state laws or regulations, as justification for the IFR. Also mentioned in the IFR was the VA's desire to develop national standards of practice for VA-employed health care professionals, something that it contends will be easier if they are unencumbered by state scope of practice laws and regulations. The IFR confirms VA's authority to allow certified registered nurse anesthetists (CRNA) to practice independently–CRNAs were excluded from December 2016 APRN Final Rule–although the hope is that the VA will not exercise this authority until national standards of CRNA practice are developed. Importantly, the IFR excludes contractors or community-based providers from the definition of health care professionals because they are not considered VA employees. The deadline to submit comments is Jan. 11.

As physicians continue to battle the worsening COVID-19 pandemic, the last thing they should have to worry about is cuts to their Medicare payments. Unfortunately, if Congress does not act soon, they may have to.   Under current law the Centers for Medicare and Medicaid Services (CMS) is required to make budget neutrality adjustments to the Medicare physician payment schedule whenever changes in relative value units (RVUs) reaches a payment increase or decrease by $200 million.  As a result, significant increases in RVUs for office evaluation and management (E/M) services are expected in 2021 leading to a wide range of payment increases and decreases based on the mix of services each specialty provides. Unfortunately, there is broad consensus that these adjustments will compound the COVID-19 pandemic's negative impact on physician practices and further aggravate concerns about the viability of independent practices.   In just the last few weeks, bipartisan legislation has been introduced to address these concerns. The "Holding Providers Harmless from Medicare Cuts During COVID-19 Act" (H.R. 8702) introduced by Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) would freeze payments at 2020 rates for services scheduled to be cut in 2021 for a period of two years, while allowing the scheduled E/M increases to take place. Analyses of this approach show improved overall impact numbers for all physician specialties.   If Congress does not act NOW, these budget neutrality adjustments will negatively impact many physician practices across the country.    Please contact your member of Congress and ask them to support the "Holding Providers Harmless from Medicare Cuts During COVID-19 Act" (H.R. 8702).