The Centers for Medicare and Medicare Services (“CMS”) published two final rules intended to reduce provider burdens and improve hospital discharge planning. The rules combine multiple proposals from 2015 through 2018.
According to CMS, the burden reduction rule will save providers an estimated 4.4 million hours previously spent on paperwork, and will result in an annual projected savings to providers of $800 million. The burden reduction rule finalizes three distinct proposed rules – an omnibus burden reduction rule, changes to hospital and critical access hospital (“CAH”) programs, and a rule directed to fire safety requirements at dialysis facilities. The burden reduction rule includes a number of provisions directed to emergency preparedness programs, hospital quality and performance improvement programs, hospital and CAH swing-bed provider staffing and reporting requirements, ambulatory surgical center (“ASC”) transfer agreements and patient care practices, as well as provisions directed to transplant centers, hospices, home health agencies, outpatient rehabilitation centers, community mental health centers, portable x-ray services, and religious nonmedical health care institutions.
The burden reduction rule also contains provisions intended to modernize hospital and CAH requirements to improve quality of care and support CMS priorities, including changes to allow flexibility in the quality reporting and quality performance programs, clarifying nursing services requirements, updating infection prevention and control programs, and requiring hospitals to establish and maintain antibiotic stewardship programs. Finally, the burden reduction rule updates fire safety requirements for certain higher-risk dialysis facilities.
Turning to the second final rule, the discharge planning rule is directed to decision-making during the transition from acute care to post-acute care. The rule implements provisions from the Improving Medicare Post-Acute Care Transformation (“IMPACT”) Act of 2014 that requires facilities to “account for and document a patient’s goals of care and treatment preferences.” It includes provisions that require the interoperability and transmission of patient information between healthcare settings, and changes to compliance language for home health agencies requiring that they ensure the safe and effective transition of care to receiving facilities or healthcare practitioners. Finally, the rule also contains provisions directed to hospital patients’ rights and requirements regarding a patient’s access to their medical records, including that medical records must be provided “in the form and format requested by the patient.”
Commenting on the burden reduction rule, CMS noted that the rule was implemented in response to the Patients Over Paperwork initiative, and added that the rule “brings a common-sense approach to reducing regulations and gives providers more time to care for their patients, while reducing administrative costs and improving health outcomes.” Regarding the discharge planning rule, CMS echoed this focus on patients, saying that it “empowers patients” and that it provides patients “with the ability to make healthcare decisions that are right for them, and gives them transparency into what used to be an opaque and confusing process.” Both rules are scheduled to take effect on November 29, 2019.