Coming out of the COVID-19 pandemic, we’ve seen an alarming increase in proposed scope of practice expansions.
The American Medical Association is unrelenting in opposing these expansions on your behalf to ensure patient safety at every turn. We are determined to ensure that patient care is led by highly trained physicians.
“We’ve had some important scope of practice wins in 2022, with more to come:
“Colorado and South Dakota struck down legislation allowing physician assistants to practice independently without physician oversight.
“Bills that would have expanded scope of practice for APRNs in Wisconsin, Tennessee, Mississippi, and Kentucky were defeated.
“All scope expansion efforts in Washington were thwarted, and Alabama defeated multiple bills, including a law that would have allowed optometrists to perform surgery.
“Maryland beat back multiple bills attempting to expand scope for physician assistants, clinical nurse specialists, and podiatrists.
“You can be sure that the AMA has your back-and we will continue the fight for patient safety and quality care while resisting unjustified scope of practice expansions.
Thank you for standing with us.
Gerald E. Harmon, MD
President
American Medical Association
The above is a note to doctors from the American Medical Association. Notice the partial admission of motives in the first part of the sentence: “The American Medical Association is unrelenting in opposing these expansions on your behalf to ensure patient safety at every turn.” (italics added)
Harmon does not explain why this will ensure patient safety. It could be true that with a doctor in charge, a patient will be safer than with a doctor not in charge. But what Dr. Harmon does not address is whether the higher rates due to restriction of competition will cause some people not only to not go to nurse practitioners but also to not go to medical professionals at all.
HT2 Ross Levatter.
READER COMMENTS
Speed
May 16 2022 at 5:20pm
Wikipedia
https://en.wikipedia.org/wiki/Cabal
Kevin Corcoran
May 16 2022 at 5:43pm
This doesn’t surprise me – if anything, this is just the AMA continuing their long established behavior. This post got me to look up some notes I had taken while reading Christy Chapin’s book Ensuring America’s Health: The Public Creation of the Corporate Health Care System and this quote seemed relevant:
Matthias
May 17 2022 at 12:49am
The interesting thing here is not so much the actions of the AMA itself, but the almost naked rhetoric used.
Pete
May 17 2022 at 11:28am
My thoughts exactly. They didn’t quite say “and protect your billable hours” but just barely.
If all these bills were unjustified scope of practice expansions, I wonder what they might consider a justified scope expansion. Seriously: “we’d like to expand the scope of Nurse Practitioners to reduce the cost of health care. In what situations, if any, might the AMA consider that justified?”
Roger McKinney
May 17 2022 at 11:15am
Insurance companies opposed healthcare for decades because illness isn’t a random event and for the most part controlled by the patient or age. But businesses wanted to offer health insurance as a way to get around laws prohibiting pay increases and to provide higher compensation.
Average profits for health insurance firms is only 5%, so eliminating them won’t save much. 85% of premium payments go to doctors, hospitals and drugs according to Price Waterhouse.
suddyan
May 18 2022 at 8:24am
Roger McKinney says: “85% of premium payments go to doctors, HOSPITALS and DRUGS according to Price Waterhouse.”
And there is the problem right before our very eyes.
Ed Davis
May 20 2022 at 7:04pm
The average profit for health insurance companies is not 5 percent. At the very best, health insurance companies spend 80 percent of premiums to pay claims. So it sounds like they keep 20 percent. But there is one issue, one of accounting, that few understand. “Losses” to an insurance company may not be real losses but money set aside to pay claims, loss reserves. Next consider if the dollars to pay claims actually are payments to providers but include the overhead to pay the claims, process the claims, pay administrators. We all know how well the insurance companies pay their execs.
Physician reimbursement accounts for 10 percent or less of the healthcare bill.
Roger McKinney
May 17 2022 at 11:05am
Everyone needs to read From Mutual Aid to the Welfare State: Fraternal Societies and Social Services, 1890-1967 by David T. Beito for a description of rational healthcare provision and how the AMA fought and destroyed it.
