Executive Order on Medicare Concerns Physicians

November 6, 2019

The Tennessee Medical Association is among more than 100 state and national healthcare advocacy organizations pushing back against alarming provisions in a recent Trump Administration Executive Order regarding scope of practice and reimbursement for midlevel healthcare providers.

The Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors directs the Secretary of Health and Human Services to work on a number of Medicare reforms within one year. Language in section five of the Order includes “proposing a regulation that would eliminate burdensome…supervision requirements,” and addressing “disparities in reimbursement between physicians and non-physician practitioners.” The Order, issued on October 3, suggests that Medicare should pay a set amount for healthcare services regardless of who delivers them, effectively ignoring physicians’ role as the most educated, highly trained and experienced leaders of the healthcare delivery team.

Some provisions in the Order align with TMA’s positions, such as improving access through health plan network adequacy and telehealth or other innovative technologies, and making regulatory changes to improve efficiencies by reducing or eliminating administrative burden from doctors.

TMA is concerned, however, about the intent of broad language with respect to physicians’ relationships with midlevel providers. TMA for years has led the charge promoting physician-led, team-based healthcare delivery models as the best option for patient safety and quality of care in Tennessee. TMA opposes independent practice for nurses or physician assistants.

TMA signed on to an October 29 letter urging the Trump Administration to reconsider its position. TMA will continue working with AMA and others to engage federal officials and make sure physicians have input on important scope of practice issues.