AAOS October 2, 2018
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CMS Proposes to Lift Unnecessary Regulations, Ease Provider Burdens


On Monday Sept 17, the Centers for Medicare and Medicaid Services (CMS) released the Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction Proposed Rule. CMS has revised the Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) through previous rules in 2012 and 2014, but this is the first such rule released in accordance with the January 30, 2017, Executive Order 13771 entitled “Reducing Regulation and Controlling Regulatory Costs.”

According to CMS, “These proposals would increase the ability of health care professionals to devote resources to improving patient care by eliminating or reducing requirements that impede quality patient care, or that divert resources away from furnishing high quality patient care.”

This rule follows the Administration’s earlier efforts to “relieve burden on healthcare providers by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare facilities.” Although the rule does not directly address physician practices, the proposals include the removal of some requirements, and a reduction in the frequency of others that may be of interest to members who utilize ambulatory surgery centers (ASC).

CMS is proposing to remove the ASC requirement of a hospital transfer agreement. There are instances of hospitals refusing to sign written transfer agreements or grant admitting privileges to physicians performing surgery in an ASC. This change is in line with what was proposed in the Medicare Physician Fee Schedule (MPFS), regarding a focus on site neutrality and addressing certain competition barriers. Because the Emergency Medical Treatment and Labor Act (EMTALA) of 1986 requires hospitals to provide emergency care without prior arrangement, the need for such transfer agreements is no longer a concern.

CMS is also proposing the removal of the current requirement that a history and physical be performed within 30 days of surgery for outpatient surgery. This would allow ASC (or hospital) policy and operating physicians’ clinical judgment to tailor pre-surgical assessments to the patient and type of surgery being performed. This requirement creates an unnecessary burden for stable individuals undergoing outpatient surgery and has not been shown to improve outcomes. Day-of-surgery assessments are sufficient and will still be required.

CMS is also seeking comment on additional ways to reduce burden on ASCs. The AAOS will work with stakeholders to develop a response. Comments are due on November 20.

Read the full CMS press release here.