A gathering storm of federal regulations

Overlapping and sometimes conflicting requirements on physicians will prove overwhelming to many practices unless they are changed.

Posted April 30, 2012.

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A storm is brewing, and many physicians are worried that they won’t be able to batten down the hatches in time.

Physicians are right in the center of the paths of multiple, colliding fronts in the form of more federal requirements, in particular under the Medicare program. The sheer size and timing of the increased regulatory burdens are raising serious concerns that some practices will founder when those rules hit them.

Preparing for just one of these new requirements is a significant undertaking for a physician practice, especially a small one. Upcoming requirements that doctors adopt and use electronic health records systems, prescribe medications electronically, report quality information to the government, and upgrade their claims reporting systems each demand significant time and resources that are hard to come by for many practices.

But what will happen when these requirements all kick in at about the same time? Physicians and their staffs will be struggling to meet overlapping deadlines, tackle implementation problems that arise and resolve conflicts among mandates that in some cases were authorized under different pieces of legislation. They will be doing all of that while worrying about the next scheduled Medicare pay formula cuts and deep, automatic deficit reduction cuts that are set to slash physician rates even more.

Amid all the complexity and confusion, some physicians might not even realize how soon the trouble might arrive.

The Centers for Medicare & Medicaid Services, for instance, plans to start assessing doctors in 2013 for compliance with several new requirements that aren’t even supposed to take effect for two years. Practices that are unable to adopt and use EHRs in 2013 or by October 2014 will face a penalty in 2015. Physicians who are unable to send quality measures to CMS through the Physician Quality Reporting System in 2013 will face another penalty in 2015. And physicians who could receive yet another 2015 pay cut from an upcoming Medicare value-based modifier — the subjects of which CMS hasn’t even identified yet — will be judged on quality and cost information from their 2013 claims.

For the physicians who realize what’s coming, worrying about this gathering storm makes it harder to focus on their paramount goals of giving patients the care they need and deserve. That’s not fair to doctors or patients.

And it doesn’t have to be this way. Fixing some of the problems won’t even require an act of Congress. The American Medical Association recently joined with nearly 60 medical specialty organizations and all state medical societies to call on CMS to act on its own to reduce the burden of several of these regulations and better align the requirements with one another.

One major thing that CMS should do, for instance, is to abandon the backdating that the agency is using to determine how penalties should be applied. When lawmakers said an incentive program should start in 2015, they meant it. They didn’t intend for Medicare to jump the gun and require doctors to be compliant a full two years earlier.

CMS also can better align the timing of and requirements under incentive programs so physician practices can prepare for all of them, without having to sacrifice attention to one so they can be compliant with another. Physicians who have hardships must be able to obtain exemptions to the rules, and doctors must be given a chance to appeal penalties when they are assessed incorrectly. All of these changes can be accomplished when the agency drafts the 2013 physician fee schedule rule.

The administration has shown that it is capable of using its privilege to adjust regulatory requirements that will prove too burdensome. Physician organizations, for instance, are reviewing a federal proposal that would delay the deadline for physicians to adopt the ICD-10 diagnosis code sets for one year, to Oct. 1, 2014.

But for the other issues of concern, the fronts are getting much closer than that. And if their course isn’t altered soon, it might be too late for many physicians to weather the storm.

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