TMA to Trump: Do Not Expand NPPs’ Scope of Practice
By David Doolittle


When President Donald Trump released an executive order earlier this month that would, in part, expand the scope of practice of nonphysician practitioners, the Texas Medical Association vowed to keep physicians at the head of the health care team.

On Monday, TMA President David Fleeger, MD, took a major step to do that, urging President Trump and Health and Human Services (HHS) Secretary Alex Azar to remove that language entirely.

“For the safety and health of our patients, we request in the strongest terms possible that you remove section 5 from the Oct. 3, 2019, Executive Order,” Dr. Fleeger wrote in a letter that was also sent to Texas lawmakers in the U.S. Senate and House of Representatives.

The executive order, proposed as an alternative to “Medicare for All” proposals, contains some items TMA has long sought, including removing unnecessary barriers to private contracting between Medicare beneficiaries and physicians who may not participate in the program.

However, section 5 gives HHS a one-year deadline to propose a regulation to ensure that services provided by "physicians, physician assistants, and nurse practitioners are appropriately reimbursed in accordance with work performed rather than the clinician’s occupation.”

“The broad language in section 5 appears to be predicated on some nonphysician practitioners’ mistaken impressions that they can provide safe and appropriate care as well as, or better than, physicians,” Dr. Fleeger wrote. “(C)hange rooted in a fundamental misunderstanding of the roles and responsibilities – as well as the training and capabilities – of various health care professions will result in lower quality, more expensive care for our patients.”

TMA recently published information that compares how physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs) are educated, trained, and employed in health care settings. It shows why APRNs and PAs are considered vital parts of medical teams – and why physicians are the leaders of those teams.

Also check out TMA’s tools for managing nonphysician providers plus CME on billing for NPP services.

Last Updated On

February 12, 2020

Originally Published On

October 29, 2019

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Medicare | Scope of Practice

David Doolittle


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Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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