Wednesday, October 19, 2011

CMS releases proposed Hospital CoPs

Below are the proposed rules published by the Centers for Medicare and Medicaid Services’ (CMS’) in line with their commitment to the general principles of the President’s Executive Order 13563, released January 18, 2011, entitled “Improving Regulation and Regulatory Review.” In these proposed rule CMS seeks to reduce the regulatory burden placed on hospitals by identifying a number of existing hospital CoPs that they believe could be reformed, simplified, or eliminated in order to reduce unnecessary burden and costs placed on hospitals and critical access hospitals (CAHs) under existing regulations. These revisions are open for comment. Please see the first few pages of the document which lists authorized means to submit comment and the deadline to do so.

Some points of interest are:

Governing Body
Revise and clarify the governing body requirement to reflect current hospital organizational structure whereby multi-hospital systems have integrated their governing body functions to oversee care in a more efficient and effective manner. Specifically, CMS proposes to revise §482.12 to state that “There must be an effective governing body that is legally responsible for the conduct of the hospital.”

Medical Staff Organization
Proposing changes to the more direct responsibilities for the organization and accountability of the medical staff. Presently, the hospital may assign these management tasks to either an individual doctor of medicine or osteopathy or, when permitted by State law of the State in which the hospital is located, a doctor of dental surgery or dental medicine. CMS proposes to expand the list to include doctors of podiatric medicine (DPMs). This change would permit a podiatric physician to serve as the president, or its equivalent, of a
hospital’s medical staff in a significant number of states.

CMS is seeking comments on whether their language is clear on the single organized medical staff as it currently allows for a multihospital system to have the option of a single organized medical staff responsible for the quality of medical care provided to patients by all of the hospitals in the system, however does not state it in those words. However, CMS is not sure if this is clear to stakeholders and welcomes comment.

Allied Health Professionals:
Propose to revise language to clarify that a hospital may grant privileges to both physicians and non-physicians to practice within their State scope of practice, regardless of whether they are also appointed to the hospital’s medical staff. That is, technical membership in a hospital’s medical staff would not be a prerequisite for a hospital’s governing body to grant practice privileges to practitioners.

Changes and clarifications regarding medical staff and privileging would allow hospitals to substitute and rearrange actual delivery of care. In particular, use of Advanced Practice Nurse Practitioners (APRNs) and Physician Assistants (PAs) in lieu of higher-paid physicians could provide immediate savings to hospitals. CMS welcomes comments on their saving assumptions which are outlined in the full text.

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