Do you see the doctor or the Physician’s Assistant?

Are there enough primary care doctors in Tucson?  Do you see the doctor or the Physician’s Assistant?  In Arizona, Nurse Practitioners are not required to work under a physician.  Medicare may soon be encouraging the use of Nurse Practitioners (NP) and Physician’s Assistants (PA) in order to save money.

Currently, Medicare’s payment rules require “medical homes” to be led by doctors, meaning NPs and PAs can’t see Medicare patients if they have their own practice. A number of states, like Arizona, allow NPs and PAs to operate on their own. The list includes California, Florida, Georgia, Idaho, Illinois, Kansas, Kentucky, Maine, Missouri, Montana, North Carolina, New York, Oklahoma, Pennsylvania, Tennessee, Vermont, Washington, Wisconsin and West Virginia.

There is a movement in Congress to change the Medicare rules to save money by expanding the role of Nurse Practitioners and Physician Assistants. One bill in the House replaces “physician” with “provider” throughout a section describing payment rules and adds “nurse practitioner and physician assistant” to the definition of “applicable provider.”

It’s good to know our representatives in Washington are working on things that will reduce Medicare costs.  But it’s kind of scary to think of the lobbying that goes on behind the scenes that is working to stop the expansion of the use of Nurse Practitioners and Physician Assistants.

Tucson and the Arizona medical community are ahead of many other parts of the country when it comes to the roles of Nurse Practitioners and Physician Assistants – and Medicare needs to catch up to us.

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