Regulation Nation

A recent survey has illustrated just how onerous the various federal regulations of healthcare have become.

If you’re feeling extra productive and accomplished this morning and want to bring yourself back to dismal reality, take a look at the regulatory dashboard on the website of the Office of Information and Regulatory Affairs (OIRA).

The dashboard shows, in real time, the number of federal regulations in their last phase of review at the White House, getting ready for a stamp of approval by the Office of Management and Budget (OMB) before being published in the Federal Register.

There are a total of about 100 federal regulatory agencies, but only about 15 agencies that we really hear about – and those are the agencies with representatives who sit on the president’s cabinet.

OIRA’s regulatory dashboard also gives a snapshot of the top 10 agencies that are putting out the most regulations at any given time.

Almost without fail, the U.S. Department of Health and Human Services (HHS) has the most regulations that are about to be approved, and usually by a long shot.

Last night, for instance, because I needed something to go with my Chianti and my overall sense of angst, I visited OIRA’s regulatory dashboard and found that HHS has 30 regulations waiting to be published. That’s three times the number of regulations expected to come out of the Environmental Protection Agency (EPA), the dashboard’s second-place winner. And HHS has more regulations in waiting than the bottom five finishers combined, including the Department of Agriculture, the Department of Labor, Housing and Urban Development (HUD), the Office of Personnel Management, and the Department of Energy.

To say that healthcare is the most regulated industry is an understatement.

A 2021 American Hospital Association (AHA) Study concluded that health systems, hospitals, and post-acute providers spend nearly $40 billion a year on activities related to regulatory compliance. That equates to an average cost of $1,200 per patient, or nearly $50,000 per hospital bed, per year.

Data from 2017 showed that health systems and hospitals must comply with 629 discrete regulatory requirements – and that was in 2017. Imagine what it is now, in the wake of the No Surprises Act and its transparency requirements.

Which brings us to last week, when the Medical Group Management Association (MGMA) published the results of its annual survey on regulatory burden. Of the 500 group practices that were surveyed, nearly 9 in 10 reported that the regulatory load on their business had increased over the past year.

The biggest reported burdens this year were prior authorization and the surprise billing and good-faith estimate requirements. More than 80 percent indicated that obtaining prior authorization was very or extremely onerous, with 95 percent of respondents stating that patients had faced delays or denials for medical care because of prior authorization. More than 70 percent struggled with surprise billing and good-faith estimates.

Other findings from the MGMA survey include the following:

• 97 percent of respondents said that a reduction in regulatory burden would allow them to reallocate resources toward patient care;
• 65 percent thought the Medicare Quality Payment Program was very or extremely burdensome;
• About three quarters of respondents thought that the lack of electronic health record (EHR) interoperability was moderately to extremely burdensome; and
• Only about a quarter of respondents said they had the technical infrastructure to comply with the convening/co-provider requirements of the No Surprises Act’s Good-Faith Estimate (GFE).

On the bright side, a whole 1 percent of the 500 surveyed thought that the regulatory burden had actually declined over the past 12 months.

I want to offer my humble apologies to anyone whose day I’ve ruined. 

Programming note: Listen to the Monitor Mondays Legislative Update with Matthew Albright, sponsored by Zelis, Mondays on Monitor Mondays at 10 Est.