New Rule to Ease Admin Burden, Save Clinicians Money: CMS

Kerry Dooley Young

September 26, 2019

Federal officials have decided on more than two dozen changes in administrative policies used in the delivery of medical care, including those regarding progress notes for psychiatric patients, orders for portable X-ray orders, and hospitals' approaches to infection control.

The Centers for Medicare & Medicaid Services (CMS) is using its bureaucratic heft to drive changes in administrative policies. CMS dictates the conditions of participation in the two giant healthcare programs.

With control of more than $1 trillion in annual combined Medicare and Medicaid spending, CMS has great clout over administrative policies used in hospitals and other medical settings across the nation.

Released online Wednesday, CMS' Omnibus Burden Reduction (Conditions of Participation) Final Rule includes several measures that "create measurable monetary savings for providers and suppliers," while others are intended more to reduce bureaucracy without generating major savings, the agency said.

"In my trips across the country, I've heard time and again that unnecessary regulations are increasing costs on providers and they are losing time with patients as a result," said CMS Administrator Seema Verma in a statement.

CMS said the rule annually will free up an estimated 4.4 million hours of time previously spent on paperwork. The agency also expects annual savings throughout the healthcare system pegged at an initial rate of about $843 million.

Among the changes likely to directly affect clinicians is a revision of rules on portable x-rays. The new rule will allow for portable x-ray services to be ordered in writing, by telephone, or by electronic methods, streamlining the ordering process. CMS estimated $28 million in initial annual savings from this change.

A large chunk of the estimated initial annual savings — $154 million — stems from changes in special requirements for psychiatric hospitals, CMS said in the final rule

The agency describes this as giving authority to "non-physician practitioners, including physician assistants, nurse practitioners, psychologists, and clinical nurse specialists," to record progress notes of psychiatric patients for whom they are responsible.

Another large portion of the estimated initial annual savings — $115 million — is attributed to a new approach to hospitals' infection control programs. The final rule will allow multi-hospital systems to have a more unified and integrated approach to this work, CMS said.

The new CMS rule also removes a requirement that hospital staff attempt to secure autopsies in all cases of unusual deaths and of medical–legal and educational interest. In addition, the omnibus rule eases requirements for hospitals and ambulatory surgical centers regarding medical histories, and eliminates certain requirements for data submission in organ transplant. CMS said the change will increase the number of organs that are available for transplantation.

The omnibus rule is part of CMS's Patients over Paperwork initiative, for which the agency plans to create an office specifically devoted to reducing administrative burden on clinicians, Verma said today on a call with reporters. The rule is not a "one and done" effort by CMS, but instead represents a continuing effort within the agency to reduce administrative burden, she said.

CMS said it has already held 102 listening sessions in 46 states and two US territories to learn more about the unnecessary hurdles clinicians face.

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