Knowledge Base Article

One frustration of healthcare workers is that they spend almost as much time on documentation and complying with burdensome regulations as they do taking care of patients. The current government Administration has promised to provide some relief by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare facilities. To this end, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule on September 17, 2018 reforming some Medicare regulations to reduce the amount of time and resources that healthcare facilities have to spend on CMS-mandated compliance activities that do not improve the quality of care. According to the CMS Administrator, this will allow hospitals and healthcare professionals to focus on their primary mission of treating patients.

Here are some of the proposals to change the Medicare Conditions of Participation (CoP) that affect hospitals either directly or indirectly:

• Hospital systems could elect to have one unified and integrated Quality Assessment and Performance Improvement (QAPI) program for all of its member hospitals instead of individual programs for each hospital. Such a program must be in compliance with State and local laws, consider the unique circumstances and differences of the member hospitals, and be able to address needs and issues specific to each hospital.
• Hospitals could establish a medical staff policy that would allow a pre-surgery/pre-procedure assessment for an outpatient in certain circumstances, instead of a comprehensive medical history and physical examination (H&P). The assessment would have to be documented in the patient’s medical record. The hospital’s policy would have to consider medical factors (such as the patient’s diagnosis and other conditions, type of surgery, etc.), nationally recognized guidelines and standards of practice, and applicable state and local health and safety laws.
• Like the above described unified quality program, the rule also proposes allowing a unified and integrated infection control program for multi-hospital systems. The same considerations of the differences and unique needs of each hospital apply for a unified infection control program as they do for the unified quality program.
• Hospitals and other facilities are required by law to have processes for cooperation and collaboration with local, tribal, regional, State and Federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation. This requirement is not changed but the requirement to document participation in collaborative and cooperative planning efforts, including documentation of contact efforts, is proposed to be eliminated. There are also proposals to provide flexibility in the time frame of review of Emergency Preparedness plans, decrease the required frequency of training to every two years instead of annually, and allow flexibility in the types of testing exercises for both inpatient and outpatient exercises.
• Remove the requirement for hospitals to perform autopsies in all cases of unusual deaths and of medical-legal and educational interest. Hospitals would follow State laws regarding such medical-legal requirements.

There are also proposals that address changes to critical access hospitals (CAHs) annual review of policies and procedures, hospital and CAH swing-bed requirements, requirements for transplant centers, and clarification of who is allowed to document progress notes in a psychiatric hospital. Other proposals address different types of providers.

One proposal for ambulatory surgery centers (ASCs) may be of interest to hospitals. CMS is proposing to remove the requirement that ASCs have a transfer agreement with a hospital and that the ASC surgeons have admitting privileges at a hospital. CMS sites hospitals’ refusals to sign such agreements and the EMTALA requirements that hospitals must treat emergencies as reasons why the current requirements do not affect patient safety and therefore are no longer needed.

If you would like more information, please refer to the proposed rule, the press release, and/or the CMS Fact Sheet.