Budget committee zeroes in on Medicare regulatory burden
Budget committee zeroes in on Medicare regulatory burden
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON The House Budget Committee heard from healthcare providers last week about the massive regulatory burden the Medicare program is now placing on providers and the limits that burden is placing on their ability to provide quality care.
The May 18 hearing was part of the committee’s comprehensive effort to improve the oversight of government agencies. But the National Association for Home Care’s (NAHC; Washington) Deputy Director of Government Affairs Yvonne Santa Anna said the hearing marked a welcome about face from the task force’s primary task of rooting out waste, fraud, abuse, and mismanagement in federal programs.
"Now they are looking at the complexity of different federal agencies and the burden that is placing on health care providers," said Santa Anna. She said that is a much-needed development given the voluminous regulations pouring out of the Health Care Financing Administration (HCFA; Baltimore) in recent months.
"The increase in everything they are asking home care providers to do is incredible," said Santa Anna, a former home health administrator and home care nurse. "Providers are basically subsidizing Medicare by performing all these tasks that are no longer reimbursed."
U.S. Rep. Saxby Chambliss (R-GA), who chairs the Health Care Task Force, said that while the task force’s primary focus is still targeted on waste within federal programs, it is equally important that Medicare does not "penalize honest providers struggling to comply with and meet the frustrating bureaucratic maze of federal healthcare regulations."
Saxby acknowledged that the government lacks any comprehensive estimate of what that cost actually amounts to. He noted that the Balanced Budget Refinement Act required the Medicare Payment Advisory Committee (MedPAC) to study this issue, but that report is not due out until December 2001.
Even though most of the evidence about the full scope of this burden is anecdotal, Saxby pointed out that healthcare providers must comply with almost 111,000 pages of Medicare regulations and supporting documents.
The American Federation of Home Care Providers’ (AFHP; Washington) Ann Howard says the regulatory burden on home care providers has never been more punishing. "There are all kinds of initiatives coming out of HCFA," said Howard. "Never have I had so many things that I have had to work on simultaneously."
Howard noted that within the next four weeks alone comments are due to HCFA and the Office of Management and Budget (Washington) on four different regulations: 1) Proposed revisions to the state survey process and interpretive guidelines for OASIS (May 19); 2) Home Health Agency Advance Beneficiary Notices (May 24); 3) Provider enrollment forms (June 10); and 4) Hospital notice to patients, Important Message About Medicare Rights: Admission, Discharge, & Appeals (June 19).
In testimony submitted to the task force, NAHC contended that "more and more new and costly demands associated with Medicare regulations are increasing agencies’ financial and operational burdens and are straining agencies’ ability to deliver quality care to their patients."
NAHC argued that the cumulative effect of these regulations along with those imposed by other government agencies has been devastating and has siphoned "scarce resources" away from patient care. Worse yet, NAHC said, many of these regulations have been developed without adherence to regulatory procedural requirements.
For example, NAHC said HCFA has seriously underestimated the costs associated with the Outcome and Assessment Information set (OASIS) in terms of initial start-up costs, data collection, and transmission, as well as the willingness of third-party payers to share in the burden of implementing this new requirement.
"Home care providers have reported that it costs them from one to three dollars per visit to comply with the requirement, whereas HCFA has allowed only three cents per visit by way of reimbursement," NAHC said. Last year, Congress tacked on a $10-per-patient payment to offset that cost, but the association said the major portion of OASIS costs is still borne by agencies.
NAHC said home health agencies should be reimbursed the full cost associated with meeting OASIS requirements. It told the task force that if HCFA lacks the authority to adjust the per-beneficiary limit to reflect these costs, Congress should grant it that power and also ensure that rates of payment under the prospective payment system reflect these costs.
Likewise, NAHC said HCFA’s 15-minute incremental billing requirement established a system for which providers are expected to discount time spent on non-treatment related interruptions during visits. Since neither HCFA nor Congress has even indicated how this information is going to be used, NAHC said, Congress should revisit the requirement.
Finally, NAHC pointed out that burdensome regulatory initiatives are only part of the challenge confronting home health agencies, which are now facing the transition to PPS and revised Medicare conditions of participation (CoP) on October 1. The PPS requires agencies to modify and replace computer hardware and software, and make other changes to meet new billing, accounting, and claims processing changes under the new system, while the new CoPs will require further operation changes, including new quality assurance systems, said NAHC.
The unprecedented cost of implementing the changes required by these dual challenges are not reflected in current payment limits or taken into account under the proposed rates under PPS, the association added.
AFHP’s Howard said that all of this does not even begin to account for the privacy regulations and other requirements included in the Health Insurance Portability and Accountability Act.
A spokesperson for the task force said the next step will be to hear from HCFA officials and other government agencies before drawing up any recommendations.
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