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AHA Sends Second Appeal to Trump

News  |  By John Commins  
   December 05, 2016

Pleading that the nation's hospitals face a "substantial and unsustainable" regulatory burden, the American Hospital Association presented an eight-page list of remedies to the president-elect.

For the second time in three days, on Friday the American Hospital Association has provided President-elect Donald Trump with a lengthy list of requests for regulatory reforms to scale back bureaucratic red tape.

"Reducing administrative complexity in healthcare would save billions of dollars annually and allow providers to spend more time on patients, not paperwork," AHA CEO and President Rick Pollack said in letter dated December 2nd.

"The Centers for Medicare & Medicaid Services and other agencies of the Department of Health and Human Services released 43 proposed and final rules affecting hospitals and health systems in the first 10 months of this year alone, comprising almost 21,000 pages of text," Pollack wrote. "In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field's ability to absorb them."

Because the rules are promulgated by CMS and other agencies within HHS, Pollack said the president-elect could take immediate action administratively.

Among the 33 reform actions listed in the letter, the AHA wants the Trump administration to:

Suspend hospital star ratings: Despite objections from a majority of the Congress, CMS published a set of deeply flawed hospital star ratings on its website this fall. The ratings were broadly criticized by quality experts and Congress as being inaccurate and misleading to consumers seeking to know which hospitals were more likely to provide safer, higher quality care.

Cancel Stage 3 of "meaningful use" program: Hospitals face extensive, burdensome and unnecessary "meaningful use" regulations from CMS that require significant reporting on the use of electronic health records (EHRs) with no clear benefit to patient care.

CIOs to Trump: Ditch Meaningful Use

These excessive requirements are set to become even more onerous when Stage 3 begins in 2018. They also will raise costs by forcing hospitals to spend large sums upgrading their EHRs solely for the purpose of meeting regulatory requirements.

Suspend electronic clinical quality measure reporting requirements: Hospitals have spent significant time and resources to revise certified EHRs to meet CMS electronic clinical quality measure requirements for 2016, with no benefit for patient care. Moreover, CMS acknowledges that the electronic test submissions by hospitals and physicians do not accurately measure the quality of care provided.

Despite these facts, CMS regulations double the electronic clinical quality measure reporting requirements for hospitals for 2017, creating additional burden without an expectation that the data generated by EHRs will be accurate.

Remove faulty hospital quality measures: Improvements in quality and patient safety are accelerating, but the ever increasing number of conflicting, overlapping measures in CMS programs take time and resources away from what matters the most, improving care.

Most recent measure additions to the inpatient quality reporting and outpatient quality ;reporting programs provide inaccurate data, and do not focus on the most important opportunities to improve care.

Eliminate unfair Long-term Care Hospital regulation: With the implementation of site-neutral payments for LTCHs, which began in October 2015 (as mandated by the Bipartisan Budget Act of 2013), the LTCH "25% Rule" has become outdated, excessive and unnecessary. CMS should rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field.

End onerous home health agency pre-claim review: CMS's mandatory Medicare demonstration to test pre-claim review is causing patient care and payment delays in the first of five states under the program.

Restore compliant codes for inpatient rehabilitation facility 60% Rule: During the transition to ICD-10-CM, CMS reduced the number conditions that qualify toward compliance under the IRF "60% Rule," which is a criterion that must be met for a hospital or unit to maintain its payment classification as an IRF. Yet certain codes that qualified under ICD-9-CM were inadvertently omitted as a result of the conversion to ICD-10-CM.

Withdraw proposed mandatory Part B drug demonstration: CMS has proposed a mandatory Medicare demonstration program that would unfairly hold hospitals financially accountable for the high prices charged by drug manufacturers.

Protect Medicaid DSH hospital payments: CMS's proposed rule that addresses how third-party payments are treated for purposes of calculating the hospital-specific limitation on Medicaid disproportionate share hospital payments could deny hospitals access to needed Medicaid DSH funds.

Undo agency overreach on "information blocking"Hospitals want to share health information to support care and do so when they can. But technology companies and the federal government have so far failed to create the infrastructure to make sharing information electronically easy and efficient.

Hold Medicare RACs accountable: Medicare RACs are paid a contingency fee that financially rewards them for denying payments to hospitals, even when their denials are found to be in error. The AHA urges the Administration to revise the RAC contracts to incorporate a financial penalty for poor performance by RACs, as measured by administrative law judge appeal overturn rates.

Adjust readmission measures to reflect socio-demographics: Hospital readmission measures and other outcome measures lack appropriate adjustment for the impact of the community and other factors, so those hospitals serving certain communities sustain larger penalties.

Make future bundled payment programs voluntary: The Center for Medicare and Medicaid Innovation has engaged in regulatory overreach by making bundled payments mandatory. Hospitals should not be forced to bear the expense of participation in complicated new programs if they do not believe they will benefit patients.

Expand Medicare coverage of telehealth services: Coverage and payment for telemedicine services remain major obstacles for providers seeking to improve patient care. Medicare, in particular, lags far behind other payers due to its restrictive statutes and regulations.

View the letter.


John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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