Tag Archives: complexity

Regulation Strangulation

The American Hospital Association (AHA) released a report that stated that there is too much regulation that is impacting patient care.

The report, Regulatory Overload Assessing the Regulatory Burden on Health Systems, Hospitals, and Post-acute Care Providers, concludes with the following assessment:

Health systems, hospitals and PAC providers are besieged by federal regulatory requirements promulgated by CMS, OIG, OCR and ONC, many of which are duplicative and cumbersome and do not improve patient care. In addition to the regulatory burden put forth by those agencies, health systems, hospitals and PAC providers are subject to regulation by additional federal agencies, such as the Department of Labor, the Drug Enforcement Administration, the Food and Drug Administration and by state licensing and regulatory agencies. They also operate under stringent contract requirements imposed by payers, such as Medicare Advantage, Medicaid Managed Care plans and commercial payers, which also require reporting data in different ways through different systems. States and payers contribute to burden through, for example, documentation, quality reporting and billing procedures layered on top of the federal requirements.
Regulatory reform aimed at reducing administrative burden must not approach the regulatory environment in a vacuum — evaluating the impact of a single regulation or requirements of a single program — but instead must look at the larger picture of the regulatory framework and identify where requirements can be streamlined or eliminated to release resources to be allocated to patient care.
In a previous post, Models, Models, Have We Got Models!, I said that from the beginning of my foray into the health administration world, I noticed that there were too many models, programs, and schemes dedicated to lowering costs and improving quality of care, that only raised the cost of health care and did not improve quality of care.
This is what I said then about all the models, programs, and rules promulgated by CMS over decades that have not made things better:
The answer was simple. Too many models, programs, rules, and so on that only gum up the works and make real reform not only impossible, but even more remote a possibility as more of these inane models are added to what is already a broken system.
So it seems that I was right even then, and now the AHA has proved it so. Why not scrap these models, programs, and rules and institute real reform…Medicare for All and be done with it?

Fourteen Hundred Plus Pages – For One Rule???

Health Affairs blog author, Sara Rosenbaum wrote an article today about the final rule for Medicaid that was released back on April 25th.

What immediately jumped out at me was the length of the rule — 1,452 pages. That’s right, fourteen hundred and fifty-two pages for one lousy rule.

Those of you who read my post from last Friday, “A Simple Friday Morning Health Care Philippic – (With Apologies to Simon & Garfunkle)”, will remember that I called our health care system, “more complex, confusing, bureaucratic, wasteful, idiotic, and expensive.”

I also said that it “is so top-heavy, so convoluted, and so complex that the sheer weight of its rules, regulations, laws, programs and models will cause it to collapse.”

At fourteen hundred and fifty-two pages, that is a lot of weight. Added to all the other rules, regulations, models, programs and whatnot, you’d need a forklift just to put it into a law library, or at best, have it craned in before the roof goes on.

I know War and Peace is a big slog through, but we are talking about health care here, not a fictionalized account of the Napoleonic Wars.


If you don’t know why our health care system is so bad, one look at this bound rule will convince you that we have gotten out of hand with something that should be basic and simple…providing every American access to health care, and not lining the pockets of paper makers, ink makers, book printers, binders and the poor schlub who has to carry these rules to wherever these things are held.

And we are also lining the pockets of physicians, lawyers and other stakeholders whose grubby little hands (must be relatives of Trump) are in every nook and cranny of the system.

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