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The Obama administration is proposing to lift a ban preventing physician assistants and nurse practitioners from caring for Medicare patients in their homes rather than the more expensive nursing facility or other inpatient care center.
The Centers for Medicare & Medicaid Services has published a proposed rule to amend the Program of All Inclusive Care for the Elderly known as PACE, which is a program that helps seniors enrolled in Medicare as well as certain poor Americans covered by Medicaid gain access to services in their own homes. It could be implemented to allow Medicare reimbursement for these primary care providers within the year.
PA Javier Esquivel-Acosta is the associate medical director of a Federally Qualified Health... [+]
The Obama administration sees physician assistants (PAs) and nurse practitioners (NPs) as key to expanding the number of primary care providers, which are in short supply in certain areas of the country. PAs and NPs are on a roll lately winning direct access to patients in states and proposals to expand their roles in Veterans Affairs facilities.
CMS also wants to expand the PACE program, which hasn’t been used to its potential and sees expanding reimbursement to NPs and PAs as increasing access and lowering costs. A New York Times report last week said just 40,000 seniors were enrolled in PACE as of January of this year.
CMS' Andy Slavitt said a "team of health care professionals works to make sure that care is coordinated in the home , in the community and at a PACE center," according to his blog earlier this month on the CMS web site.
"Team-based models that put the individual in the center, like PACE, will be a vital part of the fabric of our system," Slavitt said in his blog. "Over the last six years, since the onset of the Affordable Care Act, we have been taking significant steps to care for more people, care for them better, and make health care more affordable. But for us to be successful, we need to work hand-in-hand with patients and their families, physicians and clinicians, and other actors to support new approaches to care."
PAs and NPs say they have been lobbying to be a part of PACE for years.
“The PACE program allows elderly patients the comfort and convenience of receiving high-quality healthcare in their homes while providing it at a lower cost than hospital stays or nursing homes,” said Josanne Pagel, president of AAPA, which represents PAs across the country. “This represents a big win for both PAs and the growing population of elderly patients in the U.S. PAs are proven healthcare providers and it’s critical that we are fully utilized when it comes to expanding access to care though programs like this.”
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The new regulations, which are open to the public to comment until Oct. 16, will allow PAs to monitor patients remotely as well as provide care for chronic and other conditions in patients’ homes. The proposed rule essentially defines a “primary care provider” as a primary care physician, physicians assistant or nurse practitioner.
“We are aware that changes in the practice of medicine and state licensing laws have expanded the practice of nonphysician practitioners (for example, nurse practitioners), such that these practitioners in many cases are able to fulfill the role served by the primary care physician,” the CMS proposed rule says. “Thus, including those individuals on the interdisciplinary team in the role of the primary care provider may prove to be more operationally feasible and cost-effective, particularly in rural areas or areas where labor costs may be high.”
