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Government Affairs Update
State Government Issues
ASSISTANT PHYSICIANS (NOT PHYSICIAN ASSISTANTS)
Aside from the two special sessions called by Governor Greitens this year, perhaps the one issue that has affected physician practices around the state this summer is a newly designated category of mid-level provider. State Representative Keith Frederick (R-Rolla) sponsored HB 1842 that passed in 2014. The bill created a new category of licensed professionals - assistant physicians. These are individuals who graduate in good standing from medical school and pass key medical exams, but are not able to ‘match’ with a residency training program. This occurs frequently since about 40,000 doctors apply for 30,000 residency slots each year.
Doctors who will practice in Missouri as assistant physicians will work with a licensed physician in a collaborative practice agreement much like nurse practitioners or PAs do now. The assistant physician will need to practice primary care in one of Missouri’s Health Care Shortage Areas, which won’t be difficult since 110 or 114 Missouri counties are shortage areas for primary care and mental health care.
Numerous additional doctors from around the U.S. could become eligible to treat patients in Missouri’s underserved areas as a result of a planned expansion of a first-in-the-nation law which intends to help lessen the nationwide physician shortage. However, there seems to be quite a bit of consternation on the part of health plans regarding the credentialing for this new category of providers. So, reimbursement appears to be on a case-by-case basis.
(Footnote - Our practice has received numerous inquiries from eligible candidates from both domestic and foreign graduates.)
EFFORT TO REPEAL AND REPLACE OBAMACAREFAILS
Faced with the narrowest of margins for error and a must to garner every vote, Senate Majority Leader Mitch McConnell (R-Ky.) delayed a vote on the bill to keep debate open to replace the Affordable Care Act (Obamacare). That would give Sen. John McCain (R-Ariz.) time to recover from a surgical procedure. But the losses of Senators Mike Lee of Utah and Jerry Moran of Kansas on July 17 sealed the fate of the Senate bill. Then, McConnell made a last effort to bring a “repeal now and replace later” bill to the floor, but it was torpedoed by a trio of Republican senators, including Susan Collins of Maine and Shelley Capitol of West Virginia and Lisa Murkowski of Alaska. “I did not come to Washington to hurt people,” Sen. Capitol said in a statement. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.” McCain also cast a decisive “no’’ vote for one of the GOP-backed measures.
CMS has just unveiled its 2018 Quality Payment Program (QPP) proposed rule, which contains changes to the Merit-based Incentive Payment System (MIPS), making it the first major proposed rule released by the agency under the Trump administration. The 1,058-page document, now available online for review, shows that CMS remains committed to MACRA, MIPS, and the concept of pay-for-performance even as the Trump administration moves to roll back Obama-era regulations in other industries. The 2018 QPP proposed rule appears to increase flexibility for MIPS reporting and expand the number of exempted providers, reflecting feedback CMS was already processing under the Obama administration. CMS has also adopted a proposal by industry stakeholders to allow MIPS reporting by “virtual groups,” as explained in the analysis below. Here are the key proposals in the rule: