Oversight at issue

Lawmakers may step in to resolve a five-year dispute over the appropriate level of clinical oversight at rural hospitals.

At issue is the CMS Advisory Panel on Hospital Outpatient Payment, which was established after the agency moved in 2008 to require tightened clinical supervision of many outpatient hospital services. Rural hospitals responded that they could not afford the staff necessary to provide the heightened supervision of outpatient services, ranging from chemotherapy to drug infusion. So the CMS suspended the new requirements and created the panel to adjudicate whether to exempt specific services from the tightened supervision.

That process has fallen short, advocates for rural hospitals said, and the moratorium on the rules expires at year-end.

A new bill addressing the matter is expected to be introduced this summer and advance quickly because of bipartisan interest among senators from rural states, said Brock Slabach, senior vice president for member services at the National Rural Health Association.

“We felt like this was never really fitting with the way in which medicine is practiced in rural hospitals and re-imposition of this regulation would be terribly burdensome,” Slabach said.

Sen. John Thune (R-S.D.) told a senior CMS official last week that he is “concerned that the panel convened to advise on this issue is not sufficiently considering the input from rural critical-access hospitals.”

That 19-member panel includes only three representatives of rural providers and has overwhelmingly decided to keep tight regulations proposed by the CMS for the individual outpatient procedures it has reviewed, according to hospital advocates. Those decisions followed recommendations from the CMS staff to maintain the tighter oversight.

Jonathan Blum, director of Medicare for the CMS, told Thune that he was aware of the hospitals' concerns about the panel but indicated no plans to change its approach or to delay broad requirements for tightened clinical oversight of a broad range of outpatient services.

The American Hospital Association stated in a notice to member hospitals that “the number and variety of services that the HOP panel considers will directly depend on how many hospitals request to testify before the panel and the services they present for evaluation.” The CMS has noted the lack of hospital response led it to cut the Hospital Outpatient Payment Panel's next meeting in March to one day from two.

Any procedures not exempted by the panel will be subject to the tighter oversight requirements when a moratorium on the rules expires Dec. 31. Given that deadline, advocates are beginning to plan a new push for legislation that would block the regulations.

Sen. Jerry Moran (R-Kan.) introduced a bill in the last Congress that would have repealed the 2008 rules and established a process for the CMS to propose tighter oversight for individual procedures. But that legislation never moved out of committee.