Posted on 01/14/2020 5:59:33 AM PST by Kaslin
President Trump recently issued an Executive Order protecting and improving Medicare for our nation’s seniors. The October 3, 2019 order was intended to increase Medicare beneficiaries’ access to primary care. The executive order is little more than a policy goal at this point. Item five of the executive order annoyed physicians. It gave the Secretary of Health and Human Services (HHS) 12 months to formulate a proposal to expand the autonomy of nurse practitioners (NPs) and physician assistants (PAs) working in the Medicare program. Under the proposal, so-called midlevel providers would be allowed to practice with far less supervision, prescribe medications and bill Medicare when they see Medicare patients. The proposal also seeks to equalize compensation paid to physicians and PAs/NPs treating Medicare patients.
NPs and PAs have been fighting for greater autonomy for decades. However, the proposal has some powerful enemies: doctors. This is how it currently works: in virtually all states doctors are responsible for the care provided by NP/PAs. Some states require NPs/PAs to have collaboration agreements with physicians. Yet, not all physicians want to collaborate with NPs/PAs and those who do naturally demand a portion of the revenue and often place restrictions on what tasks NPs/PAs can perform. Many other states require a form of direct supervision, often requiring a percentage of patient case files be reviewed by the supervising physician. Thirty-nine states even place limits on the number of NP/PAs any one doctor can supervise.
This turf war, known as scope of practice, is raging not just on Capitol Hill but also in state legislatures all across the country. It is easy to see why physicians oppose greater autonomy for midlevel providers. Recall I said that doctors currently must supervise midlevel providers in virtually all states. Thus, most NPs and PAs either work for doctors or work with doctors and give them a cut of their pay. Under President Trump’s initiative, physicians would lose some of their ability to profit off NPs/PAs' work. More galling is the fact that physicians have much more rigorous training requirements, higher student loan balances yet may be paid the same for a 20-minute office visit with a senior. With this executive order President Trump seeks to turn NPs/PAs into primary care physicians’ competitors rather than employees and collaborators.
Why allow seniors to make appointments with nurse practitioners and physician assistants independent of doctors? Because the vast majority of medical conditions that patients experience are simple problems that don’t require a doctor to diagnose or treat. More complicated conditions are easily referred to specialists. General practitioners participating in Medicare already do this. Furthermore, numerous surveys have found NPs have high satisfaction ratings and are rated as better listeners than physicians. Indeed, various surveys have found physicians tend to interrupt their patients with seconds after patients begin describing symptoms. More to the point, 78 million Baby Boomers will become eligible for Medicare by 2030 and many will be unable to find a primary care provider unless the supply is expanded. The Association of American Medical Colleges predicts a shortage of nearly 122,000 physicians by 2032.
Non-seniors should care about turf battles in Medicare because what Medicare does affects other areas of medicine. Current regulations that govern the practice of medicine are exclusive. Stated another way, state and federal regulations purposely create barriers to entry, making it more difficult to practice medicine and inhibits competition. In his book Capitalism and Freedom, Nobel laureate Milton Friedman described the American Medical Association as the “strongest trade union in the United States.” Trade unions reduce competition, not promote it. Cartels and professional guilds are never pro consumer. They exist primarily to boost the wages of guild members.
Whether in rural areas or urban areas, Medicare or private health plans, patients should have the choice and convenience to decide who they want to see. Patients should be free to see a nurse practitioner, a physician assistant, a primary care doctor or a physician specialist depending on their needs. When doctors argue all other medical staff should report to physicians in the name of patient safety, keep in mind the safety they are most concerned about is the safety of their income stream.
Great idea for rural and small town health care access .
Both areas have terrible time finding very good providers .
There are plenty of quacks or DRs on the run in this locations .
Here comes Trump wielding the sword of Adam Smiths hand to sweep away restrictions and regulations
and offer you instead free market competition.
I agree with this. Like people with hypertension, I have to take a drug for my inactive thyroid for the rest of my life. And yet, prescriptions are only good for one year. To get it restarted, you MUST see a doctor (and, of course, pay for an office visit).
It must be nice to guarantee yourself permanent customers....
I get great care and service from the Nurse Practitioner at my Doctors office. Same Doctor 30 years, has had 2 NP’s for about 10 years now and it works rather well.
