MedPAC Mulls Direct Billing for Nurse Practitioners, Physician Assistants

Medicare would permit nurse practitioners and physician assistants to bill directly for their services under a proposal being considered by the Medicare Payment Advisory Commission.

Currently such services are billed as “incident to” physician services, but according to a report in Becker’s Hospital Review,

MedPAC staff told commissioners there are problems with “incident to” billing because it “obscures policymakers’ knowledge of who is providing care for beneficiaries,” “inhibits accurate valuation of fee schedule services,” and “increases Medicare beneficiary spending.”  Staff also said that physician assistants and nurse practitioners increasingly practice outside of primary care.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

MedPAC commissioners are expected to vote on the recommendation next month.

Learn more about the billing recommendation in this article in Becker’s Hospital Review.

IOM Suggests That Post-Acute, Not Acute Care, May Account for Most Geographic Variations in Medicare Spending

In a preliminary report, the Institute of Medicine has indicated that post-acute-care services used by Medicare patients, rather than inpatient care, may account for much of the geographic variation in Medicare expenditures across the country.

Policy-makers and health care analysts have been working for years to understand why Medicare spends much more money on a per capita basis in some parts of than country than in others.  As an IOM news release noted,

Looking at how much Medicare pays out for different categories of health care services, the committee observed that post-acute care, including the use of home health services, skilled nursing facilities, rehabilitation facilities, long-term care hospitals, and hospices, accounts for a substantial amount of variation.

The National Association of Urban Hospitals (NAUH) has long opposed adjusting Medicare payments based on geography.

Learn more about the IOM’s interim report, the perspectives it offers, and the potential it holds for changes in future Medicare reimbursement policy by reading this news releaseiom_logo on the IOM’s web site and following a link in the release to a copy of the report itself.