CMS proposes rule to reduce burdensome healthcare facility requirements

The Centers for Medicare and Medicaid Services on Monday announced a proposed rule designed to trim some healthcare compliance rules.

The agency says it’s proposing the steps to remove unnecessary, obsolete and excessively burdensome requirements for healthcare facilities.

Part of the agency’s Patients Over Paperwork initiative, the CMS proposal is an attempt to streamline documentation requirements and to modernize Medicare payment policies.

“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,” said CMS Administrator Seema Verma in a written statement. “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rule, CMS takes a major step forward in its efforts to modernize the Medicare program by removing regulations that are outdated and burdensome.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.”

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Seema Verma, administrator of the Centers for Medicare & Medicaid Services, speaks during a 'Conversations with the Women of America' event at the Eisenhower Executive Office Building in Washington, D.C., U.S., on Tuesday, Jan. 16, 2018. Republican leaders in Congress are angling for another short-term funding measure to avert a government shutdown at the end of this week while trying to keep a dispute over immigration separate from their attempts to get agreement on spending priorities. Photographer: Al Drago/Bloomberg

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CMS estimates that the updates in the proposed rule will result in total savings for healthcare providers of $1.12 billion annually.

The rule is divided into three categories: proposals that simplify and streamline processes, proposals that reduce the frequency of activities and revise timelines, as well as proposals that are obsolete, duplicative or that contain unnecessary requirements.

When it comes to ambulatory surgical center (ASC) requirements for comprehensive medical history and physical assessment, CMS is proposing to “remove the current requirements at § 416.52(a) and replace them with requirements that defer, to a certain extent, to the ASC policy and operating physician’s clinical judgment to ensure that patients receive the appropriate pre-surgical assessments tailored to the patient and the type of surgery being performed.”

At the same time, the agency says it “still would require the operating physician to document any pre-existing medical conditions and appropriate test results, in the medical record, which would have to be considered before, during and after surgery.”

Further, CMS has “retained the requirement that all pre-surgical assessments include documentation regarding any allergies to drugs and biologicals, and that the medical history and physical examination, if completed, be placed in the patient’s medical record prior to the surgical procedure.”

As far as hospital requirements for comprehensive medical history and physical examinations are concerned, the agency is proposing to “allow hospitals the flexibility to establish a medical staff policy describing the circumstances under which such hospitals could utilize a pre-surgery/pre-procedure assessment for an outpatient, instead of a comprehensive medical history and physical examination.”

In supporting this proposal, CMS said it believes that the “burden on the hospital, the practitioner and the patient could be greatly reduced by allowing this option” and that, in order to exercise this option, a hospital would “need to document the assessment in a patient’s medical record.”

Rick Pollack, president and CEO of the American Hospital Association, voiced AHA’s support for regulatory relief to enable hospitals and health systems to focus on delivering high-quality care and improving patients’ access to services.

“The simple truth is the regulatory burden hospitals face is substantial and unsustainable, and can be overwhelming,” said Pollack. “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. The AHA and our members look forward to continuing working with CMS to ensure that we have more responsible and reasonable regulations that reflect the realities that doctors and nurses face on the front lines to enable them to provide care in an effective and efficient way.”

The agency’s proposed rule also addresses home health agency requirements for providing patients with copies of clinical records.

“We propose 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,” states the rule proposal. “We propose to retain the requirement that the copy of the clinical record must be provided, upon request, within 4 business days.”

CMS will accept public comments on its proposed rule until November 19.

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