Loos­en­ing the rules

CMS pro­poses re­duc­ing need for su­per­vis­ing docs

Modern Healthcare - - THE WEEK IN HEALTHCARE - Ashok Selvam

Thanks to a pro­posed CMS rule change, di­eti­tians and other clin­i­cians at hos­pi­tals will be able to do the jobs they were trained for with­out hav­ing to hunt down a physi­cian to su­per­vise them. Of­fi­cials at af­fected hos­pi­tals wel­comed the changes, say­ing the cur­rent rules are far too re­stric­tive. One reg­u­la­tion the CMS wants to change re­quires physi­cians to be present when a di­eti­tian writes an or­der. Russ John­son, CEO at 44-bed San Luis Val­ley Re­gional Med­i­cal Cen­ter in Alam­osa, Colo., said that’s a bur­den­some and in­ef­fi­cient use of a small hospi­tal’s re­sources.

“The old rule was kind of a step back­wards as it didn’t really al­low clin­i­cians to prac­tice in their full scope,” he said.

The pro­posed change pro­motes bet­ter re­la­tion­ships with other clin­i­cians and leads to bet­ter co­or­di­na­tion of care, John­son said. It frees up physi­cians’ time, al­ready at a pre­mium, al­low­ing them to fo­cus on treat­ing their own pa­tients in­stead of wor­ry­ing about su­per­vis­ing other clin­i­cians.

The CMS also wants to loosen a sim­i­lar re­quire­ment for physi­cians to su­per­vise nu­clear medicine tech­ni­cians as they pre­pare ra­dio­phar­ma­ceu­ti­cals.

The Obama ad­min­is­tra­tion es­ti­mates that re­duc­ing those re­spon­si­bil­i­ties and oth­ers could save hos­pi­tals as much as $676 mil­lion an­nu­ally and $3.4 bil­lion over five years. Com­ments are due April 8 on the pro­posed reg­u­la­tions, is­sued in re­sponse to a 2011 ex­ec­u­tive or­der in­tended to re­duce bur­den­some reg­u­la­tions.

“We are com­mit­ted to cut­ting the red tape for health­care fa­cil­i­ties, in­clud­ing ru­ral providers,” HHS Sec­re­tary Kath­leen Se­be­lius said in a news re­lease. “By elim­i­nat­ing out­dated or overly bur­den­some re­quire­ments, hos­pi­tals and health­care pro­fes­sion­als can fo­cus on treat­ing pa­tients.”

Hospi­tal trade groups, in­clud­ing the Amer­i­can Hospi­tal As­so­ci­a­tion and Fed­er­a­tion of Amer­i­can Hos­pi­tals, have gen­er­ally praised the pro­posed re­vi­sions. The CMS, for ex­am­ple, nixed a widely crit­i­cized re­quire­ment that a hospi­tal’s board must in­clude a physi­cian.

The rule in­cludes sev­eral pro­vi­sions specif­i­cally in­tended to make life eas­ier at ru­ral hos­pi­tals such as San Luis Val­ley and other ru­ral clin­ics and crit­i­cal-ac­cess hos­pi­tals. Those hos­pi­tals also par­tic­u­larly like a move to elim­i­nate the re­quire­ment that a physi­cian be on­site at least once ev­ery two weeks at crit­i­calac­cess hos­pi­tals, a re­stric­tion hospi­tal lead­ers say fails to ac­knowl­edge tech­no­log­i­cal ad­vances such as telemedicine.

Smaller and ru­ral hos­pi­tals, which strug­gle to find sub­spe­cialty physi­cians, will be able to bet­ter serve their pa­tients through telemedicine in ar­eas such as pe­di­atric con­sul­ta­tions, said Dr. An­drew Ziskind, a man­ag­ing di­rec­tor of Chicago-based Huron Con­sult­ing Group. Pa­tients won’t have to rely on the care of an on-site pri­mary-care physi­cian whose skills might not be the best match for treat­ing their con­di­tions.

The CMS also struck a man­date that forced all hos­pi­tals, even those that are part of mul­ti­hos­pi­tal sys­tems, to have sep­a­rate gov­ern­ing boards. Al­low­ing boards to gov­ern mul­ti­ple fa­cil­i­ties is a step to­ward bet­ter pop­u­la­tion health and col­lab­o­ra­tion, John­son said.

But de­spite those changes, hos­pi­tals also say the changes don’t go far enough.

Last year, for ex­am­ple, San Luis Val­ley agreed to form San Luis Val­ley Health with 17-bed Cone­jos County Hospi­tal in La Jara, Colo. Even un­der the re­vised reg­u­la­tions, mul­ti­hos­pi­tal sys­tems must have sep­a­rate med­i­cal staffs at their con­stituent hos­pi­tals, and sys­tems with a sin­gle gov­ern­ing body must con­sult reg­u­larly with the leader of each hospi­tal’s med­i­cal staff. John­son said those rules are un­nec­es­sary be­cause the San Luis Val­ley hos­pi­tals are less than 20 miles apart.

The CMS ar­gues that hav­ing sep­a­rate med­i­cal staffs al­lows hos­pi­tals to bet­ter ad­dress pa­tient qual­ity and safety on a lo­cal level, said San­dra Di­Varco, an at­tor­ney with McDermott Will & Emery’s Chicago of­fice.

Most of the reg­u­la­tions, though, are in­tended to elim­i­nate re­dun­dan­cies, such as hav­ing hos­pi­tals com­plete sur­veys that re­quest the same data, Di­Varco said. She de­scribed them as “low-hang­ing fruit” that would make day-to-day life eas­ier for hos­pi­tals, but not dra­mat­i­cally so.

Brock Slabach, se­nior vice pres­i­dent for mem­ber ser­vices at the Na­tional Ru­ral Health As­so­ci­a­tion, agreed with that as­sess­ment of the pro­posed rule. “It would keep ev­ery­one from do­ing busy work, which is great,” Slabach said. “A lot of the smaller ru­rals don’t have staff to keep up with all of that.”

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