Medicare regulatory reform panel looks to cut red tape

Work is under way to implement hundreds of recommendations to relieve the paperwork burden.

By Markian Hawryluk, amednews staff. Dec. 9, 2002.

Washington -- What may end up being the largest single effort to reduce health care regulations came to a close in late November when a regulatory relief panel gave the Bush administration 255 recommendations to eliminate red tape for health practitioners and their patients.

Now it is up to the Health and Human Services Dept. to implement or reject the committee's suggestions.

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The Advisory Committee on Regulatory Reform, called by HHS Secretary Tommy Thompson more than a year ago, included in its completed report more than 100 suggestions that would directly impact doctors. It addressed such thorny rules as the advance beneficiary notice, the Emergency Medical Treatment and Active Labor Act, limited English proficiency, and Medicare evaluation and management guidelines.

"One by one, we are removing unnecessary barriers between patients and doctors, nurses and other health care providers," Thompson said. "By restoring common sense to our regulatory system, we are helping health care professionals spend more time caring for patients and less time consumed with paperwork."

Heeding Thompson's request not to wait until the final report, the panel made recommendations throughout the process, and HHS already had implemented 27 of them before the document was issued. One example is clarifications on EMTALA that physician groups had clamored for.

Of the 255 recommendations, more than half were directed at the Centers for Medicare & Medicaid Services. The agency has already implemented 17 of those suggestions, and agency officials said work was under way to implement scores of further reforms.

More than 100 suggestions directly impact doctors.

Thompson called the initiative a "great step forward, but only the first step." He pledged to continue the process of culling the reams of rules that practitioners confront in dealing with government health programs.

"Our work doesn't stop here. We will continue to carefully consider all of the recommendations and take appropriate steps to promote quality care of all Americans," Thompson said. "We will continue to focus on the potential impact that reducing regulatory burden may have on patient care as we review existing requirements and consider new regulations."

Douglas Wood, MD, chair of the regulatory reform committee, said the group had accomplished a "considerable body of work." Dr. Wood was one of six physicians on the 30-member panel. "We decided to concentrate on those rules and regulations that served little purpose," he said.

The panel was charged with making recommendations that could be implemented administratively and did not require new authorization of funds or new regulatory authority from Congress. Specifically, the committee recommended scrapping the evaluation and management guidelines, clarifying on-call requirements for physicians under EMTALA and simplifying the ABN notices.

A long to-do list

The commission's recommendations on physician issues, as well as on Medicare+Choice, hospital, home health and skilled nursing facility concerns, will leave a long to-do list for the Bush administration.

"Our goal has been to highlight ways to improve the quality of care that patients receive by focusing on some of the unintended consequences of various regulations," Dr. Wood said. "Already Secretary Thompson has moved to implement many of our ideas in ways that better serve patients. This shows the department's real willingness to consider smarter ways to regulate health care."

HHS already has implemented 27 suggestions.

Thompson created an internal strike force at HHS to move forward on the committee's recommendations. He said the next step would be to convene a new group of health experts to look at health care technology, reimbursement and delivery systems. That group met for the first time in a closed-door session at the Institute of Medicine Nov. 24. HHS plans to release the makeup and goals of that panel in the near future.

"The third step will be to go to Congress and ask for changes," Thompson said.

Dr. Wood credited HHS and CMS for their support of the effort and for helping the commission members understand the rationale behind regulations and the implications of changes considered by the members. He said the committee process was a model for further reform efforts.

Nancy Nielsen, MD, vice speaker of the AMA House of Delegates and a member of the panel, contrasted the process with the final days of the Senate -- which adjourned the week the report was released without addressing cuts in Medicare payments to physicians. She said she liked the committee process much better.

William Jessee, MD, president and CEO of the Medical Group Management Assn., lauded the list of recommendations and urged prompt approval of the remaining changes.

"Quick action on the HHS advisory committee recommendations regarding [a Medicare] electronic enrollment process and the elimination of obsolete forms should be the government's next priority," Dr. Jessee said.

While the work of the committee was widely hailed by health practitioner groups, consumer advocates bemoaned their lack of input. The committee included only one member who did not represent a practitioner or insurance plan. But Dr. Wood countered that committee members kept their focus on improving care for patients and on avoiding territorial biases when making recommendations.

Despite the progress made by the committee, Dr. Wood said, there are still significant hurdles to simplifying Medicare for practitioners and beneficiaries that need to be addressed.

"This is a starting point. We still have much to do. The hardest work is still ahead of us," he said. "I'm slightly disappointed that I have to go back to my mother-in-law and say I won't be able to solve the ABN problem."

ADDITIONAL INFORMATION:

Rooting for reform

Among the key recommendations from the Advisory Committee on Regulatory Reform:

Eliminate current Medicare evaluation and management guidelines.
Clarify on-call provisions for physicians under the Emergency Medical Treatment and Active Labor Act.
Simplify Medicare advance beneficiary notices.
Eliminate overly burdensome Medicare secondary payer regulations.
Create an electronic Medicare enrollment process for physicians and Part B suppliers.
Reduce the frequency of government communications about new rules by moving toward annual publication of regulations, with quarterly updates.