Payment & Delivery Models

How a presidential order threatens the physician-led care team

What’s the news: Physicians are raising concerns about a portion of a recent presidential executive order that pertains to the scope of practice in medicine and could undermine well-established Medicare supervision requirements for nonphysician professionals.

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Such requirements are “a critical safeguard to ensure the health and safety of Medicare patients and the cornerstone of the widely adopted team-based approach to health care,” says an Oct. 29 letter to Health and Human Services Secretary Alex Azar from the AMA and more than 100 other organizations, together representing hundreds of thousands of physicians.

The letter comes in response to an executive order covering many different aspects of health care.

The section that has caught the attention of many physicians is section five.

That portion directs Azar to propose “a regulation that would eliminate burdensome regulatory billing requirements, conditions of participation, supervision requirements, benefit definitions, and all other licensure requirements of the Medicare program that are more stringent than applicable federal or state laws require and that limit professionals from practicing at the top of their profession.”

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Why it matters to patients and physicians: Physicians have seven or more years of postgraduate training and 10,000-plus hours of clinical experience, making them “uniquely qualified to lead the health care team,” says the letter.

There are “vast differences in education and training of nonphysician health care professionals” in comparison with doctors. Those real and meaningful distinctions should be considered “before imposing broad-stroke changes to Medicare’s supervision requirements.”

Team-based care, the letter notes, “has a proven track record of success in improving the quality of patient care, reducing costs and allowing all health care professionals to spend more time with their patients.”

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Physicians also are concerned with language in the executive order requiring “a regulation that would affect the reimbursement of physicians and nonphysicians established under the Social Security Act.” The AMA and the other physician organizations noted that such a change would have to be accomplished by rewriting the underlying statute, and they urged the administration to “refrain from pursuing this proposal.”

What’s next: The president’s executive order directs Azar to act within one year. The AMA will actively engage the administration on these, and other issues outlined in the executive order.