Feds re­lease reg-killing plan

Fis­cal ben­e­fits of less red tape ques­tioned

Modern Healthcare - - FRONT PAGE - Rich Daly

Afed­eral reg­u­la­tory roll­back promis­ing more than $1 bil­lion in an­nual sav­ings to hos­pi­tals— chiefly through re­duced per­son­nel costs— is meet­ing heavy skep­ti­cism from providers and health­care ex­perts.

The Obama ad­min­is­tra­tion com­pleted one rule and pro­posed two more last week to re­duce reg­u­la­tory bur­dens on hos­pi­tals and other providers. They are part of an ini­tia­tive an­nounced in Jan­uary to elim­i­nate un­nec­es­sary and out­dated rules that hin­der pro­duc­tiv­ity and eco­nomic growth.

The fi­nal rule would sim­plify the con­di­tions for cov­er­age for am­bu­la­tory sur­gi­cal cen­ters and save those fa­cil­i­ties about $50 mil­lion an­nu­ally in reg­u­la­tory com­pli­ance. Sim­i­larly, those fa­cil­i­ties and end-stage re­nal dis­ease fa­cil­i­ties would save an­other $37 mil­lion an­nu­ally through a sep­a­rate pro­posed rule to drop other rules deemed “du­plica­tive, over­lap­ping, out­dated and con­flict­ing,” such as man­dat­ing the pur­chase and up­keep of un­nec­es­sary equip­ment.

The bulk of the ex­pected sav­ings—more than $940 mil­lion an­nu­ally—would come through a pro­posed re­vamp of Medi­care and Med­i­caid’s con­di­tions of par­tic­i­pa­tion, or COP, for hos­pi­tals.

Hos­pi­tal ad­vo­cates gen­er­ally wel­comed the reg­u­la­tory roll­back as a step in the right di­rec­tion. And in some ways, they are more sig­nif­i­cant than var­i­ous ini­tia­tives un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act be­cause those are gen­er­ally vol­un­tary.

“The changes will have some im­pact on vir­tu­ally ev­ery hos­pi­tal in the coun­try,” said Nancy Foster, vice pres­i­dent for qual­ity and pa­tient safety at the Amer­i­can Hos­pi­tal As­so­ci­a­tion.

But hos­pi­tals were skep­ti­cal about the fi­nan­cial ben­e­fits of the rule changes and ex­pressed the most in­ter­est in one pro­vi­sion with lit­tle es­ti­mated sav­ings. The pro­vi­sion most touted by hos­pi­tal ad­vo­cates was the elim­i­na­tion of a re­quire­ment that each hos­pi­tal within a health­care sys­tem main­tain its own gov­ern­ing body.

Hos­pi­tals have faced in­creased CMS scrutiny over the board pro­vi­sion since en­act­ment of the Medi­care Im­prove­ment for Pa­tients and Providers Act of 2008, said Beth Feld­push, vice pres­i­dent for ad­vo­cacy and pol­icy at the National As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems. That law moved hos­pi­tals from ac­cred­i­ta­tion by the Joint Com­mis­sion, which al­lowed the use of a sin­gle board, to the CMS’ COP, which does not.

“That re­ally chal­lenged a lot of hos­pi­tals, and it didn’t have any ben­e­fits in terms of pa­tient care,” Feld­push said about the re­quire­ment. But the chal­lenge that en­force­ment of the gov­ern­ing board pro­vi­sion cre­ated had less to do with additional costs for hos­pi­tals than the lo­gis­ti­cal headaches it cre­ated, ac­cord­ing to hos­pi­tal ex­perts.

“You’re re­quir­ing these hos­pi­tals to re-pop­u­late all of these boards with com­pe­tent, non­con­flicted and so­phis­ti­cated mem­bers,” said Michael Pere­grine, a part­ner at the law firm of Mc­Der­mott Will & Emery. “That’s an enor­mous bur­den.”

The bulk of the sav­ings from the hos­pi­tal rule changes, fed­eral of­fi­cials and hos­pi­tal ex­perts agree, will likely stem from changes for per­son­nel. What form those per­son­nel changes will take is less clear, although both groups stressed that they do not ex­pect them to in­clude lay­offs.

For ex­am­ple, when asked dur­ing an Oct. 18 call with re­porters whether the re­duc­tion in reg­u­la­tory bur­dens would al­low hos­pi­tals to re­duce their num­ber of staff de­voted to com­pli­ance with those rules, fed­eral of­fi­cials in­sisted that would not oc­cur. “We don’t ex­pect job losses here,” said Cass Sun­stein, ad­min­is­tra­tor of the Of­fice of In­for­ma­tion and Reg­u­la­tory Af­fairs in

New reg­u­la­tions would al­low hos­pi­tals to in­crease the du­ties of lower-level per­son­nel, giv­ing doc­tors more time with pa­tients.

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