Pushing paper is one of the tasks hospital and ACO administrators rarely relish about their job. Administrators feel the task of regulation compliance is becoming increasingly time consuming and distracting from their ultimate purpose—improving the quality of care and access to services for their patients. In addition to the time required, compliance is expensive. Fortunately, 2018 will likely bring some relief, as well as ongoing efforts to work with providers to continue addressing and resolving their concerns.
Beginning in early 2017, the Centers for Medicare & Medicaid Services (CMS) began looking for ways to maintain efficiency and safety while reducing the regulatory burden being placed on providers. In June, CMS issued a press release asking for help in their efforts, stating that their goal was to “identify and eliminate or change regulations that are outdated, unnecessary, or ineffective; impose costs that exceed benefits; or create inconsistencies that otherwise interfere with regulatory reform initiatives and policies.” They solicited feedback on how to change existing regulations in ways that would put patients first, provide greater affordability and choices for consumers, return control of healthcare over to the states, and increase individual provider flexibility.
Additional efforts by CMS in 2017 determined that hospitals were spending $39 billion annual to comply with federal regulations and dedicating nearly 60 positions to regulatory compliance. One hospital in Ohio had to hire 18 staff members just to extract the CMS-required quality measures from their electronic health record (EHR).
CMS, informed by their feedback and the results of their research , will be making some changes. One primary area of emphasis is Conditions of Participation (CoPs), the requirements that hospitals and other providers, such as Medicaid ACOs, must meet to participate in Medicaid and Medicare—providers were spending more than $3 million each year on CoP compliance alone. CMS is seeking to streamline CoPs, among other changes, including making them more evidence-based, aligned with other laws and industry standards, and flexible to support different patient populations and communities.
CMS’ research also illuminated wide gaps in spending habits based on different populations and communities: While the New England and Mideast regions had the highest total per capita personal healthcare spending, the lowest spending was in the Rocky Mountain and Southwest regions. Utah’s per capita personal healthcare spending was the lowest, at $5,982. Medicaid expenditures were tracked slightly differently, but still underscored the discrepancies in spending linked to specific populations and communities, which led to CMS’ efforts to increase flexibility for hospitals, ACOs, and providers who serve these unique populations. Further, CMS staff will be visiting providers during 2018 to see for themselves how they can improve the implementation of rules and regulations.
In the course of their visits, CMS staff will be seeking input from providers on the regulations they have the greatest concerns about, and will specifically be asking for opinions on whether these regulations are needed, why they are important, whether they have “topped out,” and whether they are in fact achieving quality and value.
Another area targeted for change is the meaningful use requirements of the EHR Incentive Program. Expenditures for compliance with this program are $760,000 annually for the average hospital. Additional changes include the replacement of a meaningful use program reporting requirement that formerly required a full year with a shorter 90-day reporting period for 2018. CMS has also made compliance with Stage 3 of meaningful use optional. Concerns CMS received from Medicaid ACOs and hospitals included practice costs, the need to streamline requirements, and the need to promote greater interoperability (including potential modifications to Chronic Care Management).
And future changes are already coming into view. CMS plans to aggressively shift to value-based payment models rather than fee-for-service models, in alignment with their goal to favor value and patient outcomes. Telehealth policy changes are also a priority, as CMS hopes to utilize the potential of technology to improve the accessibility and quality of care for the patient while increasing visibility and convenience for providers. Adopting technology is also expected to provide more effective and widespread adoption of virtual care strategies.
CMS also plans to address quality-reporting requirements and the design of ACOs, especially regarding the Stark Law and Anti-Kickback Statute. These rules, they argue, are hindering the implementation of new, innovative care delivery methods. The American Hospital Association (AHA) is specifically urging CMS to work with the Office of Inspector General (OIG) at making the waiver program available outside of demonstration projects and models, and to allow existing wavers to apply to similar arrangements with Medicaid or commercial payers.
While changes have already been made in 2018 to ease the regulatory burden placed on providers, both in terms of time and money, it is clear that CMS is just getting started. They will continue to elicit and respond to feedback from patients and providers across the country, while further studying where their efforts can be most effective.