The burdens of Medicare: Push for regulatory reform is on

Advisory panel will look for commonsense ways to provide real relief for health care professionals.

By Markian Hawryluk, amednews staff. Jan. 21, 2002.

Washington -- Paperwork reduction has already become a mantra in Washington this year.

Even as Medicare regulatory reform legislation awaits consideration by the Senate, Health and Human Services Secretary Tommy Thompson has named the Advisory Committee on Regulatory Reform to address paperwork reduction issues. And in response to a congressional request, the Medicare Payment Advisory Commission has issued a list of recommendations to reduce Medicare complexity and minimize the program's regulatory burden.

Douglas L. Wood, MD
Some ideas for simplification
Links

While some of the efforts will likely need congressional action, both initiatives offer the promise of real regulatory relief for physicians and other health care professionals this year.

Thompson said he hoped the 27-member advisory committee he named in late December would share recommendations as they develop them, rather than waiting until the fall deadline he imposed.

"When you look at a rule that comes through and you get something that really bothers you, sit down and write me a letter," Thompson told the panel at its first meeting, held earlier this month at a Washington, D.C., hospital. "How can it be done better -- that's what I want you to focus on."

The panel is charged with finding ways to reform and streamline the regulatory process at HHS, but in particular at the Centers for Medicare & Medicaid Services and the Food and Drug Administration. The committee will hold field hearings across the country to gather insight from physicians, consumers and businesses. Its goal, according to Thompson, is to focus on areas where real changes can be made to improve the quality of care for large numbers of patients.

"When we flood doctors and hospitals with excessive paperwork, patients suffer the consequences," he said. "This new panel will help us restore common sense to the regulatory process so that Americans can receive higher-quality health care without creating needless hassles for doctors and other health care professionals."

Thompson tapped Douglas L. Wood, MD, a practicing cardiologist at the Mayo Clinic in Rochester, Minn., to chair the committee. Dr. Wood serves on the Practicing Physicians Advisory Council and the Medicare carrier advisory committee in Minnesota, as well as the American Medical Association's CPT Advisory Committee.

"These rules have become daunting for the people this program serves," Dr. Wood said at the panel's opening meeting. "When the regulatory burden becomes a barrier to success, you must find solutions."

Dr. Wood said the committee would focus on problems that could be fixed immediately, as well as those that could take a little longer or require a more complicated solution. The committee might also consider long-term problems that require expensive or legislative fixes.

He also suggested the committee should recommend a framework for future regulations aimed at limiting their complexity or regulatory burden.

Although the panel has not yet identified the issues it would tackle, its first meeting was riddled with references to the regulatory usual suspects. Numerous committee members and presenters mentioned problems with the Emergency Medical Treatment and Active Labor Act, advance beneficiary notices, and evaluation and management guidelines -- which Barbara Paul, MD, director of CMS' Physicians' Regulatory Issues Team, called "the poster child for Medicare complexity."

Paul said she expected that PRIT would likely be the arm by which the physician-related recommendations of the advisory committee are implemented.

Suggestions for reform

Meanwhile, MedPAC issued a list of its own recommendations for regulatory relief, focusing on programwide measures, rather than specific issues.

Among its more controversial recommendations, MedPAC suggested CMS move to a nationwide system of claims processing and eliminate local discrepancies.

The MedPAC report said Medicare was initially envisioned as a local program paying locally determined rates for health care services. But as Congress has moved toward nationally determined prospective payment systems, local payment policies no longer make sense.

"For a national program that wants to provide equitable treatment to all beneficiaries, moving toward a standard, national claims processing system would be an important step toward simplification," MedPAC said.

Inconsistency of coverage between Medicare carriers is a frequent complaint by health care professionals, but many physicians believe that local medical review policy is a necessary component to ensuring access to quality health care. Indeed, MedPAC noted that national policy-making has its price. The local policies not only reflect regional practice differences but may allow more rapid introduction of innovations than the national coverage determination process allows, the report said.

MedPAC also recommended that CMS provide written guidance to physicians, plans and other health care entities, and protect them from fines or repayment if that guidance is relied upon but turns out to be incorrect. The AMA and other health care groups had unsuccessfully sought to include similar language in a regulatory relief bill passed last year by the House and now under consideration by the Senate.

MedPAC said while enforcement measures should create fear of detection and prosecution for those contemplating fraud, many honest practitioners are being discouraged from participating in the program.

"Writing rules and enforcement policies for the bad apples may cause a serious misallocation of resources and unnecessarily complicate things for the vast majority of honest providers," the commission said.

The report recommended establishing rewards for good behavior, for example, reducing administrative requirements, such as the frequency of data collection or administrative reviews, for organizations or practitioners that demonstrate sustained good performance. That would also allow oversight resources to focus on problem cases, the commission said.

ADDITIONAL INFORMATION:

Douglas L. Wood, MD

Chair of the Health and Human Services Advisory Committee on Regulatory Reform

Practicing cardiologist, Mayo Clinic, Rochester, Minn.
Member of the Centers for Medicare & Medicaid Services' Practicing Physicians Advisory Council
Member of the Medicare Carrier Advisory Committee in Minnesota
Participant in Minnesota Peer Review Organization effort to improve the quality of care for heart attack patients
Member of the AMA's CPT Advisory Committee

Some ideas for simplification

Medicare Payment Advisory Commission recommendations on reducing Medicare complexity and regulatory burden:

The Centers for Medicare & Medicaid Services should move to a standard national system of claims processing and eliminate local descriptions of policy and regulations.
The Medicare program should provide timely, binding written guidance to plans, physicians and others that protects them from civil or criminal penalties, or repayments.
CMS should explore ways to reduce routine administrative requirements for plans, physicians and others demonstrating good performance.
The Health and Human Services secretary should work with the Dept. of Justice to improve consistency and eliminate redundancy in enforcement roles and activities.
Congress should provide reasonable time limits and resources for CMS to develop and test regulations.
CMS should eliminate regulations and other issuances that become obsolete due to program changes.
Congress should appropriate the resources necessary for CMS to acquire new technology that would simplify administrative processes and improve information exchange.