The American Hospital Association (AHA) recently sent an open letter to the House Ways and Means Health Subcommittee, in which they suggested several steps that Congress can take to immediately reduce the regulatory burden on hospitals and health systems.
In the letter, the AHA states the regulatory burden on hospitals and health systems is “substantial and unsustainable”. They claim that further increases regulatory activity introduced in recent years is bringing the situation to a breaking point for the hospital system in the United States.
One example which the AHA cites refers to the Centers for Medicare & Medicaid Services. In 2016, the Center announced 49 rules related to hospitals and health systems. The document which contained the rules was nearly 2,400 pages long; a huge administrative task for hospitals to implement. Due to the complexity of the regulations, there has been an increase in sub-regulatory guidance such as FAQs and blogs to help hospitals and health systems understand how to implement administrative policies.
In the letter, the AHA points out that “In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them.”
The AHA has suggested several ways in which Congress can act to immediately reduce the regulatory burden on hospitals, health systems and their patients. The AHA included suggestions of improvements to many areas of the healthcare system, including two suggestions relating to the Health Insurance Portability and Accountability Act (HIPAA). In the letter, AHA claims that these negatively affect patient care.
Currently there are barriers that prevent beneficial sharing of patient health data. For example, HIPAA Regulations restrict the sharing of patient data for healthcare operations, including the use of data for quality assessment and improvement activities. The restrictions also apply to outcomes evaluation, activities related to evaluations of provider competence and performance, and to information about patients that has been disclosed to or received by providers that have or have previously had a patient relationship. However, in an integrated health setting is, the AHA points out that patients often do not have a relationship with all the healthcare providers with whom information must be coordinated.
The AHA says “A clinically integrated setting and each of its participating providers must focus on and be accountable for all patients. Moreover, achieving the meaningful quality and efficiency improvements that a clinically integrated setting promises requires that all participating providers be able to share and conduct population-based data analyses.”
The organisation suggests that HIPAA should allow all patients’ medical information to be disclosed to and used by all participant providers in an integrated care setting. Furthermore, that it should not be necessary for a patient to have a direct relationship with all those organizations that technically use and have access to the data.
The AHA also suggests that all treating providers should be allowed access to patients’ substance use disorder treatment records. Under current rules, patients must provide consent before treating providers can access those records, which is an obstacle to integrated patient care. Further, in certain situations, not having access to that information can endanger patients’ health.
The AHA suggests Overdose Prevention and Patient Safety Act (H.R. 3545) reforms should be enacted and “fully align requirements for sharing patients’ substance use disorder treatment records with HIPAA regulations that allow the use and disclosure of patient information for treatment, payment and healthcare operations.”
These reforms to legislation would ensure that all providers and organizations that have a direct treatment relationship with a patient have access to that individual’s complete medical record, including their history of treatment for substance use disorder.
In the letter, AHA also suggested Congress cancel Stage 3 Meaningful Use requirements. They claim this considerably increases the regulatory burden on hospitals and health systems, yet those requirements have no clear benefit to patient care.