WHA Comments on Proposed CMS Rules Aimed at Regulatory Burden

WHA Recommends Addressing Physician Co-Signature Burdens

November 27, 2018

WHA expressed support for removing regulatory burden and providing additional compliance flexibility in a comment letter submitted by WHA to the Centers for Medicare & Medicaid (CMS). The letter addresses:
  • Impacts of regulatory burden on cost and access;
  • WHA recommendations to address burdensome physician co-signatures of advanced practice clinician care;
  • Support for several CMS proposed changes to address regulatory burden; and
  • Retaining existing ASC transfer arrangement requirements

Impacts of Regulatory Burden on Cost and Access. WHA commented on several CMS proposed changes to CMS Conditions of Participation for hospitals, ambulatory surgery centers, rural health clinics and other care settings.  In the proposed rulemaking, CMS describes the changes as “(1) Proposals that simplify and streamline processes, (2) proposals that reduce the frequency of activities and revise timelines, and (3) proposals that are obsolete, duplicative, or that contain unnecessary requirements.”
“Regulatory burden creates additional cost on the health care system and limits the productivity of health care providers,” stated WHA’s letter to CMS Administrator Seema Verma. “Wisconsin, like other states, has challenges with having enough physicians to meet the demands for care of our citizens, and regulatory burden directly impacts the amount of clinical care that each physician can provide in one day.”
“We appreciate the steps that CMS has proposed to take in this proposed rule to reduce regulatory burden, but we also encourage CMS to continue to seek input from the field to identify additional regulatory reforms to reduce regulatory burden on organizations, administrators, physicians, and other clinicians when such reforms do not meaningfully impact health care quality and safety,” wrote WHA.
Address Burdensome Physician Co-signatures of Advanced Practice Clinician Care. To address regulatory burden on physicians, advanced practice clinicians and team-based care delivery, WHA’s comment letter recommended several clarifications to CMS Hospital and Critical Access Hospital Conditions of Participation that would make more clear that physicians are not required to co-sign certain actions performed by advanced practice registered nurses and physician assistants when such actions are within their scope of practice.

WHA’s recommendations to CMS regarding clarifying physician co-signature requirements were drawn from presentations at WHA’s Advanced Practice Clinician Conference held in September that highlighted problematic federal regulations that have limited the ability of advanced practice clinicians from practicing to their full scope of practice in hospital settings.
Support for Several CMS Proposed Changes to Address Regulatory Burden. WHA expressed support for several CMS proposed rule changes that could impact WHA members, including:

  • Permitting multi-hospital systems to maintain a single, integrated Quality Assessment and Performance Improvement (QAPI) program for all of its members, rather than separate programs for each hospital.
  • Permitting multi-hospital systems to maintain a single, integrated infection control program for all of its members, rather than separate programs for each hospital.
  • Providing hospitals and ambulatory surgery centers with additional flexibility in creating policies for utilizing simplified pre-surgery assessments instead of comprehensive medical history and physician examination (H&P).
  • Removing from swing bed requirements, various long-term care facility requirements that are generally unnecessary for patients receiving care in a swing bed setting.
  • Reducing the frequency of critical access hospital, rural health clinic and federally qualified health centers’ required self-review of their policies and procedures.
  • Clarifying the Authority of Non-Physician Practitioners to Record Progress Notes in Psychiatric Hospitals
  • Reducing various documentation requirements related to hospital emergency preparedness
Retain Existing ASC Transfer Arrangement Requirements. CMS also proposed removing the current requirement that ambulatory surgery centers (ASC) maintain a transfer agreement or shared medical staff with a hospital to address situations when a patient in an ASC needs services beyond the capabilities of the ASC. WHA expressed opposition to this change. WHA said that having such a relationship between an ASC and a hospital is foundational to well-managed, coordinated care for individuals needing emergency resources beyond the capabilities of an ASC.
WHA’s comment letter is posted on our website, and CMS’s proposed rule can be found here. The proposed rule and any changes to it will not go into effect until CMS promulgates a final rule, which WHA expects could occur in the next 6 to 18 months.
If you have any questions about the proposed rule contact Matthew Stanford, WHA General Counsel.

This story originally appeared in the November 27, 2018 edition of WHA Newsletter