William A. Hyman
Professor Emeritus, Biomedical Engineering
Texas A&M University, w-hyman@tamu.edu
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Back in April I commented on (mocked?) an 1832 page proposed CMS final rule with the zippy title “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices”. The final version of this rule was released on August 2, 2017 (for publication on August 14th) and it has grown to 2456 pages. I didn’t try to identify what had been added, or if anything had been taken away. Except I did note that the acronym 3M continues to be identified in the 12-page list of acronyms as “3M Health Information System”, and then is never mentioned again.
This was not the only recent proposed or final rule relevant to our interests. There was the mere 254 page proposed rule “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program” and the 436 page proposed rule “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the LongTerm Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices”. These were both mentioned in a HITECH /RCM Answers article of July 20th. A third extant proposed rule is “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs”, coming in at a brief 167 pages.
The 2456-page final rule addresses 9 parts of 42 CFR. The first proposed rule mentioned also affects one of these parts, and the last addresses the same two parts as the first. The other proposed rule affects 5 parts of 42 CFR, one of which overlaps with the referenced final rule. This reminds us that “final” is a weak adjective in regulation land in that any final rule can be subsequently changed, and possibly by a differently targeted rule with a different title.
I think it is fair to say that no provider can keep up with this blizzard of rules and requirements, making this another example of a consultant full employment measure and/or resulting in Medicare provider dropouts. There is also a telling juxtaposition with another HITECH /RCM Answers article of July 31st, “AMA Survey Finds Doctors Do Not Feel Prepared for Quality Reporting Rules”. Who could be prepared when presented with over 3000 pages of rules while also trying to treat patients and run a practice. And don’t forget in the same e-issue “Changes You May Need to Make for New Medicare Cards” arising from Medicare having discovered that using beneficiaries’ social security numbers as their Medicare ID is a bad practice that had been largely eliminated elsewhere years ago. (My university ID number and my driver’s license number being two personal examples. Even the clever disguise of my Medicare number having an ‘A’ appended to my social security number was finally recognized as insufficient.