CMS Finalizes Sweeping Changes Aimed at Reducing Regulatory Burdens

September 26, 2019

The Centers for Medicare & Medicaid Services (CMS) today announced a final rule to relieve burden on healthcare providers by “removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare providers and suppliers.” CMS estimates that these proposed changes will collectively save healthcare providers an estimated $843 million in the first year and slightly more in future years.

ASCA and its members have been working with CMS on these and similar burden reduction rules for many years, and ASCA commends CMS for its commitment to this effort.

Key provisions in the new rule, which becomes effective in 60 days, are as follows:

Transfer Agreements with Hospitals

ASCs will no longer be required to have a written transfer agreement or hospital admitting privileges for all physicians who practice in the ASC. Instead, ASCs will be required to periodically provide the local hospital with written notice of their operation and patient population served. For example, the notice would include details such as hours of operation and the procedures that are performed in the ASC. According to CMS, providing written notice, rather than securing a transfer agreement, will alleviate the administrative burden of negotiating or being denied negotiating opportunities associated with the written transfer agreement between the ASC and hospital.

Requirements for Comprehensive Medical History and Physical Assessment

CMS is finalizing its proposal to eliminate the requirement that each patient have a medical history and physical assessment (H&P) completed by a physician not more than 30 days before the scheduled surgery and replace it with the requirement for ASCs to develop and maintain a policy that identifies those patients who require a medical history and physical examination prior to surgery. The facility’s policy must include the timeframe for the H&P to be completed prior to surgery. The policy must also address, but not be limited to, the following factors: patient age, diagnosis, the type and number of procedures scheduled to be performed on the same surgery date, known comorbidities and the planned anesthesia level. Upon admission, each patient must have a pre-surgical assessment completed by a physician or other qualified practitioner, in accordance with applicable state health and safety laws, who will be performing the surgery. The operating physician would still have to document any pre-existing medical conditions and appropriate test results in the medical record, which would have to be considered before, during and after surgery. In addition, all pre-surgical assessments would still be required to include documentation regarding any allergies to drugs and biologicals. The H&P, if completed, would be placed in the patient’s medical record prior to the surgical procedure. The ASC policy also must be based on nationally recognized standards of practice and guidelines, and applicable state and local health and safety laws.

Emergency Preparedness

  • CMS will now require ASCs to review their Emergency Plan (EP) every two years instead of annually
  • ASCs will no longer be required to document efforts to contact local, tribal, regional, state and federal EP officials, although they will still need to try to coordinate with those entities
  • EP training will now be required every two years, or when the ASC’s EP is updated significantly, instead of every year
  • ASCs now need to conduct just one testing exercise per year, instead of two
    • Every other year, ASCs must either participate in a community-based full-scale exercise (if available) or conduct an individual facility-based functional exercise
    • In the opposite years, ASCs may conduct a testing exercise of their choice, which may include: a community-based full-scale exercise (if available), an individual facility-based functional exercise, a drill, or a tabletop exercise or workshop that includes a group discussion led by a facilitator
  • ASCs are exempt from the next required exercise after an event requiring activation of their EP plan (i.e., if the facility must deal with an emergency)

According to ASCA Chief Executive Officer Bill Prentice, “This rule will make it easier for ambulatory surgery centers to remain efficient and affordable providers of outpatient surgery without compromising their commitment to patient safety.”

It is important to note that if an ASC’s state law or accrediting body requirements are more restrictive than the new CMS Conditions for Coverage, those other requirements take precedence.