7 ways to cut value-based care's regulatory red tape

If lawmakers want to help the transition from fee-for-service to a value-based reimbursement system, they must take steps to cut more government red tape, according to the AMGA.

In a letter (PDF) to the House Ways and Means Subcommittee on Health’s “Medicare Red Tape Relief Project,” the AMGA outlined seven changes to government regulations that would provide more flexibility and further both Medicare and the provider community’s transition to value-based care.

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“The goal needs to be the best possible patient experience,” Chester A. Speed, AMGA’s vice president of public policy, said in an announcement.

“Too often, regulations become a compliance exercise. Our recommendations are based on a vision of patient-centric, value-based, coordinated care and are designed to shift Medicare’s rules from policing providers to partnering with them and building on the investments they’ve made in providing high-quality care in new, innovative delivery models.”

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The trade organization, which represents more than 450 multispecialty medical groups and integrated care systems and is advocating for the transformation of healthcare, recommended the following:

  1. Simplify quality measurement. The Centers for Medicare & Medicaid Services (CMS) should reduce the number of quality measures and focus on those that measure outcomes and patient experience. It should also move to a more outcomes-based system that is based on claims data.
  2. Waive the three-day qualifying inpatient stay for skilled nursing facility care. CMS should waive this requirement for all value-based providers and implement policies that encourage providers to work with their patients to provide services in the most clinically appropriate location.
  3.  Eliminate appropriate use criteria. These regulations should not be imposed on providers in value-based payment models.
  4. Reduce documentation requirements for chronic care management code. In addition, Congress should eliminate the beneficiary cost-sharing requirement.
  5. Suspend Meaningful Use regulations. They represent a significant burden on providers without a clear benefit to patients.
  6. Amend physician self-referral laws. Stark law regulations do not account for the rapidly changing provider landscape and increasing coordination. For clinical integration to succeed, the law and its regulations need to accommodate greater integration.
  7. Expand telehealth. CMS should waive the geographic limitations for telehealth use for all providers participating in value-based models.

“The regulatory framework that has developed over time is not keeping up with the advances in care coordination and delivery,” Speed said. “What made sense and was appropriate in a siloed and fractured healthcare delivery system is now holding back providers from doing the best they can for their patients.”