2003 National Health Policy Conference
Academy Health
Wednesday, January 22, 2003
J.W. Marriott
Washington, D.C.
David Bernd
I.
Introduction – Patients v. Paperwork
•
Charting the complexity
•
Burden increased by the process and the regulations themselves
II.
Overview
•
What the regulatory process should and shouldn’t do from the perspective
of providers.
•
Review Principles for Regulation, from Appendix E, “Hospital
Regulation: A New Blueprint for the Future,” of the Regulatory Reform
Task Force Report.
•
HIPAA – what HIPAA would have meant if regulations hadn’t been
modified? Dispel the myth that all hospitals think all regulations are bad.
III.
Accomplishments
•
Streamlining – special task force
•
Regulatory Reform – rethinking health care delivery system
(comprehensive health care policy) and reexamining the regulatory
framework.
IV.
What’s Needed
•
The broader discussion of the next steps to ease the regulatory burden on
health care providers.
•
What’s the way to do this?
V.
Conclusion
•
First, we need answer the bigger question: Is health care a competitive
commodity or is it a public good? This discussion needs to be part of the
broader dialogue regarding comprehensive health care reform.
•
Currently, health care is a hodge podge of services and facilities. Need to
create the incentive to change
Introduction
Good morning. Thank you, Uwe. It’s a pleasure to be with you all
today.
As you’re aware, the regulations that govern hospitals, clinics,
physicians and other medical facilities are:
voluminous,
complex and
sometimes not in the best interests of the people to whom we’re
ultimately responsible –
the patient.
Often, this regulatory burden is increased by the process itself – it
seems to feed on itself and create more regulations which then govern
other regulations –
almost a “vicious cycle” that needs to be broken.
Regulatory reform is a top priority for the AHA because our members
have become increasingly affected by over-regulation.
National Health Policy Conference, Jan. 22, 2003
Page 1
Every day hospitals must navigate thousands and thousands of pages
of rules that govern the Medicare and Medicaid programs.
In fact, Medicare and Medicaid rules and instructions cover more than
130,000 pages. That’s THREE times the size of the Internal Revenue
Code and its federal tax regulations.
National Health Policy Conference, Jan. 22, 2003
Page 2
Too often, the fundamental concepts of fairness, due process,
equal protection, and notice and comment are lost in a maze of
confusing rules, program memoranda and manuals.
I want to take a few minutes this morning to:
•
highlight the problem,
•
discuss what the regulatory process should and shouldn’t do from
the perspective of providers,
•
review accomplishments to date, and
•
propose additional reform solutions.
Patients versus Paperwork
Like a great many of my hospital administrator colleagues, I’m
concerned about the amount of time spent on paperwork.
I’m concerned about the impact this can have on patient care.
And I’m concerned about how we can remedy the situation.
In 2001, the AHA Board of Trustees formed the Task Force on
Regulatory Relief and Reform to examine this problem and possibly
propose solutions. I want to share with you the results of a study we
commissioned to determine how the regulatory requirements affect
patient care.
What’s the ratio of time spent on paperwork versus hands-on, direct
contact with patients?
National Health Policy Conference, Jan. 22, 2003
Page 3
What’s the human face of these pages and pages of regulations?
We wanted to find out.
So, in April 2001, we commissioned PricewaterhouseCoopers to
perform a regulatory burden study. Nineteen hospitals participated in
the study.
The resulting report, Patients or Paperwork? The Regulatory Burden
Facing America’s Hospitals, really highlighted the critical problem
that caregivers face on a daily basis in trying to adequately juggle the
demands of paperwork with the reason for their job – caring for
patients.
The study provided a brief overview of the regulatory burden hospitals
face, a listing and summary of the ALL the new or revised regulations
with which hospitals have had to comply since 1997, and an analysis
of the share of hospital workers time spent on paperwork.
Here are some highlights of the study – which, by the way, has since
been quoted from extensively by members of Congress and even by
Secretary Thompson:
•
The study followed a typical Medicare patient admission through
the maze of regulations with which a hospital must comply in
treating patients, from the first encounter in the emergency
department to admission and post-acute care.
National Health Policy Conference, Jan. 22, 2003
Page 4
•
This report found that physicians, nurses and other hospital staff,
on average, SPEND AT LEAST 30 MINUTES ON
PAPERWORK FOR EVERY HOUR OF PATIENT CARE
provided to a typical Medicare patient.
•
In the emergency department, EVERY HOUR OF PATIENT
CARE GENERATES AN HOUR OF PAPERWORK.
What Regulations Should and Shouldn’t Do
Let me be clear: Regulation is not inherently bad. In fact, I think most
of my colleagues would agree with me that we need regulation. It is
essential to building public trust and confidence in the health care
system.
BUT – unnecessary or poorly targeted or implemented regulations
frustrate health care providers and the patients they serve. These same
regulations can even interfere with appropriate care delivery.
