In an effort to cut red tape, the Centers for Medicare & Medicaid Services yesterday proposed a series of provisions, aimed at saving providers an annual $676 million, or $3.4 billion over five years. The proposed changes include relaxing supervision rules for nonphysicians and dropping a burdensome mandate for hospital governing boards.
Although hospital associations generally applauded the move toward efficiency, providers were disappointed that CMS is still tied to individual medical staffs at multihospital systems.
In a 2011 executive order, the president called for reducing unnecessary regulations across government agencies.
"We are committed to cutting the red tape for healthcare facilities, including rural providers," U.S Department of Health & Human Services Secretary Kathleen Sebelius said in a statement yesterday. "By eliminating outdated or overly burdensome requirements, hospitals and healthcare professionals can focus on treating patients."
The proposed rule also would allow nonphysicians to care for patients without direct supervision:
- Registered dietarians at hospitals would receive privileges and could order patient diets without a physician's approval
- Nuclear medicine technicians in hospitals could prepare radiopharmaceuticals without a supervising physician or pharmacist being present
- Practitioners who are not on the medical staff could order hospital outpatient services, according to state law and medical staff authorization
The rule also recognized the resource challenges for rural facilities in remote areas that might have limited workforce:
- Critical access hospitals (CAH) no longer must include a non-CAH staff when developing patient care policies, which would eliminate the need to pay for outside personnel
- CAHs, as well as rural health clinics and federally qualified health centers, would no longer need a physician to be on site at least once every two weeks
The proposed rule also clarifies governance and medical staff structures:
- Medical staffs would not need to be made up solely of physicians but also can include nonphysician practitioners, with eligibility determined by the governing body
- The hospital governing body would no longer need at least one member of the medical staff
- Each hospital must have an individual medical staff
The Federation of American Hospitals (FAH) was pleased with the proposed rule. "The new regulation should help hospitals free up greater resources to devote to patient care," FAH President and CEO Chip Kahn said yesterday in a statement.
Although the American Hospital Association applauded CMS rescinding the regulation that hospital governing boards must include a medical staff member, the hospital group was disappointed that CMS didn't budge on the issue of a unified medical staff for multihospital systems. While AHA has pushed for a single integrated medical staff structure, CMS still requires that each hospital have its own medical staff.
"Hospitals are delivering more coordinated, patient-centered care, and CMS should not let antiquated organizational structures stand in the way," AHA President and CEO Rich Umbdenstock said in a statement yesterday.
For more information:
- see the CMS announcement
- check out the proposed rule (.pdf)
- here's the FAH statement (.pdf)
- read the AHA brief
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