CMS Finalizes the Conditions of Participation Burden Reduction Rule

On September 30, 2019, the Centers for Medicare and Medicaid Services (CMS) published the Omnibus Burden Reduction (Conditions of Participation) Final Rule which is intended to remove Medicare regulations that were identified as unnecessary, obsolete, or excessively burdensome on hospitals and other healthcare providers to reduce inefficiencies and improve the quality of care and outcomes for patients at the lowest possible costs. The Final Rule goes into effect November 29, 2019.

The American Society of Anesthesiologists (ASA) submitted comments in November 2018 requesting that CMS heavily consider how their proposals would impact physician anesthesiologists and overall patient safety by eliminating or modifying requirements like: Comprehensive Medical History and Physical Assessments (H&P) in hospitals and Ambulatory Surgical Centers (ASCs), written transfer agreements between hospitals and ASCs, and facilities documenting efforts to collaborate and cooperate with emergency preparedness officials. Unfortunately, CMS finalized several proposals that ASA opposed, including those where the ASA argued that the changes would significantly shift the burden from other healthcare providers to physician anesthesiologists.

Although a facility does not need to alter their current policies, physician anesthesiologists may encounter local policy discussions regarding:

• ASCs periodically providing the local hospital with written notice outlining the ASC’s operation and patient population. ASCs must continue to have a procedure for immediate transfers to a hospital for emergency patients.
• In both ASCs and hospitals, the criteria used to determine which outpatient or ambulatory patients must receive an H&P. Policies must take into consideration several patient factors before the surgery or procedure.

CMS finalized other parts of the rule that ASA expressed support:

• Multi-hospital systems may have a unified and integrated Quality Assessment and Performance Improvement (QAPI) program.
• Multi-hospital systems may have integrated infection control and antibiotic stewardship programs for all of their member hospitals.

This rule did not address the recent provision in the 2020 Medicare Physician Fee Schedule/Quality Payment Program proposed rule where CMS proposed to change the Conditions for Coverage to allow nurse anesthetists to perform the preoperative assessment of anesthetic risk and pre-surgical evaluation in the ASC setting. ASA opposed that particular proposal. ASA expects CMS to make a final decision in November 2019.

Physician anesthesiologists should review their local policies and procedures effected by the Conditions of Participation Burden Reductions rule. Please contact the ASA Department of Quality and Regulatory Affairs with any questions at [email protected].