CMS NEWS
FOR IMMEDIATE RELEASE
September 17, 2018
Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries
CMS
Proposes to Lift Unnecessary Regulations and Ease Burden on Providers
Proposed rule driven by agency’s Patients Over Paperwork initiative,
expected to save U.S. healthcare facilities $1.12 billion per year
Today, the Centers for Medicare and Medicaid Services (CMS) announced a
proposed rule to relieve burden on healthcare providers by removing
unnecessary, obsolete or excessively burdensome Medicare compliance
requirements for healthcare facilities. Collectively, these updates would
save healthcare providers an estimated $1.12 billion annually. Taking into
account policies across rules finalized in 2017 and 2018 as well as this
and other proposed rules, savings are estimated at $5.2 billion.
CMS developed the proposed rule in response to President Trump’s charge
to federal agencies to “cut the red tape” and reduce burdensome
regulations. In addition, feedback from Requests for Information
(RFIs) the agency issued seeking stakeholder input on regulatory burdens
helped inform this proposed rule, with particular attention to comments and
anecdotal insights from clinicians serving Medicare beneficiaries.
“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. “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modernize the Medicare program by removing regulations that are outdated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.”
Many of the proposals simplify and streamline Medicare’s conditions of
participation, conditions for coverage, and other requirements for
participation for facilities, so they can meet health and safety standards
more efficiently. This proposal ensures continued protection for patient
health and safety.
A key provision would reduce burden and promote efficiency to support
patients who need organ transplants. 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 will maintain other
requirements in order to continue to monitor outcomes and quality of care
in transplant programs after initial Medicare approval.
Additional provisions in the proposed rule would, for example:
- Streamline hospital
outpatient and ambulatory surgical center requirements for conducting
comprehensive medical histories and physical assessments
.
- Allow multi-hospital
systems to have unified and integrated Quality Assessment and
Performance Improvement programs for all of their member hospitals.
- Simplify the
ordering process for portable x-rays and modernize the personnel
requirements for portable x-ray technologists.
- Remove duplicative
ownership disclosure requirements for Critical Access Hospitals.
Patients Over Paperwork
Following President Trump’s leadership in his “Cut the Red Tape
Initiative,” today’s proposed rule is the latest in a series of steps that
are reducing unnecessary burden on facilities, generating efficiencies and
giving healthcare providers more time to spend with their patients.
Since CMS’s Patients
Over Paperwork initiative began in 2017, the agency has led a
robust RFI process, held interviews with diverse stakeholder groups,
visited healthcare facilities across the country and organized work groups.
Stakeholders that participated include: beneficiaries/consumers,
clinicians/individual providers, institutional providers, government
entities, health plans and members of the supply chain. These efforts to
better engage with stakeholders yielded 3,040 mentions of burden, which CMS
categorized as related to 1,146 different issues.
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.
Across rules finalized in 2017 and 2018 and current proposed rules to
address these topics, CMS projects savings of nearly $5.2 billion and a
reduction of 53 million hours through 2021. That results in saving 6,000 years
of burden hours over the next three years.
|
Burden Reduction ($)
|
Burden Reduction (Hours)
|
2018
|
$ 183 million
|
10.8 million
|
2019
|
$ 1.6 billion
|
12.6 million
|
2020
|
$ 1.7 billion
|
15.3 million
|
2021
|
$ 1.7 billion
|
14.3 million
|
Total:
|
$ 5.2 billion
|
53 million
|
Moreover, many of the policies produce ongoing annual savings not
captured in this total. CMS also remains focused on ways to reduce burden
through reforms to the Stark Law and Evaluation and Management Codes. Even
beyond the burden reduction captured in these rules, we have been working
at all levels to streamline and modernize our programs, such as by reducing
the administrative burden providers associated with provider audits.
This Administration has awarded new Recovery Audit Contracts (RAC) with
checks and balances in place to ensure providers are not adversely impacted
from reviews; modified its traditional medical review process to move to a
targeted review and education process; and streamlined and clarified
documentation requirements in payment manuals.
Experts agree that reducing unnecessary burden is critical to improving
patient care. Burden hours represent the amount of time healthcare
providers spend complying with federal regulations. 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.
Meaningful Measures
CMS has heard from providers that overly burdensome and redundant
measures have taken time away from patients, which is why CMS launched the
Meaningful Measures initiative. Under this initiative CMS is closely
examining all measures, and proposing to eliminate ones that are outdated,
are duplicative, are overly burdensome, or are not strongly linked to
patient outcomes.
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 review notes that the proliferation of
quality measures and the pay-for-performance (P4P) systems that use them
have led to significant administrative burdens and unintended consequences,
often devaluing the patient-physician relationship and contributing to
clinician burnout.
Through several proposed rules, including this one, 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.
Feedback Welcome
CMS looks forward to feedback on the proposal and will accept comments
until XXX, 2018. Comments may be submitted electronically through
our e-Regulation websitehttps://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/eRulemaking/index.html?redirect=/eRulemaking.
To learn more about the proposed rule, please visit the Federal
Register: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-19599.pdf
Read the CMS fact
sheet on the proposed rule; an “at a glance” overview of Medicare
Burden Reduction can be found here: https://downloads.cms.gov/files/MedicareBurdenReductionfinal.pdf
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