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AHA Highlights Progress and Opportunities for Regulatory Relief

August 23, 2019

In a letter sent to Centers for Medicare & Medicaid Services (CMS) Administrator Seem Verma earlier this month, the American Hospital Association (AHA) highlighted both progress and additional opportunities for federal policymakers to achieve regulatory reforms that reduce administrative complexity and streamline duplicative, antiquated, and contradictory provider regulations.

In its letter, the AHA cited its 2017 report, Regulatory Overload: Assessing the Regulatory Burden on Health Systems, Hospitals and Post-acute Care Providers, that found that health care providers spend nearly $39 billion a year on administrative activities related to regulatory compliance. The analysis cites that an average size hospital dedicates 59 full time employees to regulatory compliance, more than one quarter of which are doctors and nurses.

In addition, the AHA provided an extensive list of potential regulatory relief avenues in a December 2016 letter to then President-elect Trump and reiterated many of those suggestions in an August 2017 letter to the U.S. House Ways & Means Health Subcommittee.

Consistent with many of the issues highlighted in the AHA letters, during August 2017, HAP issued a response to the Ways & Means Health Subcommittee call for stakeholder feedback on behalf of Pennsylvania hospitals and health systems.

The U.S. Department of Health and Human Services (HHS) and CMS has made regulatory relief a major focus. Collaborative work between the Administration, Congress, and the hospital community has produced positive results.

Examples of progress in removing regulatory hurdles include:

  • Eliminating the restrictive and burdensome long-term care hospital (LTCH) “25 percent rule” which reduced reimbursement if more than a quarter of an LTCH’s cases were admitted from a single referring acute care hospital
  • Recognizing administrative realities in promoting interoperability by providing a 90-day reporting period to allow for attestation of meaningful use under the Medicare Promoting Interoperability Program
  • Providing rural hospitals with needed flexibility to staff their facilities so they can appropriately meet the health care needs of their communities by modernizing policy surrounding physician supervision of hospital outpatient therapeutic services

In its comprehensive letter to CMS sent earlier this month, the AHA offered more than 30 concrete, actionable policy recommendations to go further to support health care providers place their focus on patients, rather than paperwork. HAP has echoed many of the policy recommendations, including by urging action to:

  • Continue expanding and improving access to telehealth services for patients
  • Offer clarity and flexibility for hospitals that co-locate with other hospitals or health care entities and share treatment space
  • Standardize the approach for providers to submit and receive “prior authorization” request, require that Medicare Advantage plans adhere to set standards, and address prior authorization delays and denials
  • Incorporate social risk factor adjustment into its quality measurement and pay-for-performance programs where necessary and appropriate
  • Provide those participating in alternative payment models with maximum flexibility to identify and place beneficiaries in the clinical setting that best serves their short- and long-term recovery goals

HAP looks forward to continued work with the Administration and Congress to reduce administrative burden by:

  • Promoting better alignment and consistent application of policies
  • Providing clear and concise guidance and offering appropriate time for implementing new rules
  • Streamlining reporting requirements and ensuring measures provide actionable information
  • Modernizing legacy regulations that do not reflect current models of care

Questions related to regulatory relief initiatives may be directed to Laura Stevens Kent, vice president, federal legislative advocacy, or Jeff Bechtel, senior vice president, health economics and policy.

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