A lot of doctors won’t take new medicare patients so they are complaining about the Nurse Practitioners and PA’s being able to receive compensation if the NP’s and PA’s see them?
i hater what obama did to healthcare. This move is even worse. i spend a good part of my day cleaning up messes made by PAs and NPs. if people want care by PAs (a 2 year program with no clinical experience) or NPs ( a 1 1/2 year program with a whopping 750 horoscope clinical experience) go for it. My colleagues will be here to clean up the mess maybe. i’m retiring as soon as I can.
A lot of doctors won’t take new medicare patients so they are complaining about the Nurse Practitioners and PA’s being able to receive compensation if the NP’s and PA’s see them?
Once you figure out that they're complicated, that is.
Anybody who plays MS Flight Simulator can land a 747 on a calm wind sunny day if the pilot has a heart attack.
The problem is a crossing weather front as you clear 2000 feet AGL on the way in. THEN you need a pilot.
there are many “simple” conditions that arent so simple when you look closer.
Obama Administration: The cost of healthcare is too high. People cant afford it. It is broken. We must regulate the patients wealth by having them pay US which we will pass on to the providers of healthcare.
When did we stop asking, whaddafuque?
My brother and SIL are both on Medicare. And I seem to recall several conversations with them on how upset they were when they went to the medical office for routine appointments and were angry that they were seen by an NP instead of a Dr. They seemed to think that their whopping $15 co-pay should have been at least half as much because they were not seeing a “real” doctor.
The public, saturated with bogus alternative remedies, quacks on TV and phonies writing bizarre books extolling nonsense have come to believe that real medical expertise does not really matter. Why there is a remedy for anything! The harsh reality is that unless a medical diagnosis is promptly and accurately made at the beginning of an illness, treatments and referrals are not made in a timely outcome and the results are often gruesome. The public not only suffers from political delusions but has been conditioned to accept health fantasies as well.
Simulated quality is the order of the day, because they cannot understand or measure the real thing.
Imagine bringing Larry Scherr on rounds with you today! He would have a stroke.
The failure rate of Doctors is already stratospheric.
The success rate of Doctors is abysmal.
The success rate of cancer treatment is a poorly 3%.
So where is the problem? Allow and expand other medical persons to bill to Medicare.
Medicare is not about snobby, entitled Doctors.
Medicare is about patients.
One of the very best medical practitioners I ever had was a PA. He was part of the Johns Hopkins Healthcare system. He took his time during appointments so I never felt he was rushing me and he always took the time to answer any questions I had. He was very instrumental in helping me lose weight and lower my BP without upping my medication. His name was Dave but I used to call him “Doc Dave”/
But I remember most the time I came down with conjunctivitis. It started on a Sunday night but by Monday morning it was so bad I could barely see. My eye lids were nearly swollen shut but at the same time my eye balls were swollen and big streams of yellow puss streaming out, my whole face was swollen in fact. I called to make an urgent appointment and my niece had to drive me because I couldn’t see to drive.
As soon as Dave saw me and without even examining me, he told me to put my arms up in the air and DO NOT TOUCH ANYTHING!!! And to follow him to his office where he proceeded to call first the Wilmer Eye Clinic but when they could see me right away, to an eye specialist not far away.
When I got to the specialists, not one, or two, but three eye doctors examined me with the last and most senior one telling me “a lot of times PA’s or even Dr.’s see conjunctivitis and overreact. But not in this case, this is probably the worst case I’ve ever seen in all my 25 years of practice.” They called it “hemorrhagic conjunctivitis” and wanted to admit me to the hospital to go on IV antibiotics and observation. We ended up compromising that they would give me Rxs for oral and topical antibiotics and a steroid and sent me home with instructions that I had to come back the next day and if wasn’t any better or if any worse, I’d have to be admitted to the hospital.
I did get better but it took a while and the first couple of days I was running a 101 to 103 fever.
I was so glad that my PA Dave recognized just how bad it was and got me into see an eye specialist right away.
And these delusional ravings sell! I hear them being extolled on the airwaves over and over and over!
It seems humans have an innate propensity to buy snake-oil.
I’ve received very good care from a Navy PA. Would be delighted to have this extra bandwidth available.
I MUCH prefer our PA that I ask to see over our Primary Care Doctor!!!... he is sensitive and caring and gives us MUCH MORE time than does our doctor!
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