Healthcare News of Note: Recent CMS regulations are in limbo under the new administration

• Joe Biden’s newly inaugurated administration has ordered all government agencies to pause the implementation of rules that are pending or that have been finalized but not officially published.
• The COVID-19 pandemic has spurred more hospitals to hire outside firms to handle their billing and revenue collection.
• Many emergency medicine physicians are struggling to find full-time employment, even while they work on the front lines treating covid-19 patients.

Among the healthcare finance news that I found interesting this past week are the following stories.

1. Fate of new CMS regulations in question as Biden administration orders review of recently finalized rules

The changeover in the White House has potential implications for recently finalized rules and regulations from CMS.

Joe Biden’s newly inaugurated administration has ordered all government agencies to pause the implementation of rules that are pending or that have been finalized but not officially published.

Agencies are to “immediately withdraw” such rules from the Office of the Federal Register to “allow for review and approval,” according to a memo from Ronald Klain, Biden’s chief of staff. Exceptions may be made only for rules applying to “emergency situations or other urgent circumstances.”

The order most notably affects a rule that was finalized Jan. 15 and would establish new requirements related to interoperability and prior authorization for health plans in Medicaid, CHIP and the federally operated insurance exchanges. That rule has been pulled from CMS’s website.

Even for rules that have been published but have not yet taken effect, the effective dates can be delayed for 60 days “for the purpose of reviewing any questions of fact, law, and policy the rules may raise,” Klain wrote. That part of the order theoretically could affect the following rules:

• Contract Year 2022 Medicare Advantage and Part D
• Notice of Benefit and Payment Parameters for 2022
• Medicare Coverage of Innovative Technology

CMS also has a new, albeit temporary, leader: Liz Richter, deputy director for the Center for Medicare. Richter has taken over as acting administrator after the departure of Administrator Seema Verma. Biden has yet to announce his nominee for the administrator role. 

— Nick Hut, HFMA Senior Editor

2. Survey: More CFOs indicate interest in outsourcing billing and revenue collection

The COVID-19 pandemic has spurred more hospitals to hire outside firms to handle their billing and revenue collection, says a Jan. 16 Modern Healthcare article.

“Experts who follow the industry and companies that offer revenue cycle management—the process of patient registration, billing and collecting money owed—say they’ve seen renewed interest this year from hospitals that more than ever need to collect every penny owed to them and spend less money doing it,” says the article by reporter Tara Bannow.

“Annual surveys of hospital finance chiefs conducted by investment firm Baird have captured a distinct evolution toward hospitals outsourcing their revenue cycle operations,” the article continues. “Whereas in 2016 only 5% of chief financial officers said they currently outsourced their revenue cycle, that was up to 51% in the latest survey, conducted in October 2020.”

HFMA’s Rick Gundling, senior vice president, content and professional practice guidance, provided insight on this trend.

“With the pandemic causing widespread impact to families’ incomes due to higher unemployment, hospitals have devoted more resources to help in financial communications regarding a patient’s ability to meet out-of-pocket payments,” Gundling said. “Internal hospital staff are spending more time to help families qualify for Medicaid and other coverage as well as assessing other financial assistance needs.

“Outside firms are one way to help gain capacity and expertise in the revenue cycle quickly to meet the increased demands on patient billing and collections.”

The Modern Healthcare article also points out the small sample sizes of Baird surveys. For the latest one, 80 CFOs participated, and survey respondents differ year to year, according to Matthew Gillmor, a director and senior research analyst with Baird.

3. Young emergency medicine physicians struggle to find full-time employment

The Washington Post article, “Young ER doctors risk their lives on the pandemic’s front lines. But they struggle to find jobs.” reports that many emergency medicine physicians are struggling to find full-time employment, even while they work on the front lines treating covid-19 patients.

The article reviews the experiences of these young physicians. Owais Durrani, who is training at the University of Texas Health Science Center at San Antonio, and Angela Cai, a physician in her final year of residency at SUNY Downstate’s Kings County Hospital in Brooklyn, share their stories. 

The article also says, “Hospitals, outside of academic centers, rarely hire emergency doctors outright. Most medical centers instead have contracts with physician provider groups. Those can be small, doctor-run companies, or large corporations, backed by private-equity firms, that employ thousands of doctors who work at hundreds of hospitals.”

In the article, Mark Reiter, the chief executive of the consulting group Emergency Excellence and director of the emergency medicine residency program at the University of Tennessee Health Science Center in Nashville, said: “More than half of the emergency doctors in the United States are employed by investment-firm-owned companies, and those companies have generally been ‘more aggressive’ when cutting back doctors’ hours amid the pandemic.”