Chapter Two – Regulation of

Physicians and Other Health Care

Professionals
K Jenkins, Spring 2019
HGMT 3310 - 501
  OVERVIEW
 More than 100 Professions

Chapter Two –  Physicians and Nurses

 Licensure and Education
Part A  Private, State and Federal
  Physicians: Overview
 Model – Oldest
 State Licensure (51): 1873
 American Medical Association - 1847
 Education - Flexner Report effect on schools: then Council

Chapter Two – on Medical Education

 Licensure – Promotion of State Licensing and 1912 via

Part A Federation of State Medical Boards

 Advocacy and Standards
 Federal
 National Practitioner Data Bank
 Reimbursement rules/ CoPs
  Physician Details - State
 License – Test/Background: State
 NBME
 Education
 Accredited Med School (LCME)
Chapter Two –  Accredited Residency (ACGME or AOA)

Part A  Discipline – State Medical Boards

 Due Process
 Consumers
 Private vs. Public
  Physician Details – Private
 Discipline – FSMB (historical)
 Journal
 Board Action Data Bank
 Licensure – NBME (co-sponsor, FSMB) (note, State
interaction)

Chapter Two –  Education

 FSMB oversees ACGME and ECFMG
Part A  AMA Liaison Committee on Med Ed (AAMC co-sponsor)
 JAMA and Lobbyists
 Specialty Certification (and Recertification)
 New Texas Law
 Managed Care Organizations (contracts)
  Discuss the advantages/disadvantages of licensing a
profession:
 Patient point of view – Quality, Cost and Access
 Why did the medical profession promote its own
regulation?

Chapter Two –  Do you think there are downsides to professionals

overseeing themselves? What are they? What are the
Part A benefits?

Questions  Would a uniform national system be better? Why or

why not?
 Local Standards
 Consistency
 Professional “capture”
 Bureaucratic unresponsiveness
  Table 2.2, page 37
 State, Federal and Private influence
Chapter Two –  Lack of Consistency

Part B  Scope of Practice and “Top of License” Considerations

 More Detail: History of Private Oversight of Docs
 Federation of State Medical Boards
 Specialty Organizations – List Page 27 (not
Chapter Two – comprehensive)
 Managed Care Oversight
Part B  Quality, Access, Cost
 Introduction to Advanced Alternative Payment Model

 Hospital Credentialing Process

 More Detail: Federal Impact on Physicians
 Private Viewing – NPDB
 Funding of Residency Slots
 Grants/loans for Medical School
Chapter Two –  Council on GME
 CMS Reimbursement Policy
Part B  Resource Based Relative Value Scale
 Value Based Purchasing
 MIPS incentive – Advanced APMs
 Clinical CoPs for Medicare/Medicaid
 A Word on Osteopathy
Chapter Two – o Manipulative Medicine
o ACGME/AOA Residencies
Part B o 1980s Lawsuits – Access to Training
  Nurses and Allied Health Professions
 Nursing Structure
 State and Federal, some private
 Advanced Practitioners
 Scope of Practice and “Top of License” Considerations
Chapter Two –  Allied Health
Part B  List on page 37, Table 2.2 (Not Comprehensive)
 State, Federal and Private influence
 Lack of Consistency
 Regular changes by state
  Telehealth
 Texas Rules: SB 1107
 Texas Medical Board
 Physician-Patient Relationship

Chapter Two  Issuing Prescriptions: Coordination with Texas Board of

Nursing, Texas Physician Assistant Board and Texas Board of

Part B Pharmacy
 Mental health telehealth
 Texas e-Health Alliance, Texas Academy of Physician
Assistants and Texas Hospital Association
  Could the market effectively oversee physician quality?
Does the internet have a role? How?

Chapter Two –  What are the pros and cons of the influence of hospital
credentialing and managed care organizations on
Part B physician practice?
Questions  Should Medicare funding agencies influence the
practice of physicians?
 Telehealth Details
 https://www.texmed.org/telemedicine/
 http://journalofethics.ama-assn.org/2014/12/pfor2-1412.html

Issues of Parity of Practice/Top of License

 www.texmedorg/EktronPolicySearch/
 Look for sections 30.004 and 30.035 on nurse practitioners and
allied health
Extra Reading  http://www.aacnnursing.org/Policy-Advocacy/About-
Government-Affairs-and-Policy/Federal-Policy-Agenda
 Check the Models of Care tab
 https://c.ymcdn.com/sites/texasnurses.site-
ym.com/resource/resmgr/docs/Lege_Policy/TNA_Policy2016_APR
Ns.pdf
An Interesting Take on the Perils of Licensure
 https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-621.pdf