CMS Proposes Cuts in Hospital, Surgical Center Regulations

CMS said Monday that it is proposing to reduce regulations on hospitals and ambulatory surgery centers (ASCs) in a move it estimates will save $1.12 billion annually as part of its “Patients Over Paperwork” initiative.

Under the proposed changes, ASCs would no longer have to have a written transfer agreement with a hospital that meets certain Medicare requirements or ensure that all physicians performing surgery in the ASC have admitting privileges in a hospital that meets certain Medicare requirements.

CMS said that requirement “is now duplicative of other regulatory requirements and has been rendered obsolete by other patient protections.”

It also would end current requirements that each patient have a complete comprehensive medical history and physical assessment not more than 30 days before the date of the scheduled surgery and give more discretion to the provider about when and if one has to take place. However, each ASC would have to establish and implement a policy that identifies patients who require such an assessment before surgery.

CMS said that total savings, when combined with other rules finalized previously, are estimated at $5.2 billion.

ASCs have been the focus of a recent investigation by Kaiser Heath News and USA Today, which found that they operate under a patchwork of rules across the United States, raising questions about patient safety.

“With this proposed rule, CMS takes a major step forward in its efforts to modernize the Medicare program by removing regulations that are outdated and burdensome,” said CMS Administrator Seema Verma in a statement. “The changes we’re proposing will dramatically reduce the amount of time and resources that healthcare facilities have to spend on CMS-mandated compliance activities that do not improve the quality of care, so that hospitals and healthcare professionals can focus on their primary mission: treating patients.”

Another proposal has to do with transplant centers. A rule change would eliminate a duplicative requirement on transplant programs to submit data and other information more than once for “reapproval” by Medicare. Reapproval has led to transplant programs avoiding performing transplants for certain patients, causing some organs to go unused, CMS said.

Hospitals would see changes as well. Under the proposal:

• Multihospital systems could have unified and integrated Quality Assessment and Performance Improvement and unified infection control programs for all of its member hospitals.
• Hospitals would have discretion on when an autopsy is indicated in certain instances; CMS said it will defer to state requirements.
• Hospitals could move away from the standard requirement of having a patient undergo an assessment not more than 30 days for when a presurgery/preprocedure assessment must be conducted.