HAP Blog

The Federal Government Wants to Reduce Health Care Red Tape? Here’s Pennsylvania Hospitals’ Wish List!

September 13, 2017

Our federal government says it wants to reduce the unnecessary red tape that is holding back American innovation and driving up the costs of goods and services—including those related to health care.

On behalf of Pennsylvania hospitals and health systems, I am pleased to say that we want to help with that.

Our wish list for modernizing, simplifying—and where possible, reducing—health care rules, regulations, and administrative requirements is a bit long and pretty technical. You can cut right to the chase and review a summary of our main requests here.

PA Hospitals’ Red Tape Reduction Wish List

The list may seem “in the weeds,” but the reasons driving our desire to see these changes are pretty easy to understand. We want to improve the quality of health care services while holding the line on what Pennsylvanians spend for them by:

  1. Reducing unnecessary administrative requirements, allowing hospitals and health systems to focus on providing health care—not filling out paperwork
  2. Modernizing the outdated rules and regulations that prevent hospitals and health systems from providing the right care in the right setting at the right time—and with the right care team
  3. Streamlining ever-increasing, and often redundant, quality reporting requirements and using this quality information effectively and fairly to reward hospitals and health systems for good results

I have to believe that the rationale behind reason #1 is pretty easy to grasp. I think we’ve all experienced some degree of frustration with the complexity of health care, whether we’re on the phone with our insurance company or filling out forms in a doctor’s office.

All we want to do is get help for what ails us!

Reasons #2 and #3 may require some more background.

Right Care, Right Place, Right Time—Right Care Team

Pennsylvania hospitals and health systems believe that providing the right care in the right place at the right time is an absolutely crucial step toward maintaining the enviable quality and innovation of American health care while tamping down the growth in what the nation (and our state) spend per capita on that care.

We want to provide high-quality care for our patients and communities in effective and resource-efficient health care settings. We want those settings staffed with effective and resource-efficient teams of doctors, nurses, and other clinicians and caregivers.

Right now, many federal laws and regulations keep us from doing that. Chief among them are:

  • The Anti-Kickback Statue and the Stark Law preventing hospitals, physicians, and others from collaborating to keep patients healthier and reduce health care spending
  • Medicare telehealth payment policies that restrict the innovative use of technology to connect doctors and patients wherever they are 
  • Several Medicare regulations that make it time-consuming and, in some cases, unsustainable for hospitals and health systems to help patients get high-quality care in less resource-intensive settings such doctor’s offices and outpatient clinics

The Right Quality Reporting, Used Effectively and Fairly to Reward Good Results

Monitoring and reporting on health care quality is supposed to help hospitals and health systems improve their services. What’s more, hospitals are increasingly rewarded (or penalized) based on that quality reporting.

Unfortunately, you can have too much of a good thing. As I said in this blog last summer, the amount of different quality-related data points that hospitals are asked to measure and report on  Reminds me of the I Love Lucy episode in which Lucy and Ethel are overwhelmed by the chocolates on the speeding conveyer belt.

Pennsylvania hospitals support the work of the Core Quality Measures Collaborative led by the America’s Health Insurance Plans, the Centers for Medicare & Medicaid Services (CMS), and the National Quality Forum. This group of consumers, employers, insurers, providers, and government experts  has teamed up to make sure we’re paying attention to the right stuff (instead what often feels like way too much stuff).

Meanwhile, Pennsylvania hospitals and health systems have these short-term suggestions for improving the way CMS uses quality data:

  • Adjust the appropriate Medicare quality ratings and hospital payments to take into account socioeconomic challenges that can compromise patients’ health and health care
  • Change the Medicare formula used to reward high-quality hospital care so that small, rural hospitals are not penalized for achieving extremely low infection rates

Where Does the PA Wish List Go from Here?

Pennsylvania hospitals and health systems have submitted our detailed requests and suggestions in this letter to the “Medicare Red Tape Relief Project” (also known as the Provider Statutory and Regulatory Relief Initiative) begun by the Ways and Means Committee in the U.S. House.

In our opinion, the committee is wise to undertake this work. 

Any enterprise as dynamic and science-driven as health care is bound to improve and evolve. When rules and regulations that made perfect sense for how things used to be outlive their purpose, we need to change them.

Pennsylvania hospitals and health systems crafted our wish list  to support and help shape these changes.

We are determined to play our part in transforming health care. As a state and a nation, we simply must address consumer demands for better health and excellent care while easing the strain on household and government budgets.

We are determined to play our part in transforming health care. As a state and nation, we simply must address consumer demands for better health and excellent care while easing the strain on household and government budgets.

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