Question of the Week


Just when I thought I finally understood all of the Medicare Conditions of Participation (“CoPs”), I understand that CMS has gone about rewriting many of them.  Why did they do that?


Basically, the President made CMS do it.  By Executive Order 13563,  entitled “Improving Regulations and Regulatory Review,” the President directed each executive agency to establish a plan for ongoing retrospective review of existing significant regulations, to identify those rules that could be eliminated as obsolete, unnecessary, burdensome, or counterproductive, or that could be modified to be more effective, efficient, flexible, and streamlined.

CMS was up for the challenge.  As described in CMS’s regulatory impact analysis that preceded the new CoPs as published in the Federal Register:

CMS has not reviewed the entire set of CoPs for Hospitals in many years.  These requirements have grown over time and, while often revised, have not been subject to a complete review.  CMS staffs as well as CMS stakeholders, including TJC, the American Medical Association, the AHA, and many others, have identified problematic requirements over the years.  Accordingly, we decided to conduct a retrospective review of the CoPs imposed on hospitals and to remove or revise obsolete, unnecessary, or burdensome provisions, and to increase regulatory flexibility while identifying and adding opportunities to improve patient care and outcomes.  We analyzed all potential reforms and revisions of the CoPs for both the costs and the benefits that they would bring to hospitals and CAHs [critical access hospitals].  Based on our analysis, we decided to pursue those regulatory revisions that would reflect the substantial advances made in healthcare delivery and that would benefit hospitals and CAHs through cost savings.

And what kind of cost savings are we talking about here?  According to CMS’s Summary of Costs and Benefits, the top cost savings come from the following areas of change:

  • §482.22 Medical Staff  – $330,000,000;
  • §482.54 Outpatient services – $300,000,000;
  • §482.24 Medical records services – $170,000,000;
  • §482.23 Nursing services – $110,000,000.

And the true value of these changes, if they even come close to these estimates?  Priceless.

Join HortySpringer partners Dan Mulholland and Henry Casale as they provide a thorough overview of what is in the new CoPs and what you need to know NOW to comply.

The New Medicare Conditions of Participation
June 7, 2012
1:00 – 2:30pm