TMA Says “No” to Federal Scope Expansion Under President’s Medicare Executive Order

President Donald Trump’s recent executive order on Medicare includes scope-of-practice language that is raising concerns among Texas physicians.

Fleeger_MugThe president issued the order on Oct. 3 as an alternative to “Medicare for All” proposals that, he said, “would destroy our current Medicare program.”

Early analysis of the order shows some items the Texas Medical Association has long sought, such as the president’s directive to the Secretary of Health and Human Services (HHS) to “identify and remove unnecessary barriers” to private contracting between Medicare beneficiaries and physicians who may not participate in the program.

President Trump also told the secretary to propose a regulation in the next year that would “eliminate burdensome regulatory billing requirements, conditions of participation, supervision requirements, benefit definitions, and all other licensure requirements … that are more stringent than applicable federal or state laws require and that limit professionals from practicing at the top of their profession.” (Italics added.)

The final words of that sentence lead into a section of the executive order that is raising the ire of Texas physicians. Specifically, the president gave HHS a one-year deadline to propose a regulation to ensure that services, “whether done by physicians, physician assistants, or nurse practitioners are appropriately reimbursed in accordance with work performed rather than the clinician’s occupation.”

Any proposed regulation must go through the federal rulemaking process, which gives the public an opportunity to file formal comments and request changes.

“We are not waiting for any of that,” TMA President David C. Fleeger, MD, said. “We will notify the president, HHS Secretary Alex Azar, and members of Congress of our position on scope expansion and the need to recognize that the physician must be the head of the health care team.

“Physicians, who shoulder the ultimate responsibility for patient health and safety, are the only ones who can or should lead and supervise the other members of our health care team. They do not know what we know. They can't do what we do.”

Last Updated On

October 09, 2019

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