Health providers and payers stand to save $1.1 billion in one year and $5 billion over five years because of relaxed regulatory red tape specified in two final Medicare rules released Thursday by the Center for Medicare & Medicaid Services.
The numerous changes are designed to eliminate or reduce what Health and Human Services Secretary Kathleen Sebelius called "unnecessary, obsolete, or burdensome regulations" imposed on hospitals and other healthcare providers.
"We are cutting red tape and improving health care for all Americans," Sebelius said in a statement. "Now it will be easier for health care providers to do their jobs and deliver quality care."
A Broader View of Medical Staff
The greatest savings, about $330 million, will come from provisions that broaden the definition of a hospital's medical staff in a way that allows hospitals to grant privileges to both physicians and non-physicians even if they're not on the medical staff. Also, podiatrists who are not physicians may have a role in hospital leadership.
Some of the changes are extremely controversial. In the text of its rule, CMS acknowledged "a significant number of comments from those who were adamantly opposed," with many dissenters "expressing serious concerns about allowing non-physician practitioners to obtain hospital privileges without becoming members of the medical staff," which would "circumvent medical staff oversight" and "detrimentally impact patient safety and quality."
However, the rule says, "we do not believe that any eliminated requirement in this final rule has saved lives in recent decades."
Outpatient Services
The second greatest savings, about $300 million, comes from changes in rules governing hospital outpatient services. For example, the new rules remove the duplicative requirement that a single director of outpatient services oversee all outpatient departments.
A second rule removes requirements that an ambulatory surgery center must use outdated terminology and equipment that aren't necessary for minor procedures not requiring anesthesia.
This rule also allows intermediate care facilities for individuals who are intellectually disabled to operate under open-ended agreements for conditions of participation in the Medicare program instead of time-limited ones. These facilities must now be surveyed every 12 to 15 months.
Nursing Care Plan Rules
The third greatest savings of $110 million comes in a change of nursing care plan rules, in which hospitals now have the option of having a stand-alone nursing care plan or an interdisciplinary plan rather than several.
In several instances, the rule defers to the state, or what it calls "nationally recognized and evidence-based guidelines and recommendations" or on state laws, instead of setting a national standard. For example, hospitals now have flexibility to use standing orders, as long as they comply with accepted practice standards.
Other changes include:
A redefinition of condition of program participation requirements for hospitals so that patients and their caregivers can administer their own medications.
Allowance of one governing board to set policy for all hospitals within one healthcare system instead of requiring one body for each.
Elimination of a reporting requirement of deaths among patients in soft, two-point restraints, which are often used among terminally ill patients to avoid inadvertent removal of tubes or IVs. Instead, an internal log must be kept and made available to investigators upon request.
The final rules are available here.