Making the Most of Deregulation: Three Priorities for Providers

Published May 9, 2018

Deregulation is a hallmark of the Trump economy. Healthcare providers are among the many industry groups seeking and obtaining relief from regulatory and compliance requirements. The American Medical Association (AMA) maintains a regulatory relief dashboard to track “regulatory wins” on reporting of quality measures, EHR mandates, appropriate use criteria and other requirements. The AMA’s wish list includes several additional items in the areas of program integrity, audits and documentation. Meanwhile, the long term care industry has persuaded the federal government to back off its Obama-era approach to inspections and to allow mandatory binding arbitration clauses.

The regulatory environment swings like a pendulum. Deregulation almost inevitably leads eventually to re-regulation, as government reacts to real or perceived abuses in the private sector. Providers generally prefer less regulation. If they want to build public trust and prevent or delay the pendulum from swinging back, there are three main things providers should do.

Shifting compliance resources to quality

Complying with mandates, preparing for audits, paying fines, and defending lawsuits is resource and labor intensive. Regulations that are intended to improve quality may also put providers in a defensive crouch, as they strive to stay out of the way of inspectors and respond to detailed requests. A reduction in federal requirements gives providers an opportunity to redirect resources to patient needs in ways that can result in real, patient and family-centered improvements. For example, a provider may decide to participate in a locally-tailored quality improvement initiative to track outcomes and to learn from the best practices of leading institutions.

The federal government is taking a more hands-off approach, but advocacy organizations and the media are not. The industry and individual providers are often put on the defensive by anecdotal reports of quality deficiencies and complaints from families. With the reduction in federal oversight, private groups are stepping in to the breach with their own reporting and monitoring systems that tend to highlight problems. There is interest from the general public, too, as stories of harms to vulnerable people attract significant attention.

It’s up to providers to establish their own narrative, by delivering on patient-centric quality and service measures.

Reduce the cost base

The rising cost of health insurance and health care is a critical challenge for employers and consumers. Individuals worry about going bankrupt and not being able to leave anything to the next generation, while companies’ bottom lines are squeezed by rising premiums.

A promising way for providers to sustain the swing toward deregulation is to demonstrate the linkage between a high regulatory burden and high costs. Of course these costs must be passed on to the consumer or health plan in the form of higher prices. Providers would do well to document these costs, strive to reduce them in the emerging, low-regulation environment, and pass at least some of the resulting savings on to patients and families. This process should be explained and publicized in order to help the public understand.

One complicating factor is that the same forces that are paring back regulations are also trying to weaken –or at least narrow—federal health insurance programs including Medicare and Medicaid. Consumers will be more likely to worry about whether Medicare or Medicaid will be there for them than to consider how a lower regulatory burden will help them personally.

Bolstering the “quadruple aim”

The Triple Aim –improving health and patient experience while containing costs– has become a central goal for the US healthcare system. But leading voices in the delivery realm have called for adoption of a fourth aim: improving the working life of providers and staff in order to reduce burnout and help care teams focus their attention on patients. Reducing regulatory burdens can help, especially as providers adjust their own processes to take advantage of the new realities. Enabling providers to focus more on patients and less on paperwork will help generate a greater sense of purpose and progress for staff.

Embracing the Quadruple Aim represents an opportunity for providers to implement a comprehensive, holistic plan to attract and retain top-flight talent and to make teams more productive. When it works, the provider exits the doom loop and enters a virtuous cycle.

Conclusion

Deregulation is an impetus for providers to rethink their whole approach and cost structure. They should not let the opportunity go to waste. Meaningful, measureable, long-term improvements to the healthcare industry will benefit health care providers, insurers, payers, and patients.

We need to start thinking collectively on how to fill in the gaps in care with solutions that will reduce the cost of care, improve patient outcomes, reduce hospital admissions, and eliminate unnecessary spending and testing. Now is the time for the healthcare industry to take control and implement solutions that benefit every player within the system. The health and financial stability of the nation depends on it.