WASHINGTON (AP) — The Trump administration on
Wednesday proposed overhauling decades-old Medicare rules originally meant to
deter fraud and abuse but now seen as a roadblock to coordinating better care
for patients.
The rules under revision were intended to
counter self-dealing and financial kickbacks among service providers such as
hospitals, clinics and doctors.
Those regulations are now seen as an obstacle
to progress because Medicare has put a premium on coordination among care
providers. Officials explained that the complex requirements of the original
rules can have a chilling effect on hospitals and doctors working together.
A major focus is to try to improve follow-up
care for patients after they are discharged from hospitals, an area in which
Medicare is increasingly holding hospitals accountable.
Wednesday’s announcement starts a rule-making
process expected to take months. The revised regulations run to an estimated
800 pages and will be pored over by lawyers for the health care industry, which
has billions of dollars at stake. Patient advocates are keenly interested that
consumer protections are not weakened.
Health and Human Services Secretary Alex Azar
said the goal is to make the health care system more efficient, not to open the
door to new types of fraud.
“We propose these changes with great
appreciation for the intent of these statutes, which is preventing patients
from being taken advantage of and taxpayer dollars from being misspent,” Azar
said.
Officials said patients will ultimately
benefit, because it should be easier to help them avoid foreseeable problems
after hospitalization.
The Health and Human Services inspector
general’s office is involved in rewriting one of the rules, which enforces an
anti-kickback statute that it oversees.
The other major revision involves a rule that
forbids clinicians from referring patients to facilities in which they have a
financial interest. That rule is named after a law passed by former longtime
Democratic Rep. Pete Stark of California.
The rules apply mainly to federal programs
like Medicare and Medicaid, but their impact is felt across the health care
system.
Azar said the idea is to encourage hospitals,
doctors and other service providers to enter into formal “value-based
arrangements,” in which they collaborate to improve care for patients and
commit to delivering measurable results.
For example, a hospital may send a kidney
patient home with technology to monitor critical health indicators and
automatically transmit back any signs of problems. Under existing rules, such
an arrangement could be interpreted as the hospital providing the patient an
illegal “inducement” to continue using its services.
Officials said the proposed revisions will:
— create new exceptions to the self-referral and
anti-kickback rules for value-based arrangements
— update existing exceptions
— generally clarify the rules themselves.
One new exception involves cyber-security
technology, Medicare Administrator Seema Verma said. The goal is to allow
hospitals to share cyber-security technology with medical practices that they
deal with, improving protections across the health care system.
It’s unclear how much money the revised rules
are expected to save the health care system. Officials said it depends on the
degree to which hospitals and other service providers voluntarily enter into
the new, protected arrangements.
The original rules date to when Medicare paid
piecemeal for each service delivered. The program has been shifting to paying
an overall amount for major types of procedures, which is tied to quality
results.
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