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Provider groups hope the Trump administration’s latest executive order will be the answer to their pleas to cut down on Medicare’s regulatory burden, but a beneficiary advocate is concerned a regulatory rollback could erode beneficiaries’ rights.
The order “fits in nicely with our agenda,” Anders M. Gilberg, a senior vice president at the Medical Group Management Association, told Bloomberg BNA. But David A. Lipschutz, senior policy attorney for the Center for Medicare Advocacy, said “a construct that appears to be a seek and destroy mission for regulations can be worrisome from a consumer advocate standpoint.”
President Donald Trump’s Feb. 24 order could affect Medicare by eliminating some of the regulatory burden that doctors have complained about in the new physician payment system and other regulations.
The MGMA’s support of the executive order is outlined in a letter it wrote to Health and Human Services Secretary Tom Price in which it objects to the cost and reporting burden on health-care professionals of complying with the new Medicare payment system in the Medicare Access and CHIP Reauthorization Act (MACRA) and other health-care rules, Gilberg said.
“Administrative costs account for nearly 15 percent of all health-care expenditures in the nation and the current regulatory burden on physician practices is enormous,” Gilberg said Feb. 27. The group represents administrators and executives of physician practices.
The order would require each agency to designate an agency official as a “regulatory reform officer” to oversee the implementation of regulatory initiatives. It would also require each agency to establish a “regulatory reform task force” to evaluate existing regulations and make recommendations to their agency heads about repeal, rescission, replacement or modification of the regulations on the books.
The latest order references several past ones on regulatory policies, including the most recent by Trump—which requires agencies to eliminate two regulations for every one they want to issue, Dan Mendelson, president of Avalere Health, a consulting company, told Bloomberg BNA .
The new order starts to put the regulatory relief commitment in motion “by setting a process at the agency level to identify areas appropriate for streamlining,” Mendelson, a former associate director for health at the White House Office of Management and Budget, said.
“The order sends a great message” about reducing the regulatory burden, Robert E. Moffit, a senior fellow in the Heritage Foundation’s Center for Health Policy Studies, a conservative think tank, said. It had been expected that Price, as a physician, would have done “a very intense review of the regulatory system under MACRA,” he told Bloomberg BNA. “But the executive order is basically saying ‘do it’.”
From a beneficiary aspect, however, the order could be seen as a threat.
“We’re not saying that looking at regulations by itself is a bad thing,” Lipschutz said. But beneficiary protections in areas such as due process, network adequacy and balance billing could be watered down in a “broad brush” swipe at Medicare rules and subregulatory guidance, he said.
Medicare hasn’t been as “politicized” as much as other health-care programs and its regulations may not be the subject of as much scrutiny as others, William G. Schiffbauer, a Washington health-care attorney, told Bloomberg BNA. Insurers don’t have major problems with Medicare Advantage and the Part D drug programs, he said.
If the Department of Health and Human Services’ regulatory task force is looking for rules to tackle, there are enough in the Affordable Care Act that are “ripe for picking,” he said.
Much of Medicare is regulated, including the rates for providers and the way that Medicare Advantage plans bid, Mendelson said. “Those processes are generally working well, and I don’t expect that they will be rescinded or dramatically scaled back.”
However, there are still Medicare regulations to examine, he added.
“For example, I would expect that there will be discussion of Medicare Advantage advertising and promotional materials—which are in need of streamlining,” Mendelson said.
In the home health area, there are a few Medicare programs that the National Association for Home Care and Hospice would like to have re-evaluated under the order, William A. Dombi, vice president for law at the center, told Bloomberg BNA. A demonstration that involves pre-claim reviews is just in Illinois but is scheduled to begin in Florida in April, he said.
“Our view is that it is a highly inefficient and ineffective way to address” concerns about fraud and proper payments, Dombi said. A program that could costs hundreds of millions of dollars could be addressed instead with clearer guidelines and improved contractor training, he said.
To contact the reporter on this story: Mindy Yochelson in Washington at MYochelson@bna.com
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