Patients over Paperwork initiative results in some small — very small — proposed changes.
A dab of regulatory relief is better than none at all — or is it?
On Sept. 17, the Centers for Medicare & Medicaid Services dropped a 285-page proposed rule containing a multitude of ideas for reducing Medicare providers’ regulatory burdens. The proposed changes would reduce providers’ financial burden by $1.1 billion annually, CMS claims in a release about the rule. “CMS developed the proposed rule in response to President Trump’s charge to federal agencies to ‘cut the red tape’ and reduce burdensome regulations,” the agency says.
“We are committed to putting patients over paperwork, while at the same time increasing the quality of care and ensuring patient safety and bolstering program integrity,” CMS Administrator Seema Verma says in the release. This rule is a “major step forward” in CMS’s efforts “to modernize the Medicare program by removing regulations that are outdated and burdensome. The changes … will dramatically reduce the amount of time and resources that healthcare facilities have to spend on CMS-mandated compliance activities that do not improve the quality of care, so” they “can focus on their primary mission: treating patients.”
On one hand: “Any time CMS proposes something that will actually reduce the burden on providers, it is a good day,” cheers consultant Kathy Roby with Qualidigm in Wethersfield, Connecticut.
“Any relief of regulatory burden is welcomed,” agrees consultant Pam Warmack with Clinic Connections in Ruston, Louisiana.
But experts aren’t sure exactly how significant the relief the rule calls for will provide for home health agencies.
For example:The rule proposes “to remove the requirement that Home Health Agencies (HHAs) provide a copy of the clinical record to a patient, upon request, by the next home visit. We propose to retain the requirement that the copy of the clinical record must be provided, upon request, within 4 business days.”
CMS just implemented the four-day requirement in the new Home Health Conditions of Participation that took effect in January. In its 2018 rulemaking, “we received feedback … that this requirement was impractical for HHAs to comply with because providing the record at the next visit may not allow enough time for HHAs to create a physical or electronic copy of the clinical record content, provide that copy to the next visiting clinician who may not be scheduled to come into the HHA office prior to the visit due to the nature of home based care and the significant travel that HHA clinicians must do in order to make patient visits, and successfully deliver the copy to the patient,” CMS notes in this regulation published in the Sept. 20 Federal Register.
“We agree that providing the record at the next visit is not practical or even possible in some cases. Furthermore, we agree that retaining the 4 business day timeframe is an appropriate regulatory requirement. Therefore, we propose to remove the requirement that the requested clinical record copy must be provided at the next home visit,” CMS says.
It’s good that CMS has recognized the problem with the current requirement. “If someone gets a request at 4:30 pm the day before the next visit, depending on the software the agency uses and how long the patient has been on service, it might well be impossible,” notes Julianne Haydelwith Haydel Consulting Services in Baton Rouge, Louisiana.
Another problematic scenario is when “there is a SN visit when the request is made, then if there is a PT or aide visit the next day,” illustrates attorney Liz Pearson with Pearson & Bernard in Edgewood, Kentucky. “That would require a nearly impossible turn-around.”
The catch: This change “may actually require agencies to provide records sooner if the next visit isn’t scheduled for more than four business days from the date of the request,” points out Washington, D.C.-based attorney Elizabeth Hogue.
For example, “if the ‘next visit’ was not scheduled for seven days, the new proposal of four business days is actually more of a burden,” Warmack explains.
“And whether it’s four days later or the next visit, it’s still a pretty short period of time,” Hogue stresses.
Not to mention: “Preparing and delivering the information is the same regardless of the time period allowed to do so,” Hogue says.
Another mitigating factor for burden assessment is staff training. HHAs just got done updating their policies and procedures and getting their staff trained on the next-visit timeframe. Now they’ll have to go back and change it, experts note.
Another point: The four-day requirement, if finalized, “still is more burdensome than the requirements related to providing access under HIPAA,” highlights attorney Robert Markette Jr. with Hall Render in Indianapolis. “Under HIPAA, when an individual seeks access to their PHI, the covered entity has 30 days to provide it. That provides a much greater level of flexibility than this four-day requirement,” Markette says.
“If they really wanted to reduce the regulatory burden, they would have dropped this requirement entirely and depended upon HIPAA,” Markette says.
Meanwhile: Even if the change has a positive impact on burden weight, its relief is relatively “tiny,” Warmack points out.
That’s because “this is not something that comes up a lot,” Pearson relates. “Generally when requests are made for clinical records, it’s after the episode is over.”
A good, perhaps unintended, consequence of the change would be eliminating the current requirement’s “terrific incentive for deliberately missing a visit the patient needs,” notes Haydel, who expresses hearty disagreement with the tactic.
The other HHA-specific provisions in the rule, addressing aide competency and patient rights notice, likewise offer relief in only small doses.
In the end, “every little bit certainly helps but, with these relatively small changes, perhaps it’s the thought that counts,” Hogue rues.
“This attempt to reduce paperwork won’t make much difference,” Haydel believes. “I certainly can’t see how it will save providers a billion dollars.”
Note: The proposed rule is at www.gpo.gov/fdsys/pkg/FR-2018-09-20/pdf/2018-19599.pdf.
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