Proposed Rule Continues to Chip Away at Medicare Regulations

CMS recently issued a proposed rule (114-page PDF; About PDFs) intended to continue government efforts to reduce onerous Medicare regulations that add an unnecessary layer of cost to the health care system and keep physicians mired in paperwork and out of the exam room.

The agency's action was in keeping with a January 2011 presidential executive order that called on federal agencies to modify and streamline regulations on business.

In a Feb. 4 press release announcing the proposed rule, HHS Secretary Kathleen Sebelius said CMS has identified a number of areas within Medicare and Medicaid where efficiencies could be increased by eliminating some regulations that were no longer necessary and redefining others.

"We are committed to cutting the red tape for health care facilities, including rural providers," said Sebelius in the release. "By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients."

If adopted, CMS estimated the changes could save between $231 million to $676 million the first year and accrue annual recurring savings of as much as $654 million.

The proposed changes cover a number of aspects of care, including ambulatory surgical center radiology services, hospital food and dietetic services, and transplant center reporting requirements to CMS.

Provisions of particular interest to family physicians would reduce regulatory requirements that involve physician responsibilities in critical-access hospitals, rural health clinics and federally qualified health centers.

Currently, any physician who staffs such a facility must make a face-to-face visit at least once every two weeks. The proposed rule would lift that requirement.

"Some providers in extremely remote areas or areas that have geographic barriers have indicated that they find it difficult to comply with the precise biweekly schedule requirement," says the proposed rule. "We believe that specifying a specific time frame for a physician to visit the facility does not ensure better health care."

Instead, the rule notes, implementation of new technology, such as telemedicine services, should allow physicians "the flexibility to utilize a variety of ways and time frames to provide medical direction, consultation, supervision and medical care services, including being on-site at the facility."

The proposed rule also suggests changes and clarifications to requirements related to the Clinical Laboratory Improvement Amendments of 1988; those changes could positively impact family physicians who run their own office labs.

This most recent proposed rule could be considered "round two" of the agency's efforts to comply with the president's regulatory reform order. In May 2012, CMS issued final rules easing or eliminating administrative regulations for hospitals and health care professionals.

According to CMS estimates, that first round of regulatory purging could save the health care system $5 billion during the next five years.