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CMS removes Medicare requirements identified as unnecessary, obsolete or excessively burdensome

Proposed rule on removing such mandates as "re-approval" is expected to save healthcare facilities $1.12 billion per year.

Susan Morse, Managing Editor

In a proposed rule issued Monday, the Centers for Medicare and Medicaid Services announced it would relieve the burden on healthcare providers and save them over $1 billion a year by removing Medicare requirements considered unnecessary, obsolete or excessively burdensome. 

Many of the proposals simplify and streamline Medicare's conditions of participation, conditions for coverage, and other requirements for participation.

CMS Administrator Seema Verma released the proposal today during an event at MedStar Washington Hospital Center, which was also attended by American Hospital Association President and CEO Rick Pollack.

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"The simple truth is the regulatory burden hospitals face is substantial and unsustainable, and can be overwhelming," Pollack said. "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."

A provision to streamline hospital outpatient and ambulatory surgical center requirements for conducting comprehensive medical histories and physical assessments is expected to have a great impact on lessening provider burden, CMS said.

The rule would remove requirements for ambulatory surgical centers to perform pre-surgical assessments and instead defer to the operating physician's judgment to ensure that patients are assessed appropriately.

A key provision would support patients who need an organ transplant. The rule would eliminate a duplicative requirement on transplant programs to submit data and other information more than once for "re-approval" by Medicare.

Re-approval has led to transplant programs avoiding performing transplants for certain patients, causing some organs to go unused, CMS said.

CMS said it would maintain other requirements to continue to monitor outcomes and quality of care in transplant programs after initial Medicare approval.

Another proposal on quality assessment, performance improvement and infection control programs would allow multi-hospital systems to have a unified and integrated quality assessment and performance improvement program for all of their member hospitals instead of having individual staff for each separately certified hospital.

An emergency preparedness proposed rule would revise requirements for annual reviews to allow facilities to review their plans at least every two years.

Duplicative ownership disclosure requirements for Critical Access Hospitals would be removed.

Home health agencies would no longer be required to provide a copy of clinical records to patients by the next visit.

It would simplify the ordering process for portable X-rays and modernize the personnel requirements for portable X-ray technologists.

Today's proposed updates would save healthcare providers an estimated $1.12 billion annually, CMS said. Taking into account other policies across rules finalized in 2017 and 2018, savings are estimated at $5.2 billion and a reduction of 53 million hours through 2021.

From stakeholder feedback, CMS said it has removed quality measures that were not adding value. Through today's proposal and others, CMS seeks to eliminate reporting requirements for 105 out of 416 measures across the agency's programs, saving healthcare providers $178 million over the next two years.

Today's proposed rule is the latest in a series to reduce unnecessary burden on facilities following President Trump's "Cut the Red Tape Initiative."

CMS began its Patients Over Paperwork initiative in 2017, with stakeholder feedback yielding 3,040 mentions of burden, which CMS categorized as related to 1,146 different issues. A study published in the Annals of Internal Medicine found that for every hour providers spend seeing patients, nearly two additional hours are spent on paperwork.

To date, CMS has taken action to address 55 percent (624) of the burden topics raised, while approaches to 16 percent (185) of the topics remain under consideration and 29 percent (337) were either referred to another agency or did not require further action.

This results in saving 6,000 years of burden hours over the next three years.

CMS also remains focused on ways to reduce burden through reforms to the Stark Law and Evaluation and Management Codes and reducing the administrative burden associated with provider audits.

Meaningful Measures was launched due to feedback from providers that overly burdensome and redundant measures took time away from patients. 

A recent Health Affairs study reported that U.S. physicians and their staff in four common specialties spend, on average, 15.1 hours per week and more than $40,000 per year reporting quality measures. 

This equates to 785 hours per physician and more than $15.4 billion annually. The vast majority - 81 percent - of practices reported that they now spend more effort dealing with quality measures than three years ago, and only 27 percent said current measures are representative of the quality of care.

A Family Practice Management said an unintended consequence of the burden has been the devaluing of the patient-physician relationship and has contributed to clinician burnout.

CMS Administrator Seema Verma said. "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. 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."

Twitter: @SusanJMorse
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