CMS Unveils More Flexibilities to Maximize Healthcare Workforce

April 14, 2020 - In an effort to maximize the healthcare workforce during the COVID-19 pandemic, CMS is now allowing physicians to virtually treat patients at rural hospitals and nurse practitioners to perform more medical exams on Medicare patients at skilled nursing facilities.

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The new, temporary blanket waivers are just some of the new regulatory flexibilities CMS issued late last week to support hospitals and health systems experiencing sudden and dramatic increases in patient volumes due to COVID-19. The federal agency also announced other key regulatory flexibilities on April 9 including:

• Allowing physicians to perform some medical exams on Medicare patients at skilled nursing facilities even if the services are not COVID-19 related
• Waiving the requirement that critical access hospitals have a physician there in person to provide medical direction, consultation, and supervision
• Lifting the requirement that a nurse practitioner, physician assistant, or certified nurse-midwife is available to deliver services at least half the time at rural health clinics or federally qualified health centers
• Waiving the requirement that physicians must provide medical supervision of nurse practitioners at rural health clinics and federally qualified health centers
• Enabling occupational therapists from home health agencies to furnish initial assessments on certain homebound patients
• Waiving certain hospice aide in-service training tasks
• Relaxing of regulations that limit when a physician at a long-term care facility can delegate tasks

“It’s all hands on deck during this crisis,” CMS Administrator Seema Verma said in the announcement. “All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic.”

The US currently has the highest number of COVID-19 patients, with more than 582,500 confirmed cases according to data from Johns Hopkins University at the time of publication. Hospitals and health systems are already seeing patient volumes skyrocket as the number of confirmed cases continues to rise.

But healthcare workforce challenges are getting in the way of fast and effective care for patients during the pandemic.

The healthcare industry is already facing a physician shortage but the novel coronavirus outbreak is highlighting the shortage of key critical care providers like intensivists. The industry will likely be short by over 7,900 of these critical care physicians, according to a new estimate from Array Advisors.

“While the public attention has been on beds and ventilators, we must not lose sight of the staff needed to serve the coming influx of patients,” said Neil Carpenter, strategic planning VP at Array Advisors. “We need a national conversation about how to support and leverage our existing expertise, as well as how to contend with the coming surge of COVID-19 positive providers. In this fight, we need every provider to be well enough to work.”

Despite looming shortages, rules and regulations have limited what hospitals and health systems can do to maximize their healthcare workforces in response to the pandemic. For example, federal and state laws can limit where physicians can practice, as well as how much care certain advanced practice practitioners (APPs) can deliver. Telehealth regulations also restrict where providers and patients can engage in virtual visits.

CMS has already relaxed some of these rules and regulations in order to help hospitals and health systems leverage the healthcare workforce for the expected surge of COVID-19 patients.

Some of the regulatory flexibilities already granted include allowing physicians whose privileges are set to expire to continue practicing, new physicians to start practicing before full hospital medical staff review and approval, and physicians and non-physician practitioners to use telehealth to care for patients at long-term care facilities.

The agency has also lifted certain requirements, including those limiting who can perform specific respiratory care procedures, federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants so they can work at rural hospitals, certain training and certification requirements for nurse’s aides at long term care facilities, and paperwork requirements so that hospital doctors can use more verbal medical orders.

The latest announcement from CMS builds on the regulatory flexibilities and blanket waivers issued earlier during the public health crisis. The expanded flexibilities specifically target “supervision, licensure and certification, and other limitations in healthcare settings” and are retroactive to March 1, 2020.

“These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses,” CMS stated in the announcement.

The American Academy of PAs (AAPA) supported additional regulatory flexibilities granted to physician assistants, including the new waiver that authorizes the provider to deliver visits to Medicare patients in skilled nursing facilities.

“AAPA will aggressively push CMS to make these regulatory changes permanent,” the association stated on its website.

For a complete list of healthcare workforce flexibilities CMS has issued in recent weeks, please click here.