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Top 5 Health Regulatory Issues to Watch Out for in 2022

    Since the beginning of the COVID-19 pandemic, medical practitioners and owners/managers of healthcare facilities have had to deal with seemingly never-ending regulatory changes. Sometimes things change so fast that it becomes challenging to be completely up to date.

    This trend continues into 2022, with a greater focus on the Department of Health and Human Services, Medicare, Medicaid, the FDA, etc. Here are some details on the top health regulatory issues that will require your attention in 2022.

    1. Price Transparency

    In January 2021, the Centers for Medicare & Medicaid Services (CMS) released a new federal hospital price transparency requirement. Since then, U.S. hospitals must follow regulations to provide clear and accessible pricing information online.

    The goal was to make it easier for patients to know beforehand how much they would pay for procedures for treatments. However, only 5.6 percent of hospitals nationwide were following these regulations as of the middle of last year.

    Beginning July 1, 2022, the CMS promises to take measures to ensure that the price transparency requirement is met. To avoid problems, these are some of the measures that healthcare providers will have to address until then.

    • Machine-readable files showing the price of items and services.
    • Comparison tool (online or on paper) for cost-sharing estimates for 500 items and services.
    • Comparison tool (online or on paper) for cost-sharing estimates for all items and services.

    2. The Rise of Telemedicine

    COVID-19 has popularized the use of telemedicine, especially during the lockdown. This alternative is here to stay. The problem is that many of the telehealth services’ flexibilities were temporary and limited to the duration of the pandemic.

    In March 2022, The Consolidated Appropriations Act was signed into law, extending certain telehealth flexibilities for Medicare patients – at least for a few more months. The new legislation will affect the telehealth industry in many ways, including:

    • Remote work taxation on telemedicine services provided out-of-state.
    • Expanded coverage of telehealth services, including diagnosis, evaluation, or treatment of certain mental health disorders consistent with the Consolidated Appropriations Act.
    • More practitioners are authorized to provide services through telehealth, such as occupational therapists, speech-language pathologists, and audiologists.

    3. Doctor Payments

    In July 2021, CMS released the 2022 Physician Fee Schedule, proposing to cut Medicare payments to doctors by 3.75 percent less for their services this year. A lot of associations began demanding that Congress step in to reduce these losses. 

    This led the CMS to review the proposed value in December 2021, where they subsequently decided on a 0.82 percent physician fee reduction instead. As many commercial payers base their fees on the Medicare table (although not always at the same time), it’s important to keep an eye on these changes.

    4. Data Interoperability Compliance

    Better healthcare outcomes require providers to have access to a patient’s complete medical history. Although open data exchange has been talked about for years and technological advances allow it to happen with greater speed, constant changes necessitate more dynamic regulatory adjustments as well.

    Recent regulations have at least tried to speed up the process. Among them are the CMS’ interoperability rules and Fast Healthcare Interoperability Resources standard enforcement, which address the way healthcare providers handle such data exchange requests.

    Data security risks are a common fear for many healthcare providers, specifically involving electronic health records (EHR) systems. These fears are certainly valid, as data security is something that healthcare providers need to respond to proactively. 

    One way to respond to this challenge is to conduct training for relevant staff and explain the functions and advantages of using EHRs, especially in protecting their data systems. 

    5. Value-Based Care

    Recently, the Biden Administration decided to make more payment models mandatory to streamline value-based payment models. The idea is to implement a more “patient-centric” approach in the way charges for health services are carried out.

    The most traditional model remains the fee-for-service, in which professionals are paid for the number of procedures and treatments performed and not exactly for their results.

    On the other hand, value-based care suggests that providers such as hospitals and private clinics will be paid based on patient health outcomes – that is, on the result of treatments, not quantity. The Biden administration believes that this will help reduce the incidence of chronic disease, among other benefits.

    Unfortunately, value-based care is not yet offered by most healthcare providers. Keep an eye on how the government will address the issue throughout 2022, as changes in this area may become more evident.

    Faster and More Frequent Changes

    Healthcare providers have been facing new regulations for years. Recently, the COVID-19 pandemic forced the industry to make quick adaptations that, now, the so-called new normal should make more frequent.

    With more and more regulatory changes being passed, and more to come, it can be challenging for clinicians and healthcare facilities administrators to stay up to date on what is happening. The five health regulatory issues mentioned above are expected to cause some impact, or at least a lot of debate, throughout 2022.