Chapter Nine ('Government Policy')

Non-Physician Practitioners in Primary Care
by
Timothy Bilash MD, MS
June 17, 1994
www.DrTimDelivers.com

based on
"The Roles of Physicians Assistants and Nurse Practitioners in Primary Care"
D. Kay Clawson and Marian Osterweis, Eds, 1993

1. 'Services of non-physicians commonly furnished as a necessary adjunct to the physician's in-office services are covered and paid for as if they were provided by the physician.' (p120)
   
   1. 'Medicare payments always are made to the PA's employer'
      
   2. 'NP's may bill Medicare in their own right in rural settings.'
      
   3. 'Employers of PA's and NP's have a financial incentive to bill for the services of PA and NP employees under this "incident to" policy in order to receive 100 percent of the applicable physician fee rather than some lesser amount.' (p123)
      
      
2. Should reimbursement rates be the same? This deals with methods of reimbursement which parallel the problem of costing hospital services.
   
   
3. 'There is always the potential for unproductive competition beween physicians and non-physicians, or even for anti-competitive actions to be taken by one group against the other.' (p125)
   
   
4. "At least some of the provisions expanding coverage for PA and NP services were advocated on the basis of cost-effectiveness, i.e., that these services would substitute for more expensive physician services. Budget estimators, however, have traditionally assumed that expanded coverage for PA and NP services would increase aggregate spending, since more services would be provided overall." (p127)