Proposed Rule Could Ease Regulations for Rural FPs, Office Labs

AAFP to CMS: 'Vague' Language Needs Clarification

April 10, 2013 04:10 pm News Staff

The devil may be in the details -- to paraphrase the well-known adage -- but sometimes, a lack of details presents an even bigger problem.

[Rural gravel road w/mountain backdrop]

Such is the case with a recently released CMS proposed rule on promoting efficiency and transparency and reducing the level of administrative burden on physicians and other health care professionals. The rule focuses on reforming Medicare regulations that CMS has identified as "unnecessary, obsolete, or excessively burdensome on health care providers and suppliers," including certain regulations related to critical-access hospitals (CAHs), rural health clinics (RHCs) and federally qualified health centers (FQHCs), as well as those related to the Clinical Laboratory Improvement Amendments (CLIA) of 1988.

However, after reviewing the proposed rule, which was published in the Feb. 7 Federal Register(, the AAFP has called out what it terms "vague" language in the rule and is urging CMS to clarify that wording.

story highlights

  • AAFP Board Chair Glen Stream, M.D., M.B.I., has responded to a recently released CMS proposed rule by saying the Academy appreciates the agency's work to eliminate unnecessary regulations.
  • However, after reviewing the proposed rule, the AAFP has identified what it terms "vague" language in the rule and is urging CMS to clarify.
  • The AAFP's comments specifically concern regulations pertaining to physicians who practice in certain rural and underserved communities, as well as those who operate office labs.

In a March 8 letter to CMS Acting Administrator Marilyn Tavenner(2 page PDF), M.A., AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash., says the Academy appreciates the agency's work to identify, address and eliminate unnecessary regulations.

"We continue to encourage CMS to improve the ability of family physicians to focus resources on providing patient care through the elimination and reduction of regulatory requirements that impede high-quality patient care," says Stream.

For example, CMS has proposed revising some existing regulatory language to offer more flexibility to physicians serving in remote areas where "rural populations suffer from limited access to care due to a shortage of health care professionals and physicians."

Specifically, the agency proposes to eliminate its current requirement that M.D.s and D.O.s involved with CAHs, RHCs or FQHCs visit those facilities at least once every two weeks to provide medical care and consultation services and to supervise clinical staff.

Instead, CMS is proposing that physicians who work with CAHs "be present for sufficient periods of time" to provide those services. With regard to M.D.s and D.Os who work with RHCs and FQHCs, CMS proposes that physicians "periodically review the clinic's or center's patient records, provide medical orders, and provide medical care services to the patients of the clinic or the center."

"We recognize that CMS is trying to offer flexibility," Stream notes. However, "the AAFP has concerns over the rather vague use of the term 'sufficient periods of time.'"

Moreover, Stream adds, "In the final rule, the AAFP encourages CMS to clarify which entities are authorized to deem noncompliance with the revised proposal so that all facilities can clearly ensure full compliance with the new requirements."

Clarification of language in the proposed rule is important, considering the number of FPs who stand to be affected by the final regulation.

According to demographic information included in "Facts About Family Medicine," a practice profile survey of AAFP members as of Dec. 31, 2011, found that nearly 19 percent of active members who responded to the survey -- a total of 12,017 family physicians -- reported practicing in a nonmetropolitan area.

In addition, slightly more than 8 percent of respondents -- or 2,619 FPs -- reported working in an office or clinic designated as an FQHC.

Proposed CMS rules governing proficiency testing referrals covered by CLIA regulations also matter greatly to AAFP members. Nearly 40 percent of respondents to an April 2011 practice survey said they operate office labs.

In his letter, Stream commends CMS for modifying some of the regulations governing proficiency testing rules that apply to those office-based labs.

For example, CMS has indicated it would take into account the seriousness of proficiency testing violations. "The AAFP supports these proposals since they offer CMS the opportunity to show greater leniency when appropriate," says Stream.