Proposed rule aims to eliminate excessively burdensome Medicare regulations.
The Centers for Medicare & Medicaid Services (CMS) recently proposed a wide-reaching rule to eliminate Medicare regulations that are “unnecessary, obsolete, or overly burdensome on hospitals and health care providers.” According to Health and Human Services Secretary Kathleen Sebelius, this proposed rule should give health care professionals more time to focus on treating patients by “cutting the red tape for health care facilities, including rural providers.”
The overall proposed rule is the second in a series of CMS actions to implement the regulatory reforms outlined in Executive Order 13563. In early 2011, President Obama directed each executive agency to establish a plan for both reviewing existing regulations and eliminating, modifying, or streamlining rules identified as obsolete, ineffective, or overly burdensome.
In one of the less widely discussed provisions that highlights innovations in health care technology, the proposal would no longer require that physicians make regular appearances at rural health care centers.
Currently, Medicare regulations require that a physician be present at Critical Access Hospitals, Rural Health Clinics, and Federally Qualified Health Centers, all of which receive Medicare funding, at least once every two weeks to provide medical care and oversight. Typically physicians oversee the non-physician practitioners, such as nurse practitioners and physician assistants, who tend to provide most of the services at these rural health care centers.
CMS found that this biweekly visitation requirement overlooked the considerable variation in how much physician oversight is necessary among Critical Access Hospitals. While the agency noted that the regulation might be unduly burdensome to some hospitals serving geographically isolated areas, CMS suggested it might also be “grossly inadequate” for rural hospitals that offer a wide range of complex services or have busy emergency departments. CMS argued that eliminating this rigid regulation will provide Critical Access Hospitals with the flexibility to determine the appropriate frequency of physician visits.
However, the proposed rule does not remove all physician supervision requirements for covered rural health care facilities. For Critical Access Hospitals, a physician must be present for sufficient periods of time to provide medical direction, consultation, and supervision. The physician also must be available through direct radio or by telephone for consultation, for assistance with medical emergencies, and for patient referrals. For Rural Health Clinics and Federally Qualified Health Centers, a doctor must periodically review the center’s patient records, provide medical orders, and provide medical care services to patients at the health center.
CMS expressed hope that this proposal will remove barriers to care, increase the use of telemedicine, and enhance patient access to care in rural and remote areas. The agency estimated annual savings of $42 million from this particular provision, out of approximately $676 million annual savings for the overall proposal.
CMS is accepting public comments until April 8, 2013.