A recent proposal from the Obama administration seeks to lift a ban that prevents physician assistants (PAs) and nurse practitioners (NPs) from providing home care to Medicare patients. In an article from Forbes contributor Bruce Japsen, Japsen explains that the current ruling limits access to care provided by PAs and NPs, resulting in more expensive treatment in nursing facilities and other inpatient care centers. PAs and NPs are working hard to earn full practice authority within the scope of their education, including writing proposals that would allow them direct access to patients across all states and expanded roles within Veterans Affairs facilities. The Obama administration views PAs and NPs as a crucial part of expanding the number of primary care providers nationwide, especially in certain areas where primary care providers are in shorter supply.
Following the lead of the Obama administration, the Centers for Medicare & Medicaid Services (CMS) published a proposal to amend a rule from the Program of All Inclusive Care for the Elderly, a program called PACE, designed to help provide home care access to senior Medicare patients and poor Americans covered by Medicaid. If implemented, the proposal could allow Medicare reimbursement to primary care providers who treat Medicare/Medicaid patients within the year.
CMS wants to see the PACE program used to its full potential and suggests expanding reimbursement to NPs and PAs as a way to increase access and lower costs. According to the New York Times, only 40,000 seniors were enrolled in PACE as of January 2016 and CMS wants to grow that number and expand the PACE program.
Due to population growth, aging, and expanded health insurance, demand for primary care is expected to continue rising. The Health Resources and Services Administration (HRSA) predicts there will be a primary care physician shortage of 20,400 by 2020. However, the Institute of Medicine (IOM) notes that this projection does not consider the potential that PAs and NPs have on increasing access to primary care.
According to Andy Slavitt who runs a blog on the CMS website, team-based models like PACE which put the individual in the center are a vital part of the fabric of our healthcare system. Since the Affordable Care Act was passed six years ago, CMS has been taking significant steps to care for more people with better and more affordable health care. However, in order for these models to be successful, every member of the health care team will have to work together to find and implement new approaches to care.
PAs and NPs are petitioning to be a part of PACE, arguing that providing care in the home benefits PAs and the country’s aging population. President of the American Academy of Physician Assistants (AAPA), Josanne Pagel, believes in the ability of the PACE program to provide comfortable and convenient high-quality healthcare to elderly patients in their homes at a lower cost than hospital stays and nursing homes.
The proposed rule from the Obama administration redefines the meaning of a primary care provider. Adding PAs and NPs under the blanket of primary care provider could allow for more cost-effective care, especially in rural zones and areas with high labor costs.