Tuesday, November 10, 2009

AAHPM Rebukes McCaughey WSJ Op-Ed

Betsy McCaughey, champion of the hyperbolic 'death panel' myth, published an op-ed in the Wall Street Journal this week detailing concerns she had in the House version of the Health Care Reform Bill (aka HR 3962, aka Affordable Health Care for America Act).  The one concern regarding hospice and palliative care reads as follows:

Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.
Here is what the bill actually says:

SEC. 1114. PERMITTING PHYSICIAN ASSISTANTS TO ORDER POST-HOSPITAL EXTENDED CARE SERVICES AND TO PROVIDE FOR RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS.

    (a) Ordering Post-hospital Extended Care Services- Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended--
      (1) in paragraph (2) in the matter preceding subparagraph (A), is amended by striking `nurse practitioner or clinical nurse specialist' and inserting `nurse practitioner, a clinical nurse specialist, or a physician assistant'.
      (2) in the second sentence, by striking `or clinical nurse specialist' and inserting `clinical nurse specialist, or physician assistant'.
    (b) Recognition of Attending Physician Assistants as Attending Physicians to Serve Hospice Patients-
      (1) IN GENERAL- Section 1861(dd)(3)(B) of such Act (42 U.S.C. 1395x(dd)(3)(B)) is amended--
        (A) by striking `or nurse' and inserting `, the nurse'; and
        (B) by inserting `or the physician assistant (as defined in such subsection),' after `subsection (aa)(5)),'.
      (2) CONFORMING AMENDMENT- Section 1814(a)(7)(A)(i)(I) of such Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting `or a physician assistant' after `a nurse practitioner'.
      (3) CONSTRUCTION- Nothing in the amendments made by this subsection shall be construed as changing the requirements of section 1842(b)(6)(C) of the Social Security Act (42 U.S.C. 1395u(b)(6)(C)) with respect to payment for services of physician assistants under part B of title XVIII of such Act.
    (c) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2010.
So does it 'replace' or 'allow'?  I guess it is open to interpretation, but I have to agree with the letter written by Sean Morrison and Gail Cooney to the Wall Street Journal Editors.

This portion of the bill allows nurse practioners and clinical nurse specialists the same rights as physician assistants where state laws allow.  With the shortage of qualified specialists in palliative care, all disciplines need to work together to provide the most comprehensive care for the most patients.

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