Federal rules are directed toward healthcare providers to make sure they provide safe and high-quality care, but calls for decreasing regulatory burdens are growing louder, targeting new rules that consultants and providers say do little to improve healthcare and result in lots of raised costs.
In a new research report titled “Regulatory Overload,” the American Hospital Association (AHA) charges that federal rules are getting in the way of caring for patients, and it specifically targets Medicare Conditions of Participation (CoPs). “Patients also are affected through less time with their caregivers, unnecessary hurdles to receiving care and a growing regulatory morass that fuels higher health care costs,” the report says.
The AHA is not alone, of course. For example, other consultants who work in the healthcare industry agree that the rules are getting out of hand.
The Centers for Medicare and Medicaid Services (CMS) has made numerous changes to its nursing standards chapters, and there are significant proposed changes in the Hospital Improvement Rule for 2018, said Sue Dill Calloway, who addresses the CoPs in a conference for ProfEdOnDemand, “2018 CMS Nursing CoP Standards for Hospitals: Proposed Changes and Updates.”
Other consultants add that regulation is on the answer to better quality of care. “A reduction in administrative burden will enable providers to focus on patients, not paperwork, and reinvest resources in improving care and health, as well as reducing costs,” attorneys at Manatt, Phelps & Phillips said.
Federal Oversight Paralyzing Providers?
The AHA’s report tallies healthcare providers’ regulatory compliance cost at $39 billion annually. The organization says that while regulation is necessary, opportunities for regulatory relief could help lower that cost, at no cost to quality of care.
“Providers appreciate that federal regulation is intended to ensure that health care patients receive safe, high-quality care, and prioritize it as a critical part of their day-to-day work,” the report notes. “But the scope and pace of the changes being made is out-stripping many providers’ ability to absorb them. At the same time, many of these regulations do not improve the quality of patient care or access to services.”
In particular, the AHA asserts:
- Health systems, hospital and post-acute care providers must comply with 629 regulatory requirements across nine domains, with the rules enforced by four federal agencies.
- Those providers spend nearly $39 billion annually just on admin activities related to compliance—that amounts to nearly $7.6 million for a 161-bed community hospital.
- An average-size hospital has an average of 59 employees devoted full time to regulatory compliance.
- The timing and pace of change make compliance challenging.
- Most of a hospital’s compliance efforts are spent documenting CoPs compliance and billing/coverage verification.
- There are ongoing interoperability issues despite investment in IT systems.
- Quality reporting requirements are often duplicative and inefficient.
- Fraud and abuse laws are outdated.
“A typical hospital devotes 4.6 FTEs and spends $709,000 annually on the administrative aspects of quality reporting—which is beset by duplicative reporting requirements that call for manual data extraction,” adds Health Care Finance News. “That creates inefficiencies and consumes financial resources and clinical staff time.”
Nursing CoPs Are Particularly Burdensome
Dill-Calloway’s recent conference addressed nurses, nurse managers, nurse educators, chief nursing officers, compliance staff, chiefs of medical staff, risk managers, patient safety offices, hospital legal counsel, audit staff, physicians and regulatory officers. Important changes made recently, Calloway notes, include tinkering with rules for:
- IV medication administration
- Blood transfusion
- Safe injection practices
- Compounding
- Beyond use date
- Implemented safe opioid standards
Calloway discusses CMS’s CoPs on nursing services that all hospitals must follow, addressing how all meds must be administered within three different timeframes, why nursing care plans are a frequently cited area by CMS, and the new regulatory focus on safe injection practices.