Jon Murphy
May 17 2022 at 2:43pm
Everyone should read that book regardless. ‘Tis an excellent book.
Peggy Ostrander
May 30 2022 at 8:34pm
My favorite health policy books:
The Social Transformation of American Medicine by Paul Star
America’s Bitter Pill by Steven Brill
MikeW
May 18 2022 at 8:10pm
I remember that in Milton Friedman’s Free to Choose, the AMA was the example he used of a very successful labor union.
David Henderson
May 20 2022 at 11:52am
A slight correction: Free to Choose has two authors–Milton and Rose Friedman.
But right you are. He also dealt with the AMA and doctor licensure at length in Capitalism and Freedom. The earlier treatment was a tour de force. I bought the book when I was 17 and followed my mother around our tiny apartment reading that section at her. (Not to her, because she was pretty clearly uninterested.)
Johnson85
May 20 2022 at 11:22am
There has been some very small measure of Karma against the callous doctors that work (or at least support the AMA working) to prevent the less well off from having better access to healthcare.
CMS has, I believe, stopped reimbursing doctors for reviewing charts of Nurse Practitioners. So doctors here have been whining about a “20%” pay cut because their hospital (which hospitals were able to buy almost all of the doctor’s practices after Obamacare b/c the administrative costs made private practice a lot less fun) will not come out of pocket (or find the money elsewhere) to keep their compensation the same while no longer bringing in any revenue for reviewing nurse practitioner’s charts of Medicare or Medicaid patients.
CMS implemented this policy shortly after the doctors successfully killed a bill that would have allowed independent practice by nurse practitioners.
David Henderson
May 20 2022 at 11:49am
Interesting.
Johnson
May 21 2022 at 6:16am
https://www.mwe.com/insights/cms-finalizes-changes-to-clarify-physician-and-npp-split-or-shared-billing-policy/
looks like what I posted wasn’t quite right (I was going off the complaints of a doctor I know; she has no clue how much I enjoy her complaining about reimbursements when she also complains about efforts to make care more affordable). If the link is what she was complaining about, the policy change was actually finalized for 2022, so before the state bill to allow NPs to practice independently was killed.
And it’s not that they don’t get paid for reviewing charts, they just can’t Bill at the physician’s rate going forward without the physician actually providing the majority of care for a visit. And that’s only a 15% difference. So based on her comments, it seems that they used to Bill her rate for any patients where she reviewed the charts, which I think physicians are required to review 20% of NPs charts to qualify the NP as practicing “under” them under state law.
so the state AMA still fought to kill the Bill when they knew or should have known about the change coming, which was still probably the right call from a purely self interested point of view of doctors. But rich to complain about not getting paid for looking at charts (which is more or less false; they are paid for the visit, just at a lower rate) while also fighting to make sure you have to look at charts for NPs under state law.
Peggy Ostrander
May 30 2022 at 8:26pm
Here in Texas, Nurse Practitioners cannot work unless they have an annual contract signed by a physician, delegating permission to work. Some NP’s (sadly, psych usually) pay upwards to $80,000 annually for this privilege. Minimally in return, the physician and NP are required to have a monthly phone call to discuss any matter of importance. This occurs after the care has been rendered. No standard for chart review or other activity. What other professional has to pay another profession for the right to work? And the NP can only be on insurance panels that the delegating physician is on. Also, lower reimbursement for care such as Medicare/Medicaid, 85%/92% of the physician rate for the same care. Texas ranks lowest in nearly every healthcare parameter (access to care, healthcare professionals per capita, lowest number of citizens insured). Problem is, the medical community (namely AMA/TMA) will not allow it to be otherwise, even though very few physicians even want to do Primary Care. If I were a physician, I’d see if I could find half a dozen NP’s willing to pay $80k a year for my 10 minutes of work monthly, and retire to a Caribbean island. Above is a good website with lots of Texas specific information (it is not MY website)
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