HARI: Credentialing, licensing regulations burden health care industry

PROVIDENCE – Citing Annals of Internal Medicine data that found physicians spend approximately 50 percent of their time on administrative tasks and only 27 percent of their time engaging with patients, the Hospital Association of Rhode Island’s most recent Tracking Trends newsletter asserts that regulations are unduly burdening hospitals and other health care entities. Michael Souza, HARI president, told Providence Business News that while no corresponding study has been done locally, anecdotal evidence – from conversations and discussions with local health care practitioners – supports those figures.

Given those burdens, HARI commended President Donald Trump’s Executive Order 13771 of Jan. 30, which proposes to reduce the regulatory burdens and costs on the private sector. Souza called this order somewhat effective and “a good first step in the right direction” toward reducing regulatory burdens.

HARI, however, is not relying on White House action. It is supporting two different bills in the General Assembly – one that would require health insurers or health care providers to act within a time-limited schedule, pertaining to credentialing physicians, and another that would eliminate one regulatory burden on health care providers, pertaining to licensing of physician groups purchased by hospitals or health care entities.

Legislation has been introduced in both the House and the Senate of the General Assembly that would mandate time limits on the physician-credentialing process. The legislation, S 0145, and H 5219, sponsored by State Sen. Dennis Algiere, R-Westerly, and State Rep. Robert Craven, D-North Kingstown, in the Senate and House, respectively, would require health care entities or health insurers to issue a decision on a complete credentialing application within 45 days of receipt and to issue a decision on an update to a provider’s credentialing application within seven days, said Souza. In addition, health care entities or insurers would be required to establish a written standard defining the elements of a complete credentialing application and obligate the state’s Office of Health Insurance Commissioner to issue compliance standards and enforcement provisions.

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Insurers don’t want time limits imposed on them, said Souza, who noted that Blue Cross & Blue Shield of Rhode Island testified at recent hearings in opposition to the legislation. With a “strong likelihood of success,” the legislation, said Souza, is part of a package of 14 bills addressing mental health issues that were recently introduced by State Sen. Joshua Miller, D-Cranston. “[The credentialing bill] has the support of the entire Senate leadership,” said Souza. BCBSRI, he said, recommended this issue be referred to and discussed by OHIC’s Administrative Simplification Task Force, but the issue is a longstanding concern and the Task Force has not met for more than a year, he said.

Cory King, principal policy associate at OHIC, confirmed the Task Force has not met, in part due to insufficient staff resources, given the reduced budget allotted to OHIC last year. “We are looking forward to convening the Task Force in the coming months,” said King, who noted the Task Force can now meet at the commissioner’s discretion, rather than yearly.

The length of time to approve credentialing applications runs the gamut, said Souza; some entities approve applications within 30 days, while others, including some local insurers, may take four to six months to approve applications.

With respect to licensing, HARI wants to reduce the costly licensing burden imposed when hospitals acquire physician practices. When a practice is acquired by a health care entity and the scope of the practice remains unchanged, it should not be forced to meet the licensing obligations that are imposed on larger health care facilities, such as the acquiring hospital, Souza said. In short, licensing should be based on the services provided, rather than based on the ownership of the facility that provides such services.

Because physician practices operate under the physician’s license, regulated by the R.I. Board of Medical Licensure and Discipline, and hospitals and health care systems are licensed by the R.I. Department of Health, DOH requested one technical amendment to the bill. That amendment, which HARI supports, makes the purchasing health care entity accountable for the practice it acquires. The bill (H 5840) has been introduced by State. Rep. Teresa Tanzi, D-Narragansett, and will be introduced by State Sen. V. Susan Sosnowski, D-South Kingstown; no hearings have been held to date. Sousa anticipates broad-based support for the legislation.

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