Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
The Trump administration should take specific steps to reduce the regulatory burden on hospitals, an industry group said in a May 17 letter to Health and Human Services Secretary Tom Price.
The Federation of American Hospitals, which represents investor-owned hospitals, called for changes in numerous areas, including suspending the hospital quality ratings system and readjusting bundled payment programs.
When health-care regulations ”start hindering care instead of helping people—we have a problem,” FAH President and CEO Chip Kahn said in a statement May 17. “Caregiver focus should be on the patient, not outdated or ineffective bureaucratic mandates.”
Other hospital groups, the American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC), have asked the administration for similar actions in recent months.
Ivy Baer, senior director and regulatory counsel at the AAMC, agreed with the FAH’s recommendation for a new hospital ratings system. Under the current system, hospitals are given between one and five stars depending on well they scored on dozens of quality measures, such as emergency room waiting times.
“The info in the current rating system doesn’t give patients the best knowledge to make the best decisions,” Baer told Bloomberg BNA May 18. “There is a lot of work that still needs to be done.”
The AAMC sent its own list of recommendations to Centers for Medicare & Medicaid Services Administrator Seema Verma on March 14.
In December 2016, after the election but before President Donald Trump took office, the AHA asked for regulatory relief for hospitals in numerous areas.
“We have long advocated for reducing the substantial and unsustainable regulatory burdens facing our members, " Joanna Kim, vice president of payment policy and analysis at AHA, told Bloomberg BNA May 18.
One of the AHA recommendations, Kim said, was making the future bundled payment programs voluntary.
“Hospitals should not be forced to bear the expense of participation in these complicated programs if they do not believe they will benefit patients, Kim said.” Bundled payment programs are intended to improve coordination between hospitals and post-acute care providers to avoid complications and prevent readmissions.
And the FAH, in its letter, called for an end to certain mandatory payment models, such as the Episode Payment Model (EPM) or the Comprehensive Care for Joint Replacement (CJR) models.
The industry group said it doesn’t believe federal law authorizes the Centers for Medicare & Medicaid Services to mandate providers’ participation in such models. “As such, CMS should make them voluntary,” the hospital group said.
Separately, the government delayed until January 2018 some aspects of these EPM and CJR payment models, in a notice set for May 19 Federal Register publication.
The FAH’s letter cited the Feb. 24 executive order by Trump, ordering a reduction in “unnecessary regulatory burdens placed on the American people.”
Kahn praised the Trump administration’s regulatory reform efforts. “This executive order has started a critically important dialogue that we hope will ultimately improve the quality of care for patients,” he said.
“The administration had been very open and receptive,” Lisa Tofil, an attorney at Holland & Knight in Washington, told Bloomberg BNA May 18. “It seems they really welcome people’s ideas on how to improve efficiency and reduce costs. Any regulatory relief that could be provided would be helpful, especially from the provider side.”
The FAH recommended the CMS permanently end the controversial home-health demonstration, a program intended to reduce home-health fraud in states that have historically seen high levels of fraud. The FAH said the demonstration is riddled with problems, such as delayed claims and extended wait times in submitting the pre-claims for approval, which affected hospital workflow and negatively affected outcomes for beneficiaries.
William Dombi, vice president for law at the National Association for Home Care and Hospice, told Bloomberg BNA May 18 that ending the home-health pre-claim “would save Medicare a few hundred million dollars.” Dombi is a Bloomberg BNA advisory board member.
The AHA also supported ending the program.
“We support the Administration’s current pause on the onerous home health pre-claim review demonstration,” Kim said. “We urge CMS to instead consider more targeted policies, such as education and other interventions that only focus on agencies and/or claims with high payment error rates.”
Also on the list of issues highlighted by the FAH in its letter was the Recovery Audit Contractor program, under which the RAC contractors receive payment based on their denials of Medicare claims. Industry said this has led to “overzealous denials, delayed payments to health care providers for appropriate services, and a years-long backlog of appeals.”
To contact the reporter on this story: Mike Stankiewicz in Washington at firstname.lastname@example.org
To contact the editor responsible for this story: Brian Broderick at email@example.com
The FAH's letter is at http://src.bna.com/oYl.
Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)