Regulation plays a significant function in driving the health care system. The federal government has instituted a series of regulatory agencies tasked with the protection of the public from risks that arise from facility-based activities. This discussion looks at four regulations that affect the LOS/Excess Days program at CGH.
• HIPAA
• HITECH Act
• Affordable Care Act (ACA)
• CMC’s Rule 1599-F
Implemented under CMS, HIPAA requires that CGH reduces costs while providing better healthcare in a patient-centered environment. This regulation works to improve the effectiveness and efficiency of any program that falls under CGH’s jurisdiction (Miaoulis, 2010). The regulation is a positive for CGH because it concentrates on cost reduction measures as part of the hospital’s financial objectives.
The HITECH Act mandates the HHS to have CGH improve the quality, efficiency, and safety of healthcare service delivery. The department achieves this objective by having facilities invest in health IT, among them EHRs and secure information transfers. This regulation is a positive for its emphasis on cost efficiency while improving healthcare safety and quality (Miaoulis, 2010).
Though under threat with the arrival of the Trump administration, the ACA contains two significant regulations that could affect CGH operations and the LOS program. On the one hand, a section of this Act demands that facilities such as CGH transition from the fee-for-service payment model to value-based health care. This provision mandates that CGH builds the LOS initiative centered on the value-based operations approach (Larrat, Marcoux, & Vogenberg, 2012). Second, Section 3025 of this act mandates the CMS to cut repayments to facilities with excessive readmissions, upon discharge. Given this regulation, CGH will have to place quality over increased patient discharge arising from reduced LOS (Health Catalyst, 2016).
Finally, CMC’s Rule 1599-F requires that hospitals reports of physician orders and certification as well as patient admission and medical review processes. This rule is a positive for CGH and the LOS project for its ability to shape the rate at which the hospital remains accountable for its patients (CMS, 2016).
References
CMS. (2016). Readmissions Reduction Program (HRRP). Retrieved from CMS: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html
Health Catalyst . (2016). Patient-Centered LOS Reduction Initiative Improves Outcomes, Saves Costs. Retrieved from Health Catalyst : https://www.healthcatalyst.com/success_stories/reducing-length-of-stay-in-hospital
Larrat, P., Marcoux, R., & Vogenberg, R. (2012). Impact of Federal and State Legal Trends On Health Care Service. Journal of Pharmacy and Therapeutics, 37 (4), 218-226.
Miaoulis, W. (2010). Access, Use, and Disclosure: HITECH’s Impact on the HIPAA Touchstones. Retrieved from AHIMA: http://bok.ahima.org/doc?oid=98645#.WJSd5Bt942w
