Physician Fee Proposal Generates Calls for Changes

Kaiser Permanente would like CMS to use its regulatory authority to broaden "eligible telehealth settings, locations and services under Medicare." Kaiser sees opportunities to leverage the consumer adoption of mobile medical apps as a way to improve the delivery of healthcare services.

Scope of practice for certified registered nurse anesthetists (CRNA)

Physicians are very protective of their practices and adamantly oppose any effort to allow nonphysicians to encroach on the delivery of medical services. CMS has proposed to permit certified registered nurse anesthetists to furnish and bill for chronic care management in states that allow CRNAs to provide those services.

The California Medical Association and other physician groups oppose this move. Its comment letter noted that the change would "effectively allow the safety and welfare of Medicare beneficiaries to be determined on a state-by-state basis." The CMA presents familiar arguments ii opposing the move: interventional pain management is the practice of medicine and CRNAs do not have the education or the skills required to furnish chronic pain management services.

The American Nursing Association took a different approach. It stated that chronic pain "is a significant public health challenge" and that there is a "deficit of qualified professionals to treat chronic pain." With their advanced education, training and experience CRNAs are "uniquely qualified" to address the challenge.

The ANA cited the Council on Accreditation of Nurse Anesthesia Educational Programs standards, which mandate that nurse anesthesia programs provide content in anatomy, physiology and pathophysiology, pharmacology and pain management.