HEALTHY VISION 2020 I STATE AND FEDERAL REGULATIONS SECTION 4
Repeal Harmful and Onerous State and Federal Regulations
After “health,” the most frequently used word in the Patient Protection and Affordable Care Act (PPACA) is neither “patient” nor “physician” nor “hospital” nor “insurance.” “Secretary,” as in
“the secretary of health and human services,” is mentioned more than 2,500 times in the 2,300- page bill. And more than 700 times, the PPACA says “the secretary shall.”50
Each of these directives
is a sign of new regulations to come on physicians and health care. Unfortunately, the PPACA was not the genesis of physician regulation, nor are these busy rulemakers limited to the federal government.
“An extensive regulatory framework … arose haphazardly, with little consideration of how the pieces fit together,” the Federal Trade Commission and U.S. Department of Justice reported in 2004.51 The huge numbers of state and federal regulations and their haphazard nature place tremendous burdens on physicians’ practices, most of which are still small businesses. These rules insert themselves between physicians and their patients, frequently do little to improve patient care, and divert physicians’ time and energy away from the patients in the exam room. We need to repeal, reorganize, and reprioritize if we want a functional health care delivery system.
Even the federal government realized the folly of imposing this kind of burden on a profession that is struggling under the weight of thousands of pages of regulations, plus many more pages of manuals, guidance, and interpretive information.53 The General Accounting Office took the Center for Medicare & Medicaid Services (CMS) to task for confusing inconsistencies between its incentive and penalty programs for physicians’ use of electronic prescribing and electronic health records.54
The secretary (Health and
Human Services Commission Secretary Kathleen Sebelius) offered an escape hatch for the electronic
58 TEXAS MEDICINE October 2012
prescribing deadline — then had to extend that by 120 and then 150 days. When it became obvious that neither physicians nor hospitals nor insurance companies could possibly comply with the HIPAA 5010 requirement, she offered 90 and then 120 days of leeway. The Medicare and Medicaid billing systems’ own inability to use HIPAA 5010 correctly exacerbated the medical emergency caused by Texas’ new “dual-eligibles” rule limiting what the state would pay for patients covered by both programs. (See Section 7.) And — bowing to heavy pressure from TMA, the American Medical Association, and others — the secretary delayed for one year the Oct. 1, 2013, deadline for moving to the ICD-10 coding system.
Eliminate costs and hassles that don’t contribute to or add value to patient care
New compliance requirements are bombarding physician practices seemingly every day. Just in January 2012, a new electronic format for claims and other electronic transactions (called “HIPAA 5010”) added new costs to physician practices. The switch to the International Classification of Diseases and Related Health Problems version 10 (ICD-10), currently set for October 2014, will require the adoption of an entirely new coding system to record all possible diagnoses and inpatient procedures. It will add significant physician and staff training costs.
Medicare’s required new PQRS provides a monetary incentive at first but imposes penalties beginning in 2015. A number of new state and federal privacy laws introduce more administrative hassle with no corresponding improvement in patient privacy. State and federal governments are using more “fraud” detection, resulting in monumental compliance programs that further increase the cost of running a practice. TMA and
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