AHA and CMS to Keep Regulatory Flexibilities in Place

COVID-19 continues to create obstacles and challenges for healthcare compliance professionals. Thriving in this environment means being agile and adaptive.

The AHA’s Requests

Last week, the American Hospital Association (AHA) asked the Centers for Medicare & Medicaid Services (CMS) to keep relaxed regulations in place. Specifically, the AHA is interested in keeping flexibility around telehealth, quality and compliance measures, and bed capacity.

The telehealth changes are ones that have been on the horizon for some time. Essentially, the AHA is asking CMS to continue to allow hospitals to provide a wide range of telehealth services, without limitations as to profession or geographic location. The AHA is also asking for flexibility on billing and payments related to telehealth to be made permanent.
More interestingly, the AHA has also asked that CMS extend regulatory relief related to some quality and patient safety regulations. These include expanding the use of verbal orders, and extending the reuse of PPE.

The AHA has also asked that CMS provide hospitals with a transition period, to allow them to more easily move from pandemic response to ordinary practice. This includes a request for temporary waivers for sanctions and penalties related to HIPAA , and flexibility on audit requirements. And, it includes a request that certain rules and requirements be delayed or suspended.

The Response From CMS

Three days after the AHA released this letter, Michael Caputo, Assistant Secretary for Public Affairs at the Department of Health and Human Services (HHS), tweeted this :

The public health emergency is currently set to expire on July 25. However, as of this writing, HHS hasn’t officially announced how long the extension will be

This means that we don’t yet know what will happen when the emergency finally does end. Will HHS give a transition period, as the AHA has requested? Will HHS continue to allow flexibility about telehealth, which they have previously indicated they would?

Staying up to date on this fluid situation is going to be a key task for compliance in the coming weeks.

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The Results Are In: What the Data Say About the Impact of COVID-19 on Healthcare Compliance

We keep hearing that COVID-19 changed everything, especially in healthcare. But actual data is pretty thin on the ground.

Mostly, we’ve been hearing anecdotes and stories, many of which are striking. The problem with stories is that they can be unique or unusual, and without the context of clear data, we can’t really tell.

Last week, we got some data.

In May, the Society of Corporate Compliance and Ethics (SCCE) and the Health Care Compliance Association (HCCA) surveyed their audiences on the impact of COVID-19 on their organizations and their work. They received 300 responses, have collated the results, and there are some interesting trends. You can read the full survey results here.

Confirming What We Knew

Some trends are unsurprising, and confirm what we already knew. Survey respondents said they had concerns about the increased risk of compliance failures as a result of the pandemic.

  • 77% expected that there would be some increase, or a great increase, in compliance failures.

It’s also unsurprising to see that healthcare saw more of an increase in the number of inquiries being made of the compliance team.

  • 42% reported an increase in healthcare
  • 30% reported an increase outside of healthcare

Given the number of healthcare-related regulatory waivers and temporary changes that have been issued, this makes total sense.

Positively, collaboration with other departments has been largely unaffected or increased during the pandemic. Compliance is still seen as really valuable to the organization as a whole. The numbers range from 83% to 96% of respondents reporting that collaboration has stayed the same or increased (depending on department).

Differences for Healthcare Compliance

The data also show some surprising trends, specifically related to healthcare compliance.

We know that there has been a huge shift to remote work. The surprising aspect is that the shift is very different between healthcare compliance and compliance elsewhere.

  • In healthcare, 60% reported working remotely
  • Outside of healthcare, 84% reported working remotely

This gap is big, and hard to explain. Working in healthcare institutions would, presumably, increase the risk of being exposed to the virus. It would have been reasonable to expect that healthcare institutions would do as much as possible to try to get their non-clinical staff set up to work effectively off-site.

What’s even more surprising is that healthcare professionals are less likely to report that the transition to remote work has gone well.

  • In healthcare, 47% said the transition had gone better than expected
  • Outside of healthcare, 64% said the transition had gone better than expected

The survey doesn’t indicate why this is so. Speculating a little, it could be that the disruption in moving to a remote office, coupled with the sudden influx of regulatory changes, made it more difficult for healthcare compliance professionals to manage their day-to-day work. If this is true, it would also explain why healthcare institutions were less likely to transition compliance professionals to remote work.

There’s another difference between healthcare and other types of organizations, and this suggests things will be difficult for compliance professionals going forward into 2021. In relation to budgets:

  • In healthcare, 40% reported a budget reduction
  • Outside of healthcare, 31% reported a budget reduction

In short, budget reductions are coming to compliance, as they are going to come to other parts of the healthcare system. (If they aren’t already in place.) As COVID-19 related waivers and suspensions start to expire, compliance is going to have to find a way to do more with fewer resources.

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