Premier Inc. has provided the U.S. Department of Health and Human Services (HHS) and Congress with a list of 24 regulatory waivers that should be made permanent as the COVID-19 pandemic subsides. The temporary waivers were granted earlier in the year to streamline care delivery and prevent the spread of infection.
“During the height of the COVID-19 pandemic, waivers cleared away cumbersome barriers and allowed health systems to save lives in the process,” said Blair Childs, Premier’s Senior Vice President of Public Affairs. “Many of these measures were policies for which we’ve been advocating for many years. In all practicality, these waivers were pressure tested during the pandemic, and proved to be effective at modernizing and improving healthcare delivery. Smart, effective ideas should be made permanent policy. There’s no reason to revert back to the status quo just because patients may seek different avenues for treatment.”
Specifically, Premier recommends a range of reforms to telehealth policies. Telehealth served as a critical way for patients to have their medical needs addressed at home during the pandemic, thereby reducing the risk of infection and enabling the conservation of personal protective equipment (PPE). Waivers that HHS and Congress should make permanent include those allowing providers outside of rural areas to provide telehealth services, expanding the types of practitioners who can provide telehealth, allowing for audio-only visits when applicable, and expanding telehealth services to occupational therapy and behavioral health services. According to a survey of health systems Premier administered last month, 93 percent of respondents cited these waivers as essential to make permanent.
Similarly, use of technology was also an important tool to screen patients during COVID-19. Key to preventing infection, these waivers helped avoid unnecessary hospitalizations for ambulatory conditions, estimated to cost more than $2,000 per visit. As a result, Premier recommends that the Emergency Medical Treatment and Labor Act (EMTALA) be permanently changed to allow for pre-admission screening so that only emergency or acute cases are admitted to the hospital, while others are directed to seek care in a more appropriate setting such as a clinic or urgent care center. Other admission alternatives, such as a hospital at home program that allows urgent care to be provided outside the acute care setting, should be allowed through new payment models tested by the Center for Medicare & Medicaid Innovation.
Lastly, Premier recommends several permanent changes to process rules, including those that allow nurse practitioners and physician assistants to perform routine tasks so that staff can practice to the “top of their license” with remote supervision, while physicians are freed up to care for the most acute patients. Premier is also pushing for a permanent waiver of the skilled nursing facility (SNF) three-day rule that needlessly requires a three-day inpatient hospital stay prior to admission into a Medicare-covered SNF. According to Premier’s survey, 59 of respondents recommended these two measures become permanent policy.
“These waivers are all rooted in common sense and will go far to modernizing the Medicare program in keeping with technology and other advancements that have improved care delivery,” concluded Childs. “We strongly believe the Administration should act on all these recommendations, easing regulatory burden and improving options for patients. At a minimum, these waivers should be granted to those participating in alternative payment models, as they need the greatest flexibility to manage care to contain costs and improve quality.”