SNN Interview: Congressman Wants to Find Balance Between Regulations, Operator Autonomy

September 11, 2018, Alex Spanko, Skilled Nursing News - Last week, two leaders of the powerful House Ways and Means Committee — chairman Kevin Brady and health subcommittee chairman Peter Roskam — called on the Centers for Medicare & Medicaid Services (CMS) to slash red tape for skilled nursing and other long-term care providers.

“There is a real opportunity to get red tape out of the way in order to drive more efficiency and promote innovation, while reducing costs and improving patient care,” Reps. Brady and Roskam, both Republicans, wrote.

Their comments came in the same week that another House committee hosted an occasionally testy hearing on nursing home oversight with representatives from CMS and the Department of Health and Human Services (HHS), which saw some lawmakers express frustration at continuing stories of neglect and harm in American nursing homes.

Skilled Nursing News spoke with Rep. Roskam, whose congressional district includes a wide swath of the Chicago suburbs, about the motives behind his letter and his vision for regulatory reform.

Why do you believe cutting red tape is necessary?

If you take a step back and you look at the health care debate in this country that we’ve had for the past several years, it’s been pretty unsatisfying, and it hasn’t yielded a whole lot. And so what we tried to do then is recognize that, and think through asking a different question.

Rather than asking everybody what their opinion is of the Affordable Care Act, we decided to go to providers and ask them about the regulations that they found were burdensome and difficult and were not making patients any safer, any healthier, and were just driving costs up. 

And the response that we got was overwhelmingly positive.  We had 500 different suggestions from health care providers on things we could do to improve.  So this was the result, on a bipartisan basis, of having roundtable discussions.

We brought in nursing homes and others that are caring for people in a post-acute setting — rehabilitation facilities and so forth.  We brought in hospitals, we brought in physicians and other allied medical groups.  And out of this, [we] developed this real dialogue.

What has come now is a body of work of these suggestions, and we’ve processed them and we’re in the midst of evaluating them alongside with CMS to see what are the things we need to change by statute, what do they need to change by rule, but when it all comes down to it: How do we make sure we have regulations that are smart and make sense and keep people safe, but are not a burden to the point where they just don’t make any sense?

Should the changes come from Congress or CMS?

It’s both and. So Congress obviously has a responsibility.  As the lawmakers, it’s our responsibility to make sure the law is well founded.  CMS has a lot of authority under the law to interpret what we do in ways that give the benefit of the doubt to those that are trying to cut through red tape. 

So it’s very much a collaborative effort.  On a similar track, interestingly, CMS has an initiative called Patients Over Paperwork, and so they initiated that.  They’ve given us their feedback, and now together, we’re working to reconcile these two things.

Both Congress and CMS have a responsibility, and the provider community has been helpful.

How do you find a balance between regulation and providing leeway to operators?

We’re not doing this in a vacuum.  We recognize that people who are in nursing homes are nearly the most vulnerable among us. And there’s not a suggestion that we’re deregulating to the point of putting anyone at risk.  In fact, what we’re proposing is creating a regulatory structure that allows regulations to do what they’re actually supposed to do, and not just end up with a jumbled bureaucratic mess that doesn’t serve patients.

So we think that part of this is listening to the providers who are dealing with this on a frontline basis.  Part of it is listening to other health care providers — not just nursing homes, but other health care providers — and also working closely with CMS as a regulator.

I think that we’re working to strike exactly that balance in recognizing that the most vulnerable among us are people who need to be well-served by a regulatory system that’s designed to help them, and not designed just to be a bureaucracy.

What role do the states play in an industry that has seen increasing regionalization?

States play a big role, and are our partners … in terms of oversight and reimbursement in some of these areas.  But we’re of the view that we can lead by example.  The federal government has a disproportionally significant impact on the policies and the trends in nursing facilities across the whole country.

And we’re of the view that if we do a good job, we can actually raise standards and see better outcomes, and by doing so, that can prompt the states to review what they’re doing to keep pace with us.

What’s your vision going forward for smart regulatory oversight?

To have a roundtable again in two years, and have providers come back and say: “Thank you for the relief.  Here’s how we’ve restructured these things.  Here’s how our patient outcomes are better.”  And for us to hear from patients and families to realize that they’ve been well-served by this initiative.