Federal regulation of hospitals and the need for clear supervision guidelines

Federal Hospitals Supervision

THE NEED FOR CLEAR GROUND RULES

Government Regulation of Federal Hospitals

Federal hospitals are health care institutions operated by the federal government. These are hospitals, clinics, medical schools and schools health (Brown, 2011). They are operated by the Department of Defense, the Department of Health and Human Services, and the Veterans Health Administration (Brown). Federal supervision of these health care institutions has focused on costs in response to the sharp increase in hospital care expenditures (Sloan, 1982). Its regulatory programs cover rate and revenue regulation; facilities and services regulation; and utilization of investments in beds, major equipment, and expansion of special services. Rate and revenue regulation covers the amounts private and public insurers pay the hospital. Facilities and services regulation covers the entry of hospitals. And investment utilization covers the quantity and quality of care these health care facilities provide. Costs in mandatory rates and revenues have been contained but the reasons are unclear. Regulation of facilities and services has failed on account of incomplete regulatory coverage of capital expenditure project. Regular strategies are constantly subjected to criticism as they are unable to provide sound financial incentives to patients and providers that will redound to cost-effective purchases. The health system is more and more restructured according to market-oriented principles in order to achieve this goal. But regulation is still needed even in a competitive health care environment. The government will have to pay competitive hospital rates if its beneficiaries should receive quality hospital care (Sloan). The lack of clear government rules on the regulation of federal hospitals explains these.

The 2009 Joint Commission

An attempt was made to cover this lack by the Joint Commission. The Commission issued its 2010 standard statement, which incorporated revisions from accreditation standards by the Centers for Medicare & Medicaid Services regulations (Brown, 2009). These revisions incorporated a federal supervision statement concerning certified registered nurse anesthetists. The Social Security Act and the Conditions of Participation for Hospitals, the Conditions of Participation for Critical Access Hospitals require hospitals and ambulatory surgery centers to be certified by a state agency. The only other alternative is an accreditation by a CMS-recognized organization as possessing standards complying with CMS regulation. These accrediting organizations are the Joint Commission, and the American Osteopathic Association for hospitals. Their recognition is called the organization's "deeming authority." The minimum requirement set by the CMS Conditions of Participation is participation in the Medicare and Medicaid programs included in these Conditions for anesthesia services within a given hospital. Anesthesia may be administered only by the licensed independent practitioner who formally concurs. The surgeon, obstetrician or dentist must concur and documents his or her concurrence. The use of the anesthesia is posted by the surgeon on the surgical schedule. And the established policy specifies the procedure in concurrence with the planned anesthesia. Federal regulation asks if the nurse anesthetists is allowed to provide care and services independently. If she is, the Joint Commission recognizes her privilege and credentials her without further inquiry. Fifteen States have opted out of these Conditions for anesthetists. These are Alaska, California, Iowa, Idaho, Kansas, Minnesota, Montana, Nebraska, North Dakota, South Dakota, New Hampshire, New Mexico, Oregon, Washington and Wisconsin (Brown).

Resident Physicians' Work Hours

Another attempt was the Patient and Physician Safety and Protection Act of 2001 (Lee, 2006). It sought to empower the federal government to regulate resident work hours in hospitals in the United States. PPSPA bills would have enabled federal regulation to perform this more efficiently than present regulation efforts exerted by the States and the Accreditation Council for Graduate Medical Education or ACGME. Restrictions to the ACGME self-regulation will be a problem only it they already exist. The problem is really that Congress is reluctant to pass laws to federally mandate these restrictions. Opponents to these restrictions teem the political milieu at Washington DC. Federal regulation of resident work hours should nonetheless remain in the major agenda for Congress, especially if and when ACGME regulatory efforts turn futile and ineffective (Lee).

Conclusion

Government regulation over federal hospitals has been confined to costs in view of sharp hospital expenses (Sloan, 1982). This has been in the area of rate and revenue and facilities and services. Even then, regular strategies have not been able to achieve cost-effective solutions. The 2009 Joint Commission revised its accreditation standards for registered nurse anesthetists' certification by a state agency or a CMS regulation body. Nurses from 15 States opted out of the "deeming authority." The PSPA was another attempt at regulating resident work hours, but Congress was reluctant to pass the bills. And one more consequence is that uninsured patients are billed much more by insurers than they do insured patients. Hospitals do not have the procedures needed to negotiate with uninsured patients. The lack of clear government rules on the regulation of federal hospitals explains these. #