So what should regulations really do?
One – the need to regulate should be clear and well
documented.
Two – the underlying regulation should be clear and
unambiguous. It should be used to :
- Protect patients from harm
- Inform the public about their care
- Prevent fraud or abuse
National Health Policy Conference, Jan. 22, 2003
Page 5
- Assure minimum standards are met, and
- Control costs
National Health Policy Conference, Jan. 22, 2003
Page 6
Three – each regulation should be cost-effective. It should:
- Be linked to specific objectives and regularly be
assessed as to whether it achieves its objectives
- Be based on sound scientific, technical,
economic and other relevant information
- Reflect an understanding of how the regulated
entity operates and the consequences of the
proposed action
- Minimize the cost of compliance assessment for
both the regulated and the regulators
- Be simple and easy to understand
- Be scalable to the size and complexity of each
provider regulated, and
National Health Policy Conference, Jan. 22, 2003
Page 7
- Integrate and/or coordinate its requirements
with those of other regulations
Four – regulations should establish a safe haven for innovation
and encourage the pursuit of excellence through best practices
National Health Policy Conference, Jan. 22, 2003
Page 8
Five – regulations should be applied prospectively and should
not:
- Disrupt patient care activities
- Incur unnecessary costs
- Overwhelm administrative functions and
information systems
National Health Policy Conference, Jan. 22, 2003
Page 9
HIPAA – The Common Sense Approach
We saw a perfect example of what regulations SHOULDN’T do in the
originally proposed HIPAA privacy regulations. When these proposed
regulations were issued, a lot of red flags immediately went up in
hospitals around the country. Imagine the scene:
National Health Policy Conference, Jan. 22, 2003
Page 10
Distraught parents arrive at the emergency department with
their injured son or daughter. But before their child can receive
care, the parent must read and sign a 10-page privacy notice.
And this notice must be read and signed again and again and
again – on each visit to the doctor, hospital or pharmacy prior
to receiving care or medication.
Again, hospitals are not against regulations – we’re against regulations
that put paperwork above patient care.
We worked with the HHS and the Secretary’s office, and submitted
comments, proposed changes, and a host of other documents. The
result is that the final HIPAA privacy regulation retains strong
protections for patients’ medical privacy rights while eliminating some
major barriers to timely and effective care.
Accomplishments – Streamlining and Regulatory Reform
In addition to working on the HIPAA privacy regs – and other issues –
we’ve also been working with Secretary Thompson’s Regulatory
Reform Task Force, and have succeeded in easing the burden for
caregivers on several fronts:
- HHS has signaled its intent to ease hospitals’ regulatory
burdens by eliminating the minimum data set requirement,
National Health Policy Conference, Jan. 22, 2003
Page 11
a patient assessment tool used in critical access swing bed
hospitals,
- They’re streamlining the paperwork requirements for noncritical swing bed hospitals, and
- They’re reducing the size and scope of the Medicare cost
report.
The results – less time spent on paperwork and more time spent on
direct patient care.
In November, the HHS Regulatory Reform Task Force issued its
report and recommendations, with several that would help ease this
burden for hospitals. I won’t go into all of the 255 recommendations
here.
National Health Policy Conference, Jan. 22, 2003
Page 12
But, many of the recommendations would ease the burden for
hospitals and health care givers when dealing with EMTALA, OASIS,
the minimum data set and HIPAA.
The intent – common sense regulations that will MAKE sense for
providers and patients alike.
Where Do We Go From Here
Now, here’s the million dollar question – where do we go from here?
•
We need to keep exploring. Efforts today to build a greater
consensus in the way that hospitals – and health care – are
regulated will help to develop a more unified health care policy in
America for the future.
•
We need to answer the question “Is health care a commodity or a
public good?” This question underlies the direction for the future
of health care in America.
•
We need to realize that no one model of hospital regulation will
suffice.
•
And we need to carefully monitor and manage regulatory change
to ensure that quality of care is not compromised.
Conclusion
We as a nation are on the brink of re-thinking and re-forming or recreating our health care system. Finding ways to ease the regulatory
burden …
National Health Policy Conference, Jan. 22, 2003
Page 13
National Health Policy Conference, Jan. 22, 2003
Page 14
and even finding solutions to some of our country’s other health care
crises, such as providing care for the millions of uninsured …
requires the cooperation of all the players – hospitals, physicians, the
government.
It will take a collaborative and cooperative effort among all of us to
examine the problem, analyze the consequences and develop the
framework to provide health care for our friends, our neighbors,
National Health Policy Conference, Jan. 22, 2003
Page 15
our families – the patients that our hospitals serve.
We cannot escape regulations and compliance – these are a necessary
part of health care.
But, what we can do is ensure that patient care takes precedence over
paperwork.
Thank you.
National Health Policy Conference, Jan. 22, 2003
Page 16