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Lots of industry groups want to see the temporary government waivers enacted early on during the COVID-19 public health emergency – the ones enabling the vast expansion of telehealth and remote patient monitoring over the past four months – to be made permanent once the storm has subsided. And some legislators do too.

But many, many medical associations do not – at least not those related to scope of practice and licensure.

WHY IT MATTERS
More than 100 physician groups, led by the American Medical Association, told the Centers for Medicare and Medicaid Services in no uncertain terms this past week that, while they supported temporary regulatory relaxations in response to COVID-19, they were strongly opposed to certain rules changes being made permanent.

“These temporary waivers, in extraordinary circumstances, have empowered physicians and non-physician health care professionals to focus on their patients and prevented a collapse of the health care system in the hardest hit areas of the country,” the groups wrote to CMS Administrator Seema Verma.

“However, we urge CMS to sunset the waivers involving scope of practice and licensure when the public health emergency concludes. To our dismay, it is our understanding that some organizations have already been advocating to make the temporary waivers permanent – permanently diminishing physician oversight and supervision of patient care.”

THE LARGER TREND
The letter to CMS does not mention telehealth. But issues related to licensure and scope of practice have for years been atop the list of regulatory hurdles to wider telehealth adoption.

Back in April, CMS hit pause on several existing regulations to better enable providers to shore up frontline medical staff, virtually and in-person, during the pandemic. It reduced certification requirements for clinicians to expand workforce flexibilities and sought to allow care practitioners to be hired more quickly and “perform work to the fullest extent of their licenses.”

Among the changes, CMS said it would temporarily allow physicians to care for patients at rural hospitals across state lines, “via phone, radio, or online communication, without having to be physically present.”

Giving the OK for remotely located docs to work with nurse practitioners at rural facilities would offer a more robust healthcare workforce during the pandemic, said CMS officials. The agency also allowed NPs to perform some medical exams on Medicare patients at skilled nursing facilities, and occupational therapists to perform initial assessments on certain homebound patients.

The changes, of course, were just a further expansion of many rule relaxations already given to allow broader access to care virtual care.

There has been widespread support for some of those telehealth-specific changes, and recent legislation would make many of them permanent.

Still, observers have noted, it’s likely, however popular some waivers may be, that many of those related to licensure and geography will likely be rescinded.

As Healthcare IT News senior editor Kat Jercich reported this past week, many experts expect “changes to the originating and geographic site requirements for telehealth – but not to state licensure waivers allowing physicians from one state to practice in another.”

ON THE RECORD
“Our organizations reaffirm our support for the physician-led team-based approach to care and vigorously oppose efforts that undermine the physician-patient relationship during and after the pandemic,” said AMA et al. in their letter to Verma.

“With seven or more years of postgraduate education and more than 10,000 hours of clinical experience, physicians are uniquely qualified to lead health care teams,” they added. “By contrast, nurse practitioners must complete only two to three years of graduate level education and 500-720 hours of clinical training. Physician assistant programs are two years in length and require 2,000 hours of clinical care. NPs and PAs are integral members of the care team, but the skills and acumen obtained by physicians throughout their extensive education and training make them uniquely qualified to oversee and supervise patients’ care.

“At a minimum, CMS should postpone any efforts to make these waivers permanent until after the conclusion of the [public health emergency], and pursue such permanent waivers through notice-and-comment rulemaking,” according to the letter. “This will allow for a thorough and deliberate policy making process that ensures all stakeholders, including patients, are heard and give time for CMS to study the impact of the scope of practice waivers’ on the cost and quality of patient care.”

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