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March 08, 2013

Medicare Proposes to Cut Regulations on Critical Access Hospitals

Hospital Entrance
The Centers for Medicare and Medicaid Services (CMS) recently released a 114-page proposed rule that would loosen certain regulations for critical access hospitals (CAHs) and federally qualified health centers (FQHCs).  The proposed rule would no longer require them to have a physician on site at least once every 2 weeks, as reported by Medpage Today

Comments on the proposed rule are due around early April.  Comments should reference file code CMS-3267-P. 

“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.”  “Many rural populations suffer from limited access to care due to a shortage of healthcare professionals, especially physicians.” 

Instead, greater use of telemedicine would allow physicians to provide certain types of care at much less cost, the proposed rule stated.  The rules follow a 2011 executive order from President Obama to spot and repeal needless regulations across all branches of government -- including Medicare and Medicaid regulations “identified as unnecessary, obsolete, or excessively burdensome on healthcare providers and beneficiaries.” 

Monday’s rules are “expected to save nearly $676 million annually and $3.4 billion over 5 years, the Obama administration said.  CMS finalized a similar set of rules last May that are expected to save nearly $1.1 billion in the healthcare system in the first year.”  Among the many proposed changes are:  

  • Allowing trained nuclear medicine technicians in hospitals to prepare radiopharmaceuticals for nuclear medicine without a supervising physician or pharmacist
  • Eliminating redundant data submission requirements and survey processes for transplant centers
  • Eliminating unnecessary requirements that ambulatory surgical centers must meet in order to provide radiological services
  • Removing the requirement that critical access hospitals develop patient care policies with the advice of at least one person who is not a member of the hospital staff
  • Revising the definition of "physician" in hospital and rural health clinic regulations to match that of "physician" in payment regulations  

In the proposed rule, CMS also seeks comments on changes aimed at reducing regulatory barriers to providing telehealth, hospice, and home health services in rural health clinics. 

“The proposed rule was applauded by the Federation of American Hospitals (FAH) and the American Hospital Association (AHA).  The latter especially noted removing the requirement that hospital governing boards include a member of the medical staff.  The AHA said the regulation wasn't feasible for all hospitals.” 

“However, we are disappointed that CMS did not allow hospitals in multi-hospital systems to have single integrated medicl staff structures if that's how those providers choose to be organized,” AHA President and Chief Executive Rich Umbdenstock said in a statement.

“Hospitals are delivering more coordinated, patient-centered care and CMS should not let antiquated organizational structures stand in the way.”   

The FAH praised the inclusion of qualified dietitians as practitioners with privileges to order patient diets.  “There are a number of particularly meaningful provisions in the proposed rule,” said Chip Kahn of the Federation of American Hospitals, reported Reuters.  

“We are committed to cutting the red tape for healthcare facilities, including rural providers,” Health and Human Services Secretary Kathleen Sebelius said in a press release.  “By eliminating outdated or overly burdensome requirements, hospitals and healthcare professionals can focus on treating patients.”


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