WASHINGTON -- Clinicians could be freed to practice at the top of their license as part of new flexibilities granted by the Centers for Medicare & Medicaid Services (CMS) in the wake of the COVID-19 pandemic.
For example, "nurse anesthetists could help with anesthesia during essential surgeries and procedures, which frees up anesthesiologists for ICU care," CMS Administrator Seema Verma said on a Monday evening phone call with reporters.
But there's also a catch: "States may have laws that prohibit them from taking advantage of our flexibility, and that would need to be resolved at the local level," she said.
In addition, "current Stark regulations allow hospitals to provide only minimal extra benefits to physicians while they treat patients at the hospital, but now hospitals will be able to support their hard-working physicians by providing benefits such as daily meals, laundry services, or child care services while they're on duty," said Verma.
The increased scope-of-practice flexibility was just one of several regulation relaxations that CMS announced on Monday. "We're waiving a wide and unprecedented range of regulatory requirements to equip the American healthcare system with maximum flexibility to deal with an influx of cases," said Verma. "Many healthcare systems might not need these waivers, and they shouldn't use them if the situation doesn't warrant it, but the flexibilities are there if it does. In a time of crisis, no regulatory barriers should stand in the way of patient care."
Some of the other flexibilities the agency is granting include:
- "Hospitals Without Walls": CMS will allow communities to take advantage of local ambulatory surgery centers (ASCs) that have canceled elective surgeries, per federal recommendations, the agency . "Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their state's emergency preparedness or pandemic plan." The new flexibilities also will allow ASCs to provide services typically provided by hospitals such as cancer procedures, trauma surgeries, and other essential surgeries, CMS said. In addition, the agency will allow non-hospital buildings -- such as hotels and dormitories -- to be used for patient care and quarantine, as long as each state approves and the safety of staff and patients is assured.
- More flexible testing: "Medicare will pay for laboratory companies to collect samples [for COVID-19 testing] in peoples' homes or nursing homes, and we hope that this will encourage more testing of our nursing home residents, who are among the most vulnerable," Verma said. "By increasing testing, we can isolate those patients that have been infected and keep other residents healthy." Hospital emergency departments also will be allowed to test and screen patients for COVID-19 at drive-through and off-campus test sites.
- Increased choice of transfers: Ambulances will now be able to transport patients to a wider range of locations -- such as community mental health centers, federally qualified health centers, physicians' offices, urgent care facilities, and ambulatory surgery centers -- when other transportation isn't medically appropriate.
- Special rules for physician-owned hospitals: The flexibility means physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms, the agency said. For example, "a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surge during the public health emergency." And the relaxed rules mean that patients can be screened at places not subject to the Emergency Medical Treatment and Labor Act (EMTALA), so hospitals, psychiatric hospitals, and critical access hospitals can screen patients off-site to prevent the spread of COVID-19.
- Less paperwork: Medicare will now cover respiratory equipment for patients for any clinician-approved reason, rather than requiring certain criteria to be met. Hospitals won't have to develop written policies regarding visiting patients isolated due to COVID-19; they also will have more time to give patients their medical record. CMS also is providing temporary relief from many audit and reporting requirements.
- Greater use of telehealth: CMS is adding 80 more services to its list of services that can be provided using telehealth, and patients can use interactive apps "to visit with their clinician for an even broader range of services," the agency said, adding that providers "also can evaluate beneficiaries who have audio phones only," making it easier for the patients to stay at home. Providers will also be able to bill for telehealth visits at the same rate as in-person visits. In addition, the agency is allowing clinicians to use telehealth to fulfill face-to-face visit requirements for providers treating patients in inpatient rehabilitation facilities and those receiving hospice care or home healthcare. Remote monitoring services can be provided for patients with acute or chronic conditions -- for instance, using a pulse oximeter to remotely monitor a patient's oxygen saturation level. Clinicians also can supervise staff members virtually instead of needing to be on-site.
"This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly," Verma said in the press release. On the call, she told ľֱ that the rule relaxation "is temporary and it's going to last as long as the public health emergency, as long as it's necessary."