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.
ok. When you are in the ER with chest pains a lecture on how to prevent heart disease will go a long way.
The best protection of course is a well educated, freedom loving, moral, discerning public that is aided by a truth seeking legitimate press and ethical politicians. Alas people are on their own these days.
Since Obastardcare was brought, I saw my charges at my primary care doctor go from under 100 bucks for a ten minute, or less visit, to 283 bucks.
And I dont even get to see the doctor. Its the NP I see.
There’s no money in prevention.
Big Pharma wants you to eat unhealthy, to get you hooked on their products.
Question to you. Say I became wealthy-really wealthy. And I offered to pay for your schooling if you agreed to practice in my community, a very small one, for a period of time to pay off my paying for your schooling.
Would you think it a good program to get more into the medical practice?
A similar program already exists — med school debt can be paid off if one goes to underserved communities. The system definitely could use some revamping. My daughter just graduated from med school with about 240k of educational loans. That is after we paid entirely for her undergrad and helped with med schools expenses. She has some of lowesr outstanding debt in her class
What you are implying is in order to be healthy, an outside entity needs to do that for you.
It is simple, really. Don’t eat to obesity, don’t smoke, don’t drink and exercise.
Why should the government have to pay for something that is in your own control?
Prevention is used as a mantra, but in reality poor lifestyle is the reason for premature death in the USA.
Should your preference be forced on everyone willing to see a NP or MA?
Did not know that. Is it a government run program?
I live in Golden Valley Az. A largely rural community with about 8 to 9 thousand people who are largely elderly.
And no real doctors or clinic here. And you know what I mean by real doctors.
Doctors and medical facilities pay a LOT for CYA insurances.
What’s the third leading cause of death here?
How big are some of the many pain & suffering judgements?
“Should your preference be forced on everyone?”
No but how long do you think it will be before you aren’t allowed to see a doctor unless you exhibit certain symptoms? Will there be a discount in price because you are not seeing a real doctor?
“...don’t drink and exercise.”
Oh, c’mon! I like beer with horse shoes.
A few years back I was sitting in a clinic, waiting to see my MD, and a PA was running around, frantic, looking for his cell phone, quite the drama queen. You could tell the front desk staff did not care for him. Out of curiosity when I got home I looked up his credentials and found out his degree was in...art history. This qualified him to become a PA? Yikes.
Had a good friend who for two years told the PA (he never - not once - saw the MD) that he had stomach/gut pain that over time was getting worse. The PA's standard response was "lose weight". Yes he needed to lose weight and yes, IMO, he needed to see a real doctor. The PA never suggested tests of any sort. The friend died two years later of colon cancer.
it’s a government run program. I think it favors areas like reservations etc.... Probably your best bet is looking to set up a telemedicine program with a university or large hospital system
Yes, I can give you a good lecture on preventing heart disease.
You can begin with a study that came out a couple years ago.
Prevention should require courses and classes. And it should definately be allowed to compete for Medicare dollars not just managing tragedy years later.
You can learn all about prevention in a simple google search if you so wish. However, most people are lazy and do things that are detrimental to their health. The only way to prevent that is to have the government have dictatorial powers over you.
Bookmark
>> i’m retiring as soon as I can.
An indication of the problem — the Democrat’s ACA disaster.
It’s a new game now with tele-docs, PAs, & NPs. Perhaps the middle bar could be raised a bit to ensure the necessary skills and experience.
“The problem is a crossing weather front as you clear 2000 feet AGL on the way in. THEN you need a pilot.”
You don’t think the flight simulator “pilot” can discern that condition and call the real pilot?
It’s somewhat similar to seeing a GP who refers you to a specialist when he recognizes that the problem is beyond his abilities.
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