Scope of Practice

CMS shouldn’t permanently relax rules on physician oversight

Kevin B. O'Reilly , Senior News Editor

What’s the news: The AMA and dozens of other physician organizations are urging the Centers for Medicare & Medicaid Services to resist calls to extend temporary waivers involving scope of practice and licensure when the public health emergency declared in relation to the COVID-19 pandemic ends.

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“Some organizations have already been advocating to make the temporary waivers permanent—permanently diminishing physician oversight and supervision of patient care,” notes the letter from the AMA and others.

Health systems have taken many steps during the pandemic to “reassess how they allocate human resources,” says the letter. That includes postponing or canceling elective procedures.

CMS, meanwhile, has “temporarily relaxed the direct oversight and licensure requirements to allow health care systems to stretch their capacity to treat more patients.” But such measures should not be open-ended.

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“Our organizations reaffirm our support for the physician-led team-based approach to care and vigorously oppose efforts that undermine the physician-patient relationship during and after the pandemic,” the letter says.

Learn why COVID-19 doesn’t require end-run around scope-of-practice laws.

Why it’s important: Doctors have seven or more years of postgraduate education and rack up 10,000-plus hours of clinical experience, making them uniquely qualified to lead health care teams. Nurse practitioners (NPs), in comparison, only complete two to three years of graduate-level education and tally 500–720 hours of clinical training. Physician assistant (PA) programs, meanwhile, require 2,000 hours of clinical care.

There’s no question that “NPs and PAs are integral members of the care team, but the skills and acumen obtained by physicians throughout their extensive education and training make them uniquely qualified to oversee and supervise patients’ care,” says the letter to CMS Administrator Seema Verma.

The organizations signing on to the letter are urging “CMS to sunset the waivers involving scope of practice and licensure” when the COVID-19 public health emergency ends.

At minimum, such decisions should be made only after the COVID-19 emergency ends and done through the standard regulatory notice-and-comment process.

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That would “allow for a thorough and deliberate policy making process that ensures all stakeholders, including patients, are heard and give time for CMS to study the impact of the scope of practice waivers’ on the cost and quality of patient care,” says the letter from the AMA and others.

Read more about a CMS move that may undermine doctor supervision across medicine.

Learn more: Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.