The other healthcare measure expected to advance through Congress this year is one combining some of the 66 opioid bills moving through Congress.

May 8—Although many healthcare issues are calling for congressional action this year, the run-up to the mid-term elections likely will limit legislative advancements to a regulatory relief package, according to a congressional health leader.

Rep. Peter Roskum (R-Ill.), chairman for the House Ways and Means Subcommittee on Health, cites the months-long effort by his chamber to seek ideas from providers about redundant or unnecessary statutes and regulations that could be reduced. He says the U.S. Department of Health and Human Services (HHS) has made progress this year in cutting regulatory burdens, but some changes would require statutory changes.

So far, a House GOP initiative to cut healthcare rules, called the Medicare Red Tape Relief Project, has drawn more than 500 comments from providers, Roskum said this week during the American Hospital Association (AHA) annual membership meeting in Washington, D.C.

The extent of the need for congressional action was highlighted in a 2017 AHA study, which found legislative and regulatory requirements require Medicare providers to spend nearly $39 billion a year on compliance.

“An overall reduction in regulatory burden would enable providers to focus on patients, not paperwork, and reinvest resources in innovative approaches to improve care, improve health, and reduce costs,” the AHA says in a letter to the Ways and Means Subcommittee suggesting steps for Congress to address the issue.

Providers also have identified regulatory and statutory barriers that are complicating their efforts to move from fee-for-service payment to value-based payment.

For instance, HFMA has urged Congress to modify existing Medicare fraud and abuse statutes to create safe harbors from laws such as the Stark Law against physician referrals, for healthcare entities caring for Medicare beneficiaries in alternative payment models administered by the Centers for Medicare & Medicaid Services (CMS), such as the Medicare Shared Savings Program and the Comprehensive Care for Joint Replacement program.

“CMS’s continued application of fee-for-service (FFS) regulatory barriers within payment reform models often hinders providers’ ability to identify and place beneficiaries in the most clinically appropriate setting,” HFMA writes in its letter to Congress.

Many of the provider ideas will be included in legislation that Roskum expects to be the only healthcare-related measure to pass the House before the November elections. It also is expected to mark a departure from acrimonious partisan battles over the future of the Affordable Care Act (ACA).

“This red-tape relief effort is an effort to flip the debate; to not ask members of Congress, ‘What’s your opinion about the [ACA]?’ and instead pose a different question: How can we offer relief to healthcare providers on regulations that have no value, whatsoever?” Roskum said.

Roskum said his panel is organizing provider suggestions to the Medicare Red Tape Relief Project between those that can be done administratively and those that require statutory changes.

As part of CMS’s increasing number of initiatives to reduce regulatory burdens, the agency’s recently issued inpatient prospective payment system (IPPS) proposed rule would remove 18 measures and end duplication of another 21 measures for acute care hospitals. Similarly, the Health Resources and Services Administration recently announced a request for comments it will accept through July 2 on how it could streamline its compliance and reporting requirements for certain programs and grant recipients.

Leslie V. Norwalk, former acting administrator of CMS under President George W. Bush, agreed that many regulatory rules are blocking providers from shifting to value-based payments and urged hospital leaders to identify specific barriers for the Trump administration.

“There’s a lot of opportunity for improvement,” Norwalk told the AHA attendees.

Among the rule changes that may require congressional action are facility code requirements unique to CMS, Roskum told the hospital leaders, citing reports he had received.

“Some of these regulations are obtuse; they’re cumulative; they’re foolish,” Roskum said. “They have no relationship to patient health.”

Roskum said the planned “consensus” regulatory overhaul bill aims to address whether existing rules improve patient care and strike the right balance between improving safety and imposing unnecessary burdens.

Another step the legislation should address, according to Gail Wilensky, PhD, who previously led Medicare, is reducing the number of statutorily required metrics that providers must meet in quality performance programs.

“That really needs to happen quickly, because it is mind-boggling the burdens that we can put just on performance metrics,” Wilensky told the AHA group

Nancy-Ann Deparle, another former acting administrator of the predecessor agency to CMS, also told the group she backs the Trump administration’s regulatory-reduction effort for providers.

Another area that needs to be legislatively addressed, Marilyn Tavenner, CMS administrator under President Obama, told the gathering, is modernization of rules around the use of durable medical equipment. However, Tavenner sounded a note of caution that a deregulatory push may generate a backlash—such as she experienced when she advocated reduced rules for nursing homes—from some who worried the effort could undermine patient safety.

“You’re moving someone’s cheese when you’re moving these regulations around,” Tavenner said.

Roskum said he expected that regulatory relief bill to clear Congress by its August recess.

“In election years on Capitol Hill, the traffic really tends to slow after Labor Day,” Roskum said.

Opioid Legislation

Congress also is advancing a swarm of legislation to address the opioid epidemic. But addressing that problem likely will take years.

“I’m out of the 'we’re going to pass the opioid Fix It One Time Act of 2018' and think that this is done,” Roskum said.

Legislation is needed to address a range of factors influencing the spread of opioid abuse, he said, including government policies that he believes are responsible for the problem. For example, government contributors to the problem included naming pain as the fifth vital sign and including pain in evaluations. Other factors that need to be addressed include payer and provider actions and a “cultural attitude” about pain, Roskum said.

He said he is hopeful that opioid bills will get through Congress by its August recess.

Tavenner, however, raised  doubts that the 66 opioid bills at different stages of the legislative process would produce a “logical” response to the crisis.

Future Directions

The Trump administration also is preparing imminently to announce an initiative aimed at reducing drug prices.

Although it is not clear what that initiative will include, Norwalk said the administration may consider withdrawing the drug discount safe-harbor rule, which allows drugmakers to pay rebates to pharmacy benefit managers or Part D drug plans.

The administration also may target the 6 percent provider add-on payment for drugs administered under the Part B program, Norwalk said.

Roskum noted the context in which the administration and congressional Republicans are undertaking efforts to improve the healthcare system. The future of U.S. health care either is going to be single payer or will move into a “patient-oriented healthcare delivery system,” he said. Roskum urged hospitals to drive the debate on that toward a better healthcare system.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Tuesday, May 08, 2018