United States: Hospitals And Others Respond To "Red Tape Relief Project" Requests

Last week, a number of health care industry associations sent letters to Congress detailing ways in which the government could relieve them of the burdens associated with "red tape." The letters are in response to the first stage of a House initiative dubbed the "Medicare Red Tape Relief Project," which was announced earlier this summer by the House Committee on Ways and Means' Subcommittee on Health. The project is spearheaded by Subcommittee Chairman Pat Tiberi (R-OH), who, upon announcing the initiative, described it as follows:

The Medicare Red Tape Relief Project will help members of our committee work hand-in-hand with doctors, nurses, and other health care professionals to identify areas where we can eliminate red tape and burdensome mandates that are driving up costs in the Medicare program. We will listen to feedback from providers, learn more about the challenges they face, and work to deliver the regulatory relief they need to put patients, not paperwork, first. As the Chairman of the Health Subcommittee, I encourage all stakeholders to participate and I look forward to advancing additional bipartisan solutions that strengthen Medicare for our nation's seniors

The Subcommittee received letters from the American Hospital Association (AHA), the Federation of American Hospitals (FAH), the American Association of Retired Persons, the Association of American Medical Colleges, and others. The AHA and FAH letters can be found here and here, respectively. Many of the groups called on Congress to expand Medicare's coverage for telehealth services, with several requesting that Congress eliminate geographic and setting location requirements so that patients outside of rural areas can benefit from telehealth. For its part, AHA went so far as to request that coverage be expanded to create the presumption that Medicare-covered services are covered when delivered via telehealth. A bold recommendation, indeed. Another common theme addressed in the letters was hospital readmission penalties. A number of groups want CMS to adjust the penalties to reflect sociodemographic differences in the patients that they treat.

While many of the requests are deep in the health regulatory weeds, some of the broader requests include:

  1. Creating Stark Law Exceptions and Anti-Kickback Safe Harbors for Clinical Integration Arrangements
  2. Creating an Anti-Kickback Safe Harbor for Patient Assistance
  3. Removing HIPAA's Current Barriers to Sharing Patient Information for Clinically Integrated Care
  4. Allowing Treating Providers to Access Patients' Substance Use Disorder Treatment Records
  5. Suspending Hospital Star Ratings
  6. Canceling Stage 3 of the "Meaningful Use" Program
  7. Eliminating Regulatory Barriers that Prevent Exploration of Innovative Strategies and Alternative Payment Models (APMs)
  8. Protecting Medicaid Disproportionate Share Hospital (DSH) Payments
  9. Preserving Medicaid Supplemental Payments in Managed Care
  10. Stopping Federal Agency Intrusion in Private Sector Accreditation Standards
  11. Holding Medicare Recovery Audit Contractors (RACs) Accountable
  12. Making Future Bundled Payment Programs Voluntary
  13. Halting Use of Encounter Data to Formulate MA Risk Scores

The above list is just a subset of the full list of recommendations from the AHA and FAH letters. But if the federal government is to make good on their promise of removing all of this red tape, where would they begin? An answer to this question was telegraphed last week in an easy-to-miss blog post from CMS administrator Seema Verma. In her post, the new CMS administrator described how her husband's recent heart attack had inspired her to make it easier for providers to practice medicine. After describing her recent ordeal, Administrator Verma writes:

We have heard time and again that documentation for payment and for quality reporting is unnecessarily time-consuming and keeps clinicians working late into the night just to keep up on paperwork. Electronic health records that were supposed to make providers' lives easier by freeing up more time to spend on patient care have distanced them from their patients. New payment structures that were meant to increase coordination have added yet another layer of rules and requirements.

To translate, "documentation for payment and for quality reporting" refers to new requirements that providers will face under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); the "electronic health records" comment refers to the requirements under the the Meaningful Use EHR incentive program that will live on as the Advancing Care Information performance category under MACRA; and "new payment structures" is a reference to the alternative payment models (APMs) that are at the heart of MACRA. It's not difficult to see that removing MACRA's red tape is top of mind for CMS right now. And, if recent developments are any indication, it looks like they are serious. As we recently discussed, CMS has proposed to eliminate or scale back a number of mandatory alternative payment models for cardiac and orthopedic care. Stay tuned in the coming months for additional discussion of the government's efforts on this front.

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