image description

Former Congressman Dr. Phil Gingrey provides public policy and government relations counsel to clients on a variety of issues. Here at Phil on the Hill, Phil draws upon his long career in public service to provide perspective and context on policy topics such as health care, the federal budget, annual appropriations, regulatory reform, and life sciences.

CMS’s National Conversation and Call for Regulatory Reform

Monday, June 26, 2017

On April 14, the Centers for Medicare & Medicaid Services (CMS) posted a proposed rule that includes an RFI (that’s government for “Request for Information”). Behind this seemingly bland solicitation is an opening by CMS to promote a “national conversation” on ways to improve our national health system that are “less bureaucratic and complex.”

The window on that comment period closed on Tuesday, June 13. The good news is a similar call for input also was included in the proposed payment rules for Skilled Nursing Facilities (SNF) and Inpatient Rehabilitation Facilities (IRF). So if you have a better mousetrap or a complaint, time is of the essence to submit your ideas and proposals to CMS in time for the SNF and IRF deadline June 26.

This opportunity is sandwiched in a proposed rule that would update Medicare payment and polices for when patients can be admitted into hospitals. (search for “C: Request for Information on CMS Flexibilities and Efficiencies”)

It is the open-endedness of the RFI’s request that I find commendable. It signals a willingness to think anew and think big. CMS wants advice on “positive solutions to better achieve transparency, flexibility, program simplification and innovation” to “inform the discussion on future regulatory action related to inpatient and long-term hospitals.”

CMS says that it wants this national conversation to be about improving “the health care delivery system … and how we can reduce burden for clinicians, providers and patients in a way that increases quality of care and decreases costs — thereby making the health care system more effective, simple, and accessible while maintaining program integrity and preventing fraud.”

CMS is asking for your ideas on ways to accomplish these goals through regulatory, sub-regulatory, policy, practice and procedural changes. When you think about it, the areas open to discussion are almost limitless.

How could we redesign the Medicare payment system? Eliminate or streamline reporting? Improve monitoring and documentation requirements? Promote operational flexibility? Share data to enhance patient care? Bolster the doctor-patient relationship?

CMS is also asking for recommendations about ways it can simplify rules and policies for beneficiaries, clinicians, providers and suppliers.

In making your submissions, CMS says it wants you to give “clear and concise proposals” that are supported by data and examples. What ideas might we include in this public inbox for thoughtful suggestions?

Some might want to propose a CMS waiver allowing certified professionals, such as rehabilitation nurses, to have the same authority as physicians to order and create a plan for patients’ home care.

Others might suggest that the agency waive the requirement for patients to first have a three-day inpatient stay before qualifying for Medicare coverage of a stay in a SNF. With direct access to SNFs, this rule change might save some patients money and improve their outcomes.

I urge you to give CMS your best ideas on how to improve our nation’s delivery of health care to Medicare beneficiaries — and send them in before June 26.