Medicare
ably regulated just as heavily as facilities are.
providers include physician assistants (PAs),
Findings regarding health professionals regula-
optometrists, podiatrists, and advance prac-
physician
tion are summarized in Table 3.44
tice nurses (such as nurse practitioners, nurse
payment rules
midwives, and nurse anesthetists), all of whom
impose a net cost
have a more limited scope of practice than
Access-Related Professionals Regulations
physicians and are subject to varying supervi-
Under access related, only Medicare physician
of $1.2 billion.
sion requirements depending on the state in
payment rules are included, as these were explic-
which they practice. Also included are mental
itly designed to expand access for Medicare ben-
health providers such as psychiatrists (MDs),
eficiaries by prohibiting physicians from billing
psychologists (PhDs), psychological associ-
Medicare patients for the difference between
ates, social workers (MSWs and PhDs), and
their standard charges and the amount Medi-
others; other allied health providers such as dental
care would recognize as allowable (i.e., balance
hygienists, licensed practical nurses, pharma-
billing), and placing restrictions on the ability of
cists, registered nurses (RNs), radiology tech-
physicians and Medicare beneficiaries to con-
nicians, therapists (e.g., physical, occupational,
tract for Medicare-covered services outside the
speech, and their assistants), and others; and
Medicare program (i.e., private contracting).
alternative medicine providers such as chiroprac-
While the ban on balance billing effectively
tors, naturopaths, acupuncturists, and others.
transfers income from physicians to patients
Although some aspects of facilities regula-
(which patients presumably would view as ben-
tion are directed at changing the behavior of
eficial), they also encourage higher demand (and
health professionals (e.g., surgical outcomes
hence additional waste) relative to the situation
reporting systems), I have included these under
that prevailed before the ban was imposed.
facilities since the burden of compliance typi-
Taking all of these effects into account, these
cally is borne by the facility rather than health
rules impose a net cost of $1.2 billion.
professionals directly. Thus, in terms of sheer
numbers, there are fewer regulations included
Cost-Related Professionals Regulations
on the health professionals side, even though in
Cost related include federal and state regu-
reality health professionals as a group are prob-
lations related to fraud and abuse; federal
Table 3
Cost of Regulation of Health Professionals (millions of 2002 dollars)
Costs
Benefits
Type of Regulation
Expected
Minimum
Maximum
Expected
Minimum
Maximum
Net Cost Percent
Access
6,771
5,082
7,972
5,614
4,481
6,172
1,157
16.2%
Medicare assignment rules
6,771
5,082
7,972
5,614
4,481
6,172
1,157
16.2%
Costs
15,092
12,131
34,722
11,069
10,257
11,991
4,023
56.4%
Fraud and abuse
1,502
1,186
2,166
1,567
1,401
1,843
(65)
-0.9%
Professional medical records (includes privacy)
1,024
731
7,846
1,260
1,056
1,464
(236)
-3.3%
Medicare GME cap
12,566
10,214
24,711
8,242
7,800
8,684
4,324
60.6%
Quality
7,686
3,522
22,239
5,734
2,085
18,199
1,952
27.4%
Professional accreditation/licensure
6,549
3,414
15,754
4,740
1,981
12,981
1,809
25.4%
National Practitioner Databank
44
39
66
98
49
392
(54)
-0.8%
Commercial limits on practice of medicine
988
18
6,004
817
16
4,694
171
2.4%
Limitations on medical resident working hours
106
50
416
80
39
131
27
0.4%
Grand Total
29,549
20,735
64,933
22,417
16,823
36,361
7,133
100.0%
Note: Figures may not add up to totals due to rounding.
11