Medicare Compliance & Reimbursement

Recent proposal offers more burden-reducing shake-ups.

There’s no denying that Medicare providers’ paperwork has increased exponentially over the past decade. Moreover, the heavy workload has contributed to physician burnout as clinicians try to balance patient care with these administrative burdens. That’s why CMS is rolling out more proposals to cut extra work across the Medicare spectrum.

Update: Since its inception at the end of last year, CMS’s flagship initiative, “Patients Over Paperwork,” has been at the center of a slew of rollbacks aimed at nixing administrative hassles. Last month, the agency added another proposed rule to its deregulation junket, which focuses on reducing providers’ costs at an expected savings of around $1.12 billion annually according to a CMS release on the subject. An Executive Order from President Trump factored into the different objectives as well with an eye toward cutting the “red tape” that sometimes gets in the way of patient care, the agency release suggested.

Read the Medicare proposed rule published in the Federal Register on Sept. 20 at www.gpo.gov/fdsys/pkg/FR-2018-09-20/pdf/2018-19599.pdf.

Input: In addition to addressing the presidential order, CMS asked stakeholders for their input in nine separate Requests for Information (RFIs), noted the latest edition of the Patients Over Paperwork newsletter. More than 2,800 comments were received, and agency leadership, also, engaged in workgroups and visited “healthcare facilities” to “speak directly with care providers, beneficiaries, and patients,” the newsletter mentioned.

Find the Patients Over Paperwork newsletter at www.cms.gov/Outreach-and-Education/Outreach/Partnerships/POPSeptember2018Newsletter.pdf.

“We are committed to putting patients over paperwork, while at the same time increasing the quality of care and ensuring patient safety and bolstering program integrity,” stressed CMS Administrator Seema Verma in a statement on the Medicare proposals. “With this proposed rule, CMS takes a major step forward in its efforts to modernize the Medicare program by removing regulations that are outdated and burdensome.”

Verma added, “The changes we’re proposing will dramatically reduce the amount of time and resources that healthcare facilities have to spend on CMS-mandated compliance activities that do not improve the quality of care, so that hospitals and healthcare professionals can focus on their primary mission: treating patients.”

What’s In the Proposed Rule?

CMS’s new proposals want to “lift unnecessary burdens” for healthcare facilities and look primarily at implementing changes under Medicare Conditions of Participation (CoP), Conditions of Coverage (CoC), and facility requirements related to providers’ participation, a CMS release indicated.

Here’s the short list of seven changes up for review:

1. Nod to emergencies. Emergency preparedness continues to be a thorn for Medicare, and the agency wants to simplify procedures, making it easier and more efficient for providers to offer care during crunch times. Hot topics include testing and training revisions, planning overhauls, and reduced emergency setups for both inpatient and outpatient facilities. The proposed rule aims to cut duplicative requirements while leaving more of the emergency decisionmaking up to the discretion of the individual facility and its “unique needs and specific circumstances,” points out the proposal.

2. Give hospitals more flexibility. The plan submits to let hospital systems unify their infection control programs as well as quality and performance measures. Other highlights include using state standards for autopsies and giving hospital medical staffs a say in how pre-surgery/pre-procedure assessments for outpatients will be used versus the current requirement of comprehensive medical histories and physical exams within 30 days.

3. Remove roadblocks for portable x-rays. To make portable x-ray services more efficient, CMS wants to allow providers to order via writing, telephone, or electronic methods to “streamline the ordering process,” the agency maintains.

4. Eliminate a current HHA standard. According to the proposed rule, CMS would like “to remove the requirement that Home Health Agencies (HHAs) provide a copy of the clinical record to a patient, upon request, by the next home visit.”

5. Nix transplant center barriers. In order to ensure that transplantable organs don’t go unused, CMS wants to cut some transplant center requirements related to re-submission.

6. Give physicians more say in ASC pre-surgical assessments. CMS proposes scaling back the current pre-surgical assessments required of Ambulatory Surgical Centers (ASCs). The proposed rule suggests following “the operating physician’s clinical judgment” instead “to ensure patients receive the appropriate pre-surgical assessments that are tailored for the patient and the type of surgery being performed,” the agency advises.

7. Revert to the states’ licensure requirements for Hospice aide training. In another cost-cutting measure, CMS recommends that hospices defer to their specific states’ rules on aide training and competency requirements with the idea that hiring for this critical need would be easier.

AHA weighs in: “The simple truth is the regulatory burden hospitals face is substantial and unsustainable, and can be overwhelming,” said Rick Pollack, president and CEO of the American Hospital Association (AHA) in a speech at MedStar Washington Hospital Center last month. “CMS’s commitment to reduce the regulatory burden is crucially needed as we strive to meet the increasingly complex needs of our patients and accelerate efforts to reduce costs.

Deadline: Stakeholders interested in submitting their comments and concerns have until Nov. 19, 2018.

Resource: For a closer look at the CMS fact sheet on the proposed rule, visit www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-proposed-regulatory-provisions-promote-program-efficiency-0.