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Hospitals Say Regulatory Compliance Drives Up Annual Costs

The American Hospital Association (AHA) reports hospitals and healthcare providers spend more than $39 billion annually on tasks related to compliance issues. Investing in technology, training, and staff allows them to keep up with demands, but causes them to feel overworked and pressured to meet continually rising requirements. Just last year, providers saw 629 changes in nine domains related to reporting, meaningful use, billing and other administrative tasks. There are 4 groups involved in creating legislation: CMS, OIG, OCR, and ONC.

Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) is a part of the U.S. Department of Health and Human Services. The association is in charge of many federal healthcare programs. Some of the large programs that CMS oversees involve healthcare information technology such as the meaningful use incentive program that is used for electronic health records (EHR).

CMS runs the Children’s Health Insurance Program (CHIP) and the Health Insurance Portability and Accountability Act (HIPAA). They also administer large parts of the Medicare Access and CHIP Reauthorization Act (MACRA) law. One of the programs that is in MACRA is the Merit-Based Incentive Payment System (MIPS) that was created to pay healthcare providers that exhibit high quality healthcare and have high patient satisfaction rates.

In 2009, CMS was put in charge of running the meaningful use program. The meaningful use program determines if healthcare providers have effectively utilized their healthcare technical systems and decides reimbursement rates for healthcare providers that use IT systems that are certified by the federal government.

Office of Inspector General (OIG)

The Office of Inspector General (OIG) is in charge of protecting the Department of Health & Human Services programs. Most of OIGs efforts focus on Medicare and Medicaid programs. It involves 6 components: Immediate Office of Inspector General (IO), Office of Audit Services (OAS), Office of Evaluation and Inspections (OEI), Office of Management and Policy (OMP), Office of Investigations (OI), and Office of Counsel to the Inspector General (OCIG). Each office works together to develop audits, investigations, and evaluations to help speed up the transfer of healthcare information, save costs, and recommend policies to lawmakers and the public. Their main focus is to protect the United States from fraud and theft of medical information.

Office for Civil Rights (OCR)

The Office for Civil Rights (OCR) focuses on working with medical professionals and patients to protect the privacy of people’s medical information. OCR works to calm the widespread concern about electronic health records putting medical records at risk by teaching organizations how to follow health information privacy and patient confidentiality laws to protect each person’s right to medical privacy.

This office is also in charge of investigating any complaints or concerns about medical confidentiality and taking the necessary actions to fix the issue if they discover a problem. The OCR has the legal right to fine healthcare providers and businesses if they have personal health information stolen or anything goes missing.

Office of the National Coordinator for Health Information Technology (ONC)

The Office of the National Coordinator for Health Information Technology (ONC) is a part of the U.S. Department of Health and Human Services that promotes and oversees national health information technology infrastructure and development. The ONC played a large part in creating and implementing electronic health records. Their stated goals are:

  • To improve the quality of healthcare while also reducing costs
  • To improve the coordination of care and information between all healthcare providers and organizations
  • To prevent personal health records from being stolen or lost
  • To improve the health system’s ability to discover and cure chronic illnesses

The ONC created a rule called the Standards and Certification Criteria Final Rule that paired up with a similar rule, which CMS released shortly afterwards in 2010. The rules established the meaningful use program and laid out requirements that healthcare providers must meet to be eligible for EHR incentive payments.

Regulations That Are Causing Difficulties

There are many regulations that CMS, OIG, OCR, and ONC have created that are causing problems for healthcare providers all over the country.

Quality Reporting Requirements

One of the central aspects of the programs that CMS, OIG, OCR, and ONC have created is quality assurance. These requirements are causing a significant strain on providers. The purpose of CMS’s
quality reports is to be able to support incentive programs that help boost quality of healthcare. However, reports that are misplaced or duplicated often require somebody to manually track down or remove them, wasting significant amounts of time. On average, hospitals spend $709,000 every year on administrative tasks regarding quality reporting.

Technical Systems

The creation of meaningful use has motivated healthcare providers to use EHR and keep it secure and safe. Though studies have shown that the program has succeeded in moving more healthcare providers to EHR, the technical aspects of the systems are causing issues for healthcare providers. Hospitals and health centers end up spending large amounts of time and money setting up these programs and tending to any issues. Hospitals are spending an average of $760,000 on IT requirements, most of which is spent on maintaining additional staff to run EHR systems. Many medical professionals are also now spending large amounts of time entering information into computers, speeding up burn-out and taking away from time that could be spent with patients.

Medical Billing Clearinghouses Can Help

In order to be able to save precious time and money, healthcare providers need to find ways to follow these requirements without being financially burdened as much as they are. A medical billing
clearinghouse can help reduce the damage of the regulations. They can reduce the number of errors and save time on the claims, which will save money in both areas. Contact APEX EDI for more
information about how a medical billing clearinghouse can help healthcare providers lessen the financial toll that medical regulations are taking on their association.

www.forbes.com/sites/physiciansfoundation/2013/11/05/healthcare-is- turing-into- an-industry-focused-on- compliance-regulation- rather-than- patient-care/#796cc95f2e3c
revcycleintelligence.com/news/hospitals-systems- spend-39b- annually-on- regulatory-compliance

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