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Loosening the rules

CMS proposes reducing need for supervising docs


By Ashok Selvam
Posted: February 16, 2013 - 12:01 am ET
Tags:

Thanks to a proposed CMS rule change, dietitians and other clinicians at hospitals will be able to do the jobs they were trained for without having to hunt down a physician to supervise them.

Officials at affected hospitals welcomed the changes, saying the current rules are far too restrictive. One regulation the CMS wants to change requires physicians to be present when a dietitian writes an order. Russ Johnson, CEO at 44-bed San Luis Valley Regional Medical Center in Alamosa, Colo., said that's a burdensome and inefficient use of a small hospital's resources.

“The old rule was kind of a step backwards as it didn't really allow clinicians to practice in their full scope,” he said.

The proposed change promotes better relationships with other clinicians and leads to better coordination of care, Johnson said. It frees up physicians' time, already at a premium, allowing them to focus on treating their own patients instead of worrying about supervising other clinicians.

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The CMS also wants to loosen a similar requirement for physicians to supervise nuclear medicine technicians as they prepare radiopharmaceuticals.

The Obama administration estimates that reducing those responsibilities and others could save hospitals as much as $676 million annually and $3.4 billion over five years. Comments are due April 8 on the proposed regulations, issued in response to a 2011 executive order intended to reduce burdensome regulations.

“We are committed to cutting the red tape for healthcare facilities, including rural providers,” HHS Secretary Kathleen Sebelius said in a news release. “By eliminating outdated or overly burdensome requirements, hospitals and healthcare professionals can focus on treating patients.”

Hospital trade groups, including the American Hospital Association and Federation of American Hospitals, have generally praised the proposed revisions. The CMS, for example, nixed a widely criticized requirement that a hospital's board must include a physician.

The rule includes several provisions specifically intended to make life easier at rural hospitals such as San Luis Valley and other rural clinics and critical-access hospitals. Those hospitals also particularly like a move to eliminate the requirement that a physician be on-site at least once every two weeks at critical-access hospitals, a restriction hospital leaders say fails to acknowledge technological advances such as telemedicine.

Smaller and rural hospitals, which struggle to find subspecialty physicians, will be able to better serve their patients through telemedicine in areas such as pediatric consultations, said Dr. Andrew Ziskind, a managing director of Chicago-based Huron Consulting Group. Patients won't have to rely on the care of an on-site primary-care physician whose skills might not be the best match for treating their conditions.

The CMS also struck a mandate that forced all hospitals, even those that are part of multihospital systems, to have separate governing boards. Allowing boards to govern multiple facilities is a step toward better population health and collaboration, Johnson said.

But despite those changes, hospitals also say the changes don't go far enough.

Last year, for example, San Luis Valley agreed to form San Luis Valley Health with 17-bed Conejos County Hospital in La Jara, Colo. Even under the revised regulations, multihospital systems must have separate medical staffs at their constituent hospitals, and systems with a single governing body must consult regularly with the leader of each hospital's medical staff. Johnson said those rules are unnecessary because the San Luis Valley hospitals are less than 20 miles apart.

The CMS argues that having separate medical staffs allows hospitals to better address patient quality and safety on a local level, said Sandra DiVarco, an attorney with McDermott Will & Emery's Chicago office.

Most of the regulations, though, are intended to eliminate redundancies, such as having hospitals complete surveys that request the same data, DiVarco said. She described them as “low-hanging fruit” that would make day-to-day life easier for hospitals, but not dramatically so.

Brock Slabach, senior vice president for member services at the National Rural Health Association, agreed with that assessment of the proposed rule. “It would keep everyone from doing busy work, which is great,” Slabach said. “A lot of the smaller rurals don't have staff to keep up with all of that.”


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