October 10, 2019

President Trump’s Response to “Medicare-for-All”

As you may have seen, there has been a growing movement among the public and lawmakers to push for Medicare-for-All, which would dramatically expand the current Medicare program to provide a public health care option to all Americans.

The Trump Administration has been vocal in its opposition to such a policy. Last week, in addition to releasing a fact sheet warning against Medicare-for-All, President Trump signed an executive order laying out his vision for Medicare and directing the Secretary of the U.S Department of Health and Human Services (HHS) to take a series of actions to “protect and improve the Medicare program by enhancing its fiscal sustainability.”

As you may remember from a previous edition of Regs & Eggs, HHS must issue regs to effectuate any of the policies in an executive order. While we wait to see the details, here are a few actions the executive order calls for that you may want to know about in case you get asked at a cocktail party or even ACEP19 what this could mean for emergency physicians.

  • Promoting Medicare Advantage: In Medicare, beneficiaries have the option of enrolling in private plans to receive their benefits through Part C, or Medicare Advantage. The Trump Administration has continually praised Medicare Advantage, and this executive order reaffirms its commitment to the program by specifically stating that traditional, fee-for-service Medicare should never be promoted over Medicare Advantage. Of interest, the executive order calls on the Secretary to adjust network adequacy requirements for Medicare Advantage plans. ACEP has repeatedly argued against narrow networks and called on the Centers for Medicare & Medicaid Services (CMS) to enforce strong network adequacy requirements. We will keep a watchful eye on how any changes to Medicare Advantage network adequacy requirements will affect Medicare beneficiaries’ ability to access to a full range of health care services.
  • Reimbursement for Non-Physician Services: The executive order requires HHS to propose a reg that would “ensure that items and services provided by clinicians, including physicians, physician assistants, and nurse practitioners, are appropriately reimbursed in accordance with the work performed rather than the clinician’s occupation.” ACEP believes the intent of this policy is to remove any discrepancies between reimbursement policies and current state scope of practices laws—meaning that non-physician practitioners should be allowed to practice and be reimbursed “appropriately” for those services in accordance with state laws. We will need to wait until the reg comes out to fully understand the policy. ACEP has issued guidelines on the role of physician assistants and advanced practice registered nurses in the emergency department, so we are interested to see how any changes to Medicare reimbursement policies intersect, and potentially conflict, with these guidelines.
  • Reducing Provider Burden: The executive order calls on HHS to propose changes to Medicare to reduce the burden on providers. CMS has already done substantive work on reducing burden through its Patients over Paperwork Initiative. ACEP has also submitted a formal letter to CMS outlining additional ways that the federal agency could reduce your burden and improve your ability to provide the best possible care to your patients.

While these are the main policies of note in the executive order, ACEP is also keeping an eye on these directives:

  • Continuing to move towards more “site neutral” payments (i.e payment for the same service is the same regardless of where it is delivered);
  • Providing clinicians with Medicare claims data to give them a better idea if their practice patterns “may pose undue risks to patients”; and
  • Using new technology to help crack down on fraud, waste, and abuse in Medicare.

As is the way of all regs, the devil will be in the details, so stay tuned for updates as HHS starts releasing regs implementing the executive order.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

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