Regulatory Wish List: Which Rules Would Healthcare Leaders Eliminate?

The individual mandate tops the list of regulations that healthcare leaders would eliminate, followed by a general appeal to simplify and reduce provider documentation regulations, according to the Healthcare in the Trump Era survey.

This is part of a series covering the Shaping of Healthcare's Future in the Trump era.

President Donald Trump said Monday that he aims to cut regulation "massively… by 75 percent, maybe more."

It will be tough for the White House to decide what to cut. There are so many healthcare rules that industry leaders asked to identify a single governmental regulation they would like to eliminate were not able to coalesce around just one.

Results from Healthcare in the Trump Era, a new survey by HealthLeaders Media, include feedback from 350 healthcare industry leaders on the most onerous regulations.

The largest share of respondents, 10%, selected a regulation that does not directly impact providers: the individual insurance mandate and tax penalties. Next, at 9%, was a general plea to simplify and reduce provider documentation regulations, followed by 8% who cited a mix of rules related to payers, such as eliminating bundled payments or closed networks.

Some of the favorite targets of criticism also are cited for elimination: meaningful use and EHR-related regulations (4%); the three-day hospital stay requirement for SNF Medicare coverage (3%); the two-midnight rule and observation status regulations (3%). Another 3% said there were too many to pick just one.

Here's a sampling of some of the open-ended comments from healthcare leaders, which were used to compile the categories and percentages listed in the survey report:

• The Two-Midnight rule has created significant confusion and increased costs within the medical community. The rule was poorly implemented, inconsistently enforced, and much like the ACA, has required multiple changes and clarifications.
   
• All-cause readmission penalties should be eliminated because it doesn't make sense to punish a healthcare provider for not predicting the future accurately.
   
• Change the focus of HCAHPS scores to realistic expectations. As they stand now, the pain questions have led to much bigger problems with patients feeling they have a right to extreme measures to control pain and this has increased the distribution of pain medications and increased abuse of prescription pain medications.
   
• Government has no business telling us in the healthcare business what to do and how to do it when they can't take care of federal healthcare for vets nationwide.
   
• Make meaningful use more meaningful. Who cares if a patient is signed up for a portal if they are getting appropriate care?
   
• Imposing the 30-day readmission penalties for mental health patients is both ludicrous and potentially damaging to an already faltering mental health system.
   
• Some of the payment rules for certain providers are so stringent that it is hard to envision population health management working while still being able to keep our doors open. There should be more compensation for keeping our patients out of the hospital than there is for having them in the hospital.

Among the 2% of respondents who said they would not eliminate any regulations, here are some comments:

• I do not think governmental regulations on healthcare are the problem. I think managed care organizations and private insurance policy "obstacles" are the problem.
   
• We need everyone in the insurance pool and EHR with seamless information-sharing but with privacy. We need risk-based payment, etc. I can't think of any regulation that should be eliminated.

Despite the clear objection to many healthcare regulations, the survey results also reveal that most leaders (65%) want the Trump administration reduce healthcare-related within reason, noting that some regulations are necessary.

One in five (20%) want greater regulatory reduction, citing that most are unnecessary and burdensome. Only 15% say they would not reduce regulations, because most are necessary.

Clearly, healthcare regulation is complex and extensive. And now is the time for healthcare leaders to express their concerns to legislators and regulators, who are currently embarking on some significant changes.