HHS Releases Final Rules To Ease Regulations for Health Care Providers

TOPIC ALERT:

On Thursday, HHS issued two final rules intended to ease regulatory burdens on hospitals and health providers and save more than $5 billion over five years, The Hill's "Healthwatch" reports.

The changes -- which were first proposed in October 2011 -- would reduce "burdensome red tape for hospitals and providers" and help them "improve patient care while lowered costs," says acting CMS Administrator Marilyn Tavenner (Viebeck, "Healthwatch," The Hill, 5/10).

According to Modern Healthcare, the two new health care rules are among five rules announced this week as part of a government-wide effort to reduce administrative costs. Altogether, the five rules are expected to save nearly $6 billion over five years (Zigmond, Modern Healthcare, 5/10).

A White House statement described Thursday's announcements as "an important milestone in the ambitious regulatory 'lookback' that President Obama ordered in 2011 to cut through unnecessary red tape while promoting economic growth and protecting public health, safety, welfare, and our environment" (Sanger-Katz, National Journal, 5/10).

First Rule Revises Medicare Conditions of Participation

One of the final rules will eliminate "outdated" hospital management requirements and reporting rules included in the Medicare Conditions of Participation, which hospitals must receive Medicare funding. The rule is expected to save $940 million annually and includes provisions that will:

  • Allow hospitals to review all eligible candidates -- including physician assistants and advanced practice RNs -- for appointment to the medical staff, with all the privileges and rights of other medical staff members;
  • Eliminate a requirement for a single director of outpatient services, allowing hospitals to determine the best way to oversee and manage outpatients (Modern Healthcare, 5/10);
  • Allow smaller hospitals to outsource some lab tests and radiology tasks; and
  • Allow hospitals in the same system to have their own governing boards (CMS final rule, 5/10).

CMS' decision to expand the roles of certain health care providers, like nurse practitioners, comes with some controversy. When the agency first proposed in October that non-physician practitioners would be allowed to administer medications, including those use for anesthesia and pain management, critics submitted more than 1,100 comments in protest.

However, CMS opted to preserve the language in the final rule, noting that practitioners will only be allowed to administer medications if they are authorized to do so under state law and hospital medical staff regulations. The agency said it disagrees with critics who argue that only physicians possess the required training to prescribe certain medications.

CMS also stood behind a provision that allows podiatrists to lead a hospital medical staff or even the organization, despite lacking a medical degree or doctor of osteopathic medicine degree. However, CMS did retreat from a proposal that would have allowed providers to obtain hospital privileges without becoming members of the medical staff, if they were already permitted to practice under state law (Norman, CQ HealthBeat, 5/10).

Second Rule Promotes Efficiency

The second rule, called the Medicare Regulatory Reform rule, eliminates regulatory requirements that CMS has deemed duplicative, overlapping, or outdated. It is expected to generate $200 million in savings in its first year through increased efficiency (CMS release, 5/9).

The rule includes includes provisions that will:

  • Update electronic prescribing technical requirements to retire "older versions of e-prescribing transactions for Medicare Part D and [adopt] the newer versions to be in compliance with the current e-prescribing standards" (CMS final rule, 5/10);
  • Eliminate "outdated" infection control instructions for ambulatory surgical centers;
  • Repeal "outdated" physical and occupational therapist qualification standards for Medicare;
  • Eliminate duplicative requirements for the governance of organ procurement organizations; and
  • Require only facilities that offer treatment for higher risk end stage renal disease to comply with National Fire Protection Agency Life Safety Code rules (Modern Healthcare, 5/10).

Hospitals React

American Hospital Association President and CEO Richard Umbdenstock in a statement said the rules provide "some much-needed regulatory relief for an overburdened health care system," highlighting hospitals' approval of rules streamlining outpatient service management, allowing critical access hospitals to partner with other facilities, and allowing for one governing board at multi-hospital systems.

However, he said, "CMS misses some important opportunities to further modernize the rules to better reflect how care is organized and delivered today." For example, he said that the rules should have allowed multi-hospital systems to have single integrated medical staff structures, rather than separate governing boards. "

Hospitals and medical staff members across the country are working together to streamline all areas of operation," Umbdenstock added. "CMS should not let antiquated organizational structures stand in the way" (AHA release, 5/10).

Wells Shoemaker
Great start. "Waste" has been long identified and legitimately criticized as a clinical problem on the delivery side (doctors and hospitals). However, money and scarce human resources squandered on feckless compliance processes...call it "administrative waste"... drains the same pools of funds and has the same negative effect upon our nation's ability to improve quality, expand access, and honor Equity. Thank you, Mr. President!